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In this paper, we aimed to assess cross-sectionally and longitudinally associations between disturbances in maternal early attachment experiences, symptoms of separation anxiety and depression and oxytocin plasma levels. We examined a mediational model that tested the hypothesis that anxious attachment style arising from the mothers' early bonding experiences with her own parents was associated with high levels of separation anxiety which, via its impact on depression, was associated with reduced levels of oxytocin in the postnatal period. Data is reported on a structured sample of 127 women recruited during pregnancy from a general hospital antenatal clinic and an initial follow up cohort of 57 women who were re-assessed at 3-months post-partum. We found an association between lower oxytocin level in the post partum period and symptoms of separation anxiety and depression during pregnancy, as well as maternal negative interpersonal representations, upbringing attributes and anxious attachment style. Further meditational analysis revealed that the unique association between anxious attachment and depression is mediated by separation anxiety and that depressed mood mediated the relationship between separation anxiety and oxytocin. In conjunction with evidence from the literature suggesting that lower oxytocin level is associated with bonding difficulties, our findings have significant implications for understanding the biological processes underpinning adverse attachment experiences, negative affect state, and mother-to-infant bonding difficulties.

Medicinal cannabis has been trialled for Tourette syndrome in adults, but it has not been studied in adolescents. This open-label, single-arm trial study evaluated the feasibility, acceptability and signal of efficacy of medicinal cannabis in adolescents (12–18 years), using a Δ9-tetrahydrocannabinol:cannabidiol ratio of 10:15, with dose varying from 5 to 20 mg/day based on body weight and response. The study demonstrated feasibility of recruitment, acceptability of study procedures, potential benefits and a favourable safety profile, with no serious adverse events. Commonly reported adverse events were tiredness and drowsiness, followed by dry mouth. Statistically significant improvement was observed in parent and clinician reports on tics (paired t-test P = 0.003), and behavioural and emotional issues (paired t-test P = 0.048) and quality of life as reported by the parent and young person (paired t-test P = 0.027 and 0.032, respectively). A larger-scale, randomised controlled trial is needed to validate these findings.

ObjectivesImplementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents’/caregivers’ experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting.DesignThis qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, ‘General Practice Surveillance for Autism’, a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically.ParticipantsTwelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed.SettingsAll interviews were completed over the phone.ResultsThere were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient–doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers.ConclusionThe findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting.Trial registration numberANZCTR (ACTRN12619001200178).

Background Autism spectrum disorder (ASD) is a complex neurodevelopmental condition whose biological basis is yet to be elucidated. The Australian Autism Biobank (AAB) is an initiative of the Cooperative Research Centre for Living with Autism (Autism CRC) to establish an Australian resource of biospecimens, phenotypes and genomic data for research on autism. Methods Genome-wide single-nucleotide polymorphism genotypes were available for 2,477 individuals (after quality control) from 546 families (436 complete), including 886 participants aged 2 to 17 years with diagnosed ( n  = 871) or suspected ( n  = 15) ASD, 218 siblings without ASD, 1,256 parents, and 117 unrelated children without an ASD diagnosis. The genetic data were used to confirm familial relationships and assign ancestry, which was majority European ( n  = 1,964 European individuals). We generated polygenic scores (PGS) for ASD, IQ, chronotype and height in the subset of Europeans, and in 3,490 unrelated ancestry-matched participants from the UK Biobank. We tested for group differences for each PGS, and performed prediction analyses for related phenotypes in the AAB. We called copy-number variants (CNVs) in all participants, and intersected these with high-confidence ASD- and intellectual disability (ID)-associated CNVs and genes from the public domain. Results The ASD ( p  = 6.1e−13), sibling ( p  = 4.9e−3) and unrelated ( p  = 3.0e−3) groups had significantly higher ASD PGS than UK Biobank controls, whereas this was not the case for height—a control trait. The IQ PGS was a significant predictor of measured IQ in undiagnosed children ( r  = 0.24, p  = 2.1e−3) and parents ( r  = 0.17, p  = 8.0e−7; 4.0% of variance), but not the ASD group. Chronotype PGS predicted sleep disturbances within the ASD group ( r  = 0.13, p  = 1.9e−3; 1.3% of variance). In the CNV analysis, we identified 13 individuals with CNVs overlapping ASD/ID-associated CNVs, and 12 with CNVs overlapping ASD/ID/developmental delay-associated genes identified on the basis of de novo variants. Limitations This dataset is modest in size, and the publicly-available genome-wide-association-study (GWAS) summary statistics used to calculate PGS for ASD and other traits are relatively underpowered. Conclusions We report on common genetic variation and rare CNVs within the AAB. Prediction analyses using currently available GWAS summary statistics are largely consistent with expected relationships based on published studies. As the size of publicly-available GWAS summary statistics grows, the phenotypic depth of the AAB dataset will provide many opportunities for analyses of autism profiles and co-occurring conditions, including when integrated with other omics datasets generated from AAB biospecimens (blood, urine, stool, hair).

