Effectiveness and Adverse Effects of Risperidone in Children with Autism Spectrum Disorder in a Naturalistic Clinical Setting at a University Hospital in Oman.

Objective: To study risk factors, incidence, indications, maternal and perinatal complications of women who underwent emergency peripartum hysterectomy (EPH) at Sultan Qaboos University Hospital (SQUH) in Oman.
 Method: This is a retrospective study, in which all cases EPH performed at SQUH between January 2007 and December 2016 were reviewed.
 Results: During the 9 years study period, there were 18 cases of EPH; the total number of deliveries during the same period was 32,963, so the incidence of EPH was 0.55 per 1,000 deliveries. Of all cases of EPH, 13 cases (72.2%) were cesarean hysterectomy compared with 5 cases (27.8%) were postpartum hysterectomy. Twelve cases (66.7%) were total hysterectomy while 6 cases (33.3%) were subtotal hysterectomy. The most common risk factor for EPH was placenta previa and accrete with previous cesarean section (CS) (27.6%); followed by previous CS without placenta previa (24.1%). The most common indication for EPH was placenta previa and accreta (44.4%), and previous CS (16.7%). During the study period, there was only one case of maternal death (5.6%). There were no cases of stillbirths or early neonatal deaths. There were 4 cases of bladder injury (22.2%). Women aged between 35-34 years and para > 5 had the highest incidence of EPH (50.0%).
 Conclusion: To reduce the incidence of EPH and its catastrophic consequences, we need to identify high-risk cases ante-natally and potential cases for EPH should be booked early during pregnancy and managed during pregnancy and delivery at a tertiary hospital by an experienced team.

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006

Aims This study surveyed Child and Adolescent Psychiatrists (CAPs) to explore the service settings and conditions that CAPSS may cover. Child and Adolescent Mental Health Services (CAMHS) have widely varying criteria for accepting referrals. When children are seen in CAMHS, CAPs involvement in their care also varies considerably. This variation in practice creates a problem for service based surveillance through CAPSS, which collaborates with the British Paediatric Surveillance Unit (BPSU). CAPSS surveillance is only meaningful if CAPs are involved with the care of the conditions studied. Methods Online survey of CAPSS members across the UK and Ireland using postal and email contacts. Results Survey participation was 49%. CAPs reported working in services that generally will see children and young people with psychosis, mood disorder, eating disorder, (psychological) trauma, psychological disorder associated with physical symptoms, self-harm, Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and Tourette (syndrome). Specialist CAMHS with CAPs are described particularly for Learning Disability (LD), psychosis and eating disorder. At least half reported that alcohol/drug problems and under 5s were seen in services with no CAP. Referrals for ASD, psychological disorder associated with physical symptoms, ADHD, Tourette, trauma and self-harm may also be seen in services with no CAP; comments highlighted the importance of paediatric services for some of these. Two-thirds of inpatient and day unit CAMHS had exclusion criteria, commonly for LD and alcohol/drug problems. CAPs are usually involved with presentations to CAMHS of psychosis, mood disorder, eating disorder, ADHD, Tourette and ASD, however self-harm, trauma, psychological disorders associated with physical symptoms and LD may be seen without CAPs’ involvement. CAPs are unlikely to be involved in CAMHS with alcohol/ drug problems and under 5s. Conclusion The survey confirms the variation in CAPs’ involvement with conditions that may be referred to CAMHS. CAPSS case ascertainment is therefore limited for some conditions and joint surveillance with BPSU may improve this. It is interesting that CAMHS patients with LD who may have complex medical histories are often seen without CAP involvement.

BackgroundChildren with neurodevelopmental disorders including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) often experience sleep disturbances, but little is known about when these sleep differences emerge and how they relate to later development.MethodsWe used a prospective longitudinal design in infants with a family history of ASD and/or ADHD to examine infant sleep and its relation to trajectories of attention and later neurodevelopmental disorders. We formed factors of Day and Night Sleep from parent‐reported measures (including day/night sleep duration, number of naps in the day, frequency of night awakenings and sleep onset problems). We examined sleep in 164 infants at 5‐, 10‐ and 14‐months with/without a first‐degree relative with ASD and/or ADHD who underwent a consensus clinical assessment for ASD at age 3.ResultsBy 14‐months, infants with a first‐degree relative with ASD (but not ADHD) showed lower Night Sleep scores than infants with no family history of ASD; lower Night Sleep scores in infancy were also associated with a later ASD diagnosis, decreased cognitive ability, increased ASD symptomatology at 3‐years, and developing social attention (e.g., looking to faces). We found no such effects with Day Sleep.ConclusionsSleep disturbances may be apparent at night from 14‐months in infants with a family history of ASD and also those with later ASD, but were not associated with a family history of ADHD. Infant sleep disturbances were also linked to later dimensional variation in cognitive and social skills across the cohort. Night Sleep and Social Attention were interrelated over the first 2 years of life, suggesting that this may be one mechanism through which sleep quality influences neurodevelopment. Interventions targeted towards supporting families with their infant's sleep problems may be useful in this population.