IntroductionThe increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currently considerable variation in developmental surveillance and screening between Australian states and territories and low rates of developmental screening uptake by parents. This study aims to evaluate an innovative web-based developmental surveillance programme and a sustainable approach to referral and care pathways, linking primary care general practice (GP) services that fall under federal policy responsibility and state government-funded child health services.Methods and analysisThe proposed study describes a longitudinal cluster randomised controlled trial (c-RCT) comparing a ‘Watch Me Grow Integrated’ (WMG-I) approach for developmental screening, to Surveillance as Usual (SaU) in GPs. Forty practices will be recruited across New South Wales and Queensland, and randomly allocated into either the (1) WMG-I or (2) SaU group. A cohort of 2000 children will be recruited during their 18-month vaccination visit or opportunistic visit to GP. At the end of the c-RCT, a qualitative study using focus groups/interviews will evaluate parent and practitioner views of the WMG-I programme and inform national and state policy recommendations.Ethics and disseminationThe South Western Sydney Local Health District (2020/ETH01625), UNSW Sydney (2020/ETH01625) and University of Queensland (2021/HE000667) Human Research Ethics Committees independently reviewed and approved this study. Findings will be reported to the funding bodies, study institutes and partners; families and peer-reviewed conferences/publications.Trial registration numberANZCTR12621000680864.

Background Significant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics. Methods A qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program (“GP Surveillance for Autism”) were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically. Results Twenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services. Conclusions The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.

This study investigated the associations of maternal oxytocin, self-reported attachment insecurity and depressive symptoms with maternal caregiving sensitivity at 3–4months postpartum, observed during the ‘free play’ and ‘reunion’ episodes of the Still Face Procedure. 112 mothers completed questionnaires and gave blood samples to determine oxytocin plasma levels before (time 1) and after participating in the Still Face Procedure with their infant (time 2). Sensitive maternal caregiving during the free play episode was predicted by ‘good’ infant behavior; during the reunion episode it was predicted by ‘good’ infant behavior, higher baseline levels of maternal oxytocin and a greater maternal oxytocin response, or in other words, a larger increase in maternal oxytocin level from time 1 to time 2. With other variables free to vary, baseline maternal oxytocin levels mediated an inverse relation between maternal adult attachment avoidance and sensitive maternal caregiving during the reunion episode. Results highlight the association between oxytocin and sensitive maternal caregiving and suggest that oxytocin is a biological mechanism through which maternal attachment insecurity affects early parenting quality.

Background: Hepatitis B virus (HBV) infection is the most easily transmitted blood-borne pathogen and is an occupational hazard for health care workers (HCWs). Despite the fact that infection is preventable through vaccination and post-exposure immunoglobulin therapy, many HCWs are unaware of the risks of HBV infection and of appropriate preventative measures. This study is unique in the South African setting as it focuses on the exposure, attitude and knowledge of doctors to HBV infection. Method: This was an observational descriptive study. Records of the HBV immune status of all doctors who reported an occupational injury (OI) to the occupational health clinic between June 2010 and May 2011 were reviewed. A structured questionnaire was then distributed to all laboratory personnel and senior doctors employed at the hospital. Results: Of the 67 doctors who reported an OI, 39% (26 out of 67) had no HBV immunity and only 19% (5 out of 26) had received Hepatitis B immunoglobulin. Of the 78 doctors who completed the questionnaire, 65% (51 out of 78) reported at least one OI during their career. Fifty-six percent of the respondents were unaware of their HBV immune status and only 31% had received a booster within the previous 5 years. Conclusion: Poor compliance of HCWs to HBV vaccination and post-exposure prophylaxis is a concern. In-service training is needed to inform staff of the efficacy of HBV vaccination and immunoglobulin therapy. Contexte: L'infection par le virus de l'hepatite B (VHB) est l'agent pathogene transmis par le sang qui se transmet le plus facile. Ceci constitue un risque du metier pour les professionnels de la sante (PS). Malgre le fait que l'infection puisse etre evitee par la vaccination et l'administration post-expositionnelle d'immunoglobulines, beaucoup de PS n'ont pas conscience des risques d'infection par le VHB et des mesures preventives appropriees. Cette etude est unique dans le contexte sud-africain car elle se concentre sur l'exposition, l'attitude et la connaissance par les medecins de l'infection par le VHB. Methodologie: Il s'agit d'une etude descriptive observationnelle. Les historiques relatifs au statut immunitaire vis-a-vis du VHB de tous les medecins ayant signale un accident du travail (AT) a l'etablissement de sante qui les employait entre juin 2010 et mai 2011 ont ete examines. Un questionnaire structure a ensuite ete distribue a tout le personnel de laboratoire et aux chefs de service employes par l'hopital. Resultats: Parmi les soixante-sept medecins qui ont signale un AT, 39% (26 de 67) n'etaient pas immunises contre le virus de l'hepatite B et seulement 19% (5 de 26) avaient recti des immunoglobulines de l'hepatite B. Parmi les 78 medecins qui ont repondu au questionnaire, 65% (51 de 78) ont signale au moins un AT au cours de leur carriere. Cinquante-six pour cent des personnes interrogees ne connaissaient pas leur statut immunitaire vis-a-vis du VHB et seulement 31% avaient recu un vaccin de rappel au cours des cinq dernieres annees. Conclusion: La mauvaise observance par le personnel de sante de la vaccination contre le VHB et la prophylaxie post-expositionnelle est inquietante. Une formation interne est necessaire pour informer le personnel de l'efficacite de la vaccination contre le VHB et de l'administration d'immunoglobulines.

We aimed to address a policy-relevant research area with high priority, namely disseminating early intervention for children on the autism spectrum into mainstream community settings. The study cohort comprised 47 children with a diagnosis of Autism Spectrum Disorder (ASD) receiving the Early Start Denver Model (ESDM) intervention: 23 children attending an Autism Specific Early Learning and Care Centre (ASELCC) and 24 children attending a mainstream preschool setting. Group comparisons revealed that the overall response to intervention was in the majority of cases not significantly different between settings. One difference was found in that children in the mainstream preschool setting showed a significant reduction in externalising behaviours compared to the children attending the autism-specific preschool. Intervention duration was found to influence outcomes with a one-month increase in duration found to improve expressive language skills. While the results need to be interpreted with caution due to the small sample size, these findings suggest that early intervention can be successfully delivered in both autism-specific and mainstream settings. However, those families needing additional parent support may be better served by a specialised service.

Autism omics research has historically been reductionist and diagnosis centric, with little attention paid to common co-occurring conditions (for example, sleep and feeding disorders) and the complex interplay between molecular profiles and neurodevelopment, genetics, environmental factors and health. Here we explored the plasma lipidome (783 lipid species) in 765 children (485 diagnosed with autism spectrum disorder (ASD)) within the Australian Autism Biobank. We identified lipids associated with ASD diagnosis ( n  = 8), sleep disturbances ( n  = 20) and cognitive function ( n  = 8) and found that long-chain polyunsaturated fatty acids may causally contribute to sleep disturbances mediated by the FADS gene cluster. We explored the interplay of environmental factors with neurodevelopment and the lipidome, finding that sleep disturbances and unhealthy diet have a convergent lipidome profile (with potential mediation by the microbiome) that is also independently associated with poorer adaptive function. In contrast, ASD lipidome differences were accounted for by dietary differences and sleep disturbances. We identified a large chr19p13.2 copy number variant genetic deletion spanning the LDLR gene and two high-confidence ASD genes ( ELAVL3 and SMARCA4 ) in one child with an ASD diagnosis and widespread low-density lipoprotein-related lipidome derangements. Lipidomics captures the complexity of neurodevelopment, as well as the biological effects of conditions that commonly affect quality of life among autistic people. Detailed analyses pairing deep phenotyping and molecular profiles reveal mediating roles of plasma lipids in genetic and environmental factors associated with autism-related traits in children.