To determine the incidence and predictors of bleomycin pulmonary toxicity in a university hospital in Oman. This retrospective chart review consisted of 46 patients treated with bleomycin-containing regimes at Sultan Qaboos University Hospital in Oman between January 2007 and December 2010. Data regarding patient age, chemotherapy protocol, cumulative bleomycin dose, smoking history, renal function and concurrent use of granulocyte colony stimulating factor (GCSF) were collected from the hospital's electronic database. Analyses were performed using univariate statistical techniques. Of the 46 patients, 22% (n = 10) experienced bleomycin pulmonary toxicity. There was an overall mortality of 4.3% (n = 2; N = 46), with significantly more deaths in the bleomycin pulmonary toxicity group compared to the cohort that did not have bleomycin pulmonary toxicity (20% versus 0%; p = 0.043). The bleomycin pulmonary toxicity group was significantly older compared to the cohort that did not have bleomycin pulmonary toxicity (48 versus 34 years; p = 0.017). Furthermore, adriamycin, bleomycin, vinblastine, dacarbazine, as front-line chemotherapy, was found to have a trend towards increased risk of bleomycin pulmonary toxicity (90% versus 56%; p = 0.067; power = 31%). There did not seem to be significant differences in bleomycin dose (143 versus 149 units; p = 0.727), smoking status (10% versus 14%; p = 1.000) and systolic blood pressure (133 versus 131 mmHg; p = 0.746) between the two study groups. This study confirms a relatively high incidence of bleomycin pulmonary toxicity in a tertiary hospital in Oman. Older patients were significantly more likely to suffer bleomycin pulmonary toxicity compared to younger patients.

Early diagnosis and prompt treatment of mental and behavioral disorders in preschoolers is critical for a better prognosis, ultimately leading to improved quality of life for both the child and the family. Our study investigated the clinical profile of mental and behavioral disorders in children < 7 years of age, seeking consultation at Sultan Qaboos University Hospital, Muscat, Oman, between 1 June 2006 and 31 December 2010. The objective was to explore demographic variables, intervention types, and annual trends. This retrospective, descriptive study was conducted by reviewing the electronic records of preschoolers seeking consultation on mental and behavioral disorders at the Department of Behavioral Medicine. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The total number of cases was 466, the majority (77.9%) being boys. The cumulative frequencies and annual hospital-based prevalence rates were estimated for each category of mental and behavioral disorders. Our findings showed increased service utilization among preschoolers, as reflected in the annual trend and case-specific prevalence rates. While comorbidity was common, the most frequent disorders encountered were attention deficit hyperactivity disorder (70.8%), developmental language disorder (23.6%), autism spectrum disorders (20.2%), and disruptive behavior disorders (11.6%). The most commonly prescribed drugs/supplementation were risperidone (18.7%), atomoxetine (9.7%), omega-3 (8.8%), and methylphenidate (6.2%). Consultations for mental and behavioral disorders are being sought for Omani preschoolers. Beside pharmacotherapy, other interventions, which are an integral part of a much desired multidisciplinary approach should be introduced. Readdressing the missing needs is essential for a comprehensive approach to managing mental and behavioral disorders.

BackgroundOutpatient child and adolescent mental health services (CAMHS) are faced with the challenge of balancing increasing demands with limited resources. An additional challenge is high rejection rates of referrals which causes frustration for referring agents and families. In order to effectively plan and allocate available resources within CAMHS there is a need for up-to-date knowledge on referral patterns and factors associated with rejection of referrals.MethodsIn this cross-sectional observational study we did a retrospective review of all referrals (n = 1825) for children (0–18) referred for assessment at the outpatient CAMHS of the North Denmark Region in 2018.ResultsThe most common referral reasons to CAMHS were attention deficit disorder (ADHD/ADD) (27.9%), autism spectrum disorder (22.4%), affective disorders (14.0%) and anxiety disorders (11.6%). The majority of referrals came from general practitioners, but for neurodevelopmental disorders educational psychologists were the primary referral source. Re-referrals constituted more than a third of all referrals (35.9%). Children in care were overrepresented in this clinical sample and had an increased risk (Adj. OR 2.54) of having their referrals rejected by CAMHS. Referrals from general practitioners were also associated with an increased risk of rejection (Adj. OR 3.29).ConclusionsA high proportion of children with mental disorders have a repeated need for assessment by CAMHS. There is a need for future research on predictors of re-referral to outpatient services to identify potential targets for reducing re-referral rates as well as research on how to optimize service provision for children with a repeated need for assessment. General practitioners are the main gatekeepers to CAMHS and research on interventions to improve the referral process should be aimed towards general practitioners.

Evaluating a specialized autism spectrum disorder clinic in Qatar: A multidisciplinary model for comprehensive assessment and diagnosis.

Objectives: To enhance the early detection of Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) by leveraging clinical variables collected at child and adolescent mental health services (CAMHS). Methods: This study included children diagnosed with ADHD and/or ASD (n = 857). Three logistic regression models were developed to predict the presence of ADHD, its subtypes, and ASD. The analysis began with univariate logistic regression, followed by a multicollinearity diagnostic. A backward logistic regression selection strategy was then employed to retain variables with p < 0.05. Ethical approval was obtained from the local ethics committee. The models' internal validity was evaluated based on their calibration and discriminative abilities. Results: The study produced models that are well-calibrated and validated for predicting ADHD (incorporating variables such as physical activity, history of bone fractures, and admissions to pediatric/psychiatric services) and ASD (including disability, gender, special education needs, and Axis V diagnoses, among others). Conclusions: Clinical variables can play a significant role in enhancing the early identification of ADHD and ASD.

Background Recent data indicate that rates of autism spectrum disorder (ASD) are increasing and therefore, studies exploring risk factors for ASD that can further support early diagnosis and intervention are needed. A link between immigration and autism has been made by several international studies, but despite high rates of immigration, a Canadian study examining this association has not been conducted. Objectives To determine the proportion of children diagnosed with ASD at Manitoba’s primary autism referral site (the only publicly funded site for ASD evaluation of children &amp;lt;6 years of age) that were born to immigrant parents, and compare it with the known proportion of immigrants in Manitoba. Also, to compare demographic and clinical characteristics of children whose parents are immigrants with those whose parents were born in Canada. Design/Methods We conducted a retrospective chart review of &amp;gt;2000 electronic records that identified all children &amp;lt;6 years diagnosed with ASD at the referral site between May 2016 and September 2021. Data on parental immigration, demographics, diagnostic evaluation, and medical history was collected. Descriptive statistics were used to compare the relative proportion of children with ASD from immigrant parents with the proportion of immigrants in Manitoba based on 2016 census data. Results A total of 1865 children were diagnosed with ASD during the study period. The mean age at referral and diagnosis was 2.81 (SD 1.26) years and 3.88 (SD 2.90) years respectively; 78% were male and 13.5% were born preterm. The proportion of children with ASD from immigrant parents (36%) was greater than the expected proportion (18.3%) of immigrants based on Manitoba census data (p &amp;lt; 0.001). The most common countries of origin of immigration were the Philippines (30.7%), India (11.6%), Nigeria (8.6%), and Ethiopia (6.4%). Overall, children of immigrants were younger at referral (2.71 years, SD = 0.98 versus 2.91 years, SD = 1.43; p &amp;lt;0.001), less likely to have a family history of ASD (17.1% versus 35.6%; p = &amp;lt;0.001) and less likely to have comorbidities (46.8% versus 53.9%; p &amp;lt;0.001) including global developmental delay (18% versus 27.6%; p &amp;lt;0.001). Conclusion At Manitoba’s primary autism referral site, there was a greater proportion of children diagnosed with ASD born to immigrant parents than expected when compared to the Manitoba population. Overall, children of immigrants were younger, less likely to have comorbidities, developmental delay, and a family history of ASD. Future prospective studies are required to better understand the complex relationship between immigration and ASD diagnosis.

For young people with autism spectrum disorder (ASD), the transition from childhood to adulthood especially for those with additional mental health problems can be challenging. Increasing numbers of young people attending child and adolescent mental health services (CAMHS) have a recognised diagnosis of ASD. What are the outcomes of these young people when they are discharged from CAMHS and how best can services support their needs? In this editorial we consider the emerging literature on transition for young people with long-term conditions and in particular those with ASD. Longer term studies suggest that the outcomes for individuals with ASD across the ability range is mostly poor and that healthcare transfer has generally not been managed well, with service users often reporting a lack of appropriate types of support. Encouragingly there is an increasing awareness of the need to support young people with long-term conditions as they negotiate the many developmental tasks of transition to adulthood. However, less is known about the experiences and aspirations of autistic individuals of all abilities as they transition to adulthood. This knowledge can inform a more nuanced approach to identifying developmentally appropriate outcomes. Recent studies with cognitively able young people with ASD, highlight some features in common with young people with long-term conditions but also the importance of identifying ways to foster underlying skills and the ability of young people with ASD to develop and maintain relationships. Child-focussed and adult-orientated healthcare services need to work directly with autistic individuals and their support networks to facilitate successful engagement with services and enable adults to manage their mental health needs. There is an urgent need to investigate the implementation and effectiveness of research and clinical guideline recommendations that aim to increase wellbeing, health self-efficacy and improve the mental health outcomes for autistic adults.

Little is known about the incidence and burden of chemotherapy-induced neutropenia (CIN) in Oman or the Arabian Gulf. To determine the epidemiology of CIN at Sultan Qaboos University Hospital in Oman. A retrospective observational study of all eligible CIN episodes in adult (>18 years) patients with solid tumors and hematological malignancies at Sultan Qaboos University Hospital (SQUH) from January to December 2010. Analyses were performed using univariate statistics. A total of 1,357 episodes in 159 patients with a mean age of 50 ± 15 years (19-91) were evaluated. Fifty-four percent (n = 86) of the patients were female. A total of 46 % (73/159) of the patients developed CIN accounting for 15 % (210/1,357) of all episodes. Twelve percent (25/210) of these CIN episodes were associated with fever in 26 % (19/73) patients. There was significant association between CIN and chemotherapy regimen (P < 0.001), younger age (P < 0.001), low hemoglobin (Hb) levels (P < 0.001) and advanced cancer stage (P = 0.006). This study suggests a high incidence of CIN in SQUH patients which resulted in chemotherapy delays, longer hospital stays, and inpatient mortality. CIN was significantly correlated with chemotherapy regimen, younger age, low Hb levels and cancer stage.

Many autistic young people and/or those with attention deficit hyperactivity disorder (ADHD) have co-occurring mental health conditions. These individuals can experience significant challenges when transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). However, barriers and enablers to the transition from CAMHS to AMHS are poorly understood for this population. This scoping review sought to synthesise the available evidence on barriers and enablers to the transition from CAMHS to AMHS for autistic young people and/or those with ADHD. Arksey and O'Malley's six-step framework for scoping reviews was used to map out the evidence available and report the findings with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR). Electronic databases of Medline, PsycINFO, CINAHL, Scopus and ProQuest Central were searched for relevant studies published in English with no date limitations. The review included studies that focused on young people with a primary diagnosis of autism spectrum disorder (ASD) and/or ADHD (population) and their care transition barriers and/or enablers (concept) from CAMHS to AMHS (context). A socioecological framework informed data extraction and narrative synthesis of data on barriers and enablers to transition. This review identified 1677 studies, of which 66 proceeded to full-text screening, and 10 were included. Most studies focused on institutional-level transition barriers, including poor communication between CAMHS and AMHS and lack of clarity about their role in the transition process. Involvement of the neurodivergent young person in decision-making processes about their mental health care and clinicians who tailored their approaches to the needs of the neurodivergent young person emerged as key enablers of a positive transition experience. Studies largely failed to examine community and policy-related barriers to mental health care transitions. Most studies examined the perspectives of providers or carers, with only five representing the perspectives of neurodivergent people. Young people who are autistic and/or have ADHD experience many barriers to their transition from CAMHS to AMHS; however, few studies have examined barriers and enablers to the service transition process.

Sampling time and indications appropriateness for therapeutically monitored drugs at a teaching university hospital in Oman

Aims: Emerging research indicates a higher prevalence of Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) among individuals with eating disorders (EDs) compared with the general population. Understanding this overlap is crucial for service planning, as neurodiversity assessments and tailored interventions require additional clinical resources. This study aimed to quantify the incidence of neurodiversity within a community specialist Child and Adolescent Mental Health Services (CAMHS) ED caseload to better predict workload demands and inform clinician training and treatment adaptations.Methods: A cross-sectional survey was conducted among clinicians in a specialist CAMHS ED service. Clinicians were asked to report the number of patients on their current caseload with a formal diagnosis of ASD and/or ADHD, as well as those identified as requiring further assessment for these conditions. This methodology provided a snapshot of the prevalence of neurodiversity within active caseloads at the time of data collection.Results: The total caseload was 96 patients. Of these, 22 (23%) had a confirmed diagnosis of ASD and/or ADHD, while 40 (42%) were identified as needing an assessment for neurodevelopmental conditions. In total, 65% of the caseload had either a diagnosis or a suspected diagnosis of ASD, ADHD, or both.Conclusion: Our findings highlight a substantial overlap between eating disorders and neurodiversity in a community specialist CAMHS setting. The high proportion of young people requiring assessment underscores the need for integrated neurodevelopmental screening within ED services. Additionally, these results emphasize the importance of upskilling clinicians in neurodiversity-informed care and adapting treatment models to meet the needs of this population. Addressing these factors will be essential for optimizing clinical outcomes and resource allocation within specialist ED services.