Efficacy Of Early Intervention Research Articles

A study on risk factors, clinical profile, spectrum of comorbidities in children with cerebral palsy and efficacy of early intervention by rehabilitation units on neurodevelopmental outcome in these children

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide with the greatest burden found in developing countries. This study is undertaken as there is limited data available regarding CP children in the Andhra Pradesh region. This study was done to evaluate the clinical spectrum, risk factors, and comorbidities associated with CP that will help in better understanding of etiology and for early intervention by District early intervention centers. Methods: This is a hospital-based prospective observational study conducted over 18 months among children from 6 months to 5 years of age visiting a tertiary care hospital. Results: Among 65 enrolled children majority of the children (74%) were between 2 to 5yrs with a male-to-female ratio of 4:1. Consanguinity was observed in 33.8% and the majority were from rural areas (71%). The most frequent presenting complaint was delayed milestones (33.4%). 67.6% of subjects were born at term with the most common risk factor being birth asphyxia (27.6%). The most common type was spastic CP (87%) in whom the Developmental quotient (DQ) was severely affected (56.7%) and 32.3% of children belong to GMFCS level III. Comorbidities like feeding difficulties and GERD (47.6%), visual problems (24.8%), and hearing problems (30%) were commonly associated. At the time of enrollment, only 21.5% of children had normal nutritional status which improved to 30.7% after 12 months of follow-up. Conclusions: Efforts should be made to increase awareness among parents regarding the availability of encouraging utilization of the services to relieve the burden of disorder.

Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT.

To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.

Exploring the Cost-Utility of a Biomarker Predicting Persistent Severe Acute Kidney Injury: The Case of C-C Motif Chemokine Ligand 14 (CCL14).

Approximately 24% of hospitalized stage 2-3 acute kidney injury (AKI) patients will develop persistent severe AKI (PS-AKI), defined as KDIGO stage 3 AKI lasting ≥3 days or with death in ≤3 days or stage 2 or 3 AKI with dialysis in ≤3 days, leading to worse outcomes and higher costs. There is currently no consensus on an intervention that effectively reverts the course of AKI and prevents PS-AKI in the population with stage 2-3 AKI. This study explores the cost-utility of biomarkers predicting PS-AKI, under the assumption that such intervention exists by comparing C-C motif chemokine ligand 14 (CCL14) to hospital standard of care (SOC) alone. The analysis combined a 90-day decision tree using CCL14 operating characteristics to predict PS-AKI and clinical outcomes in 66-year-old patients, and a Markov cohort estimating lifetime costs and quality-adjusted life years (QALYs). Cost and QALYs from admission, 30-day readmission, intensive care, dialysis, and death were compared. Clinical and cost inputs were informed by a large retrospective cohort of US hospitals in the PINC AI Healthcare Database. Inputs and assumptions were challenged in deterministic and probabilistic sensitivity analyses. Two-way analyses were used to explore the efficacy and costs of an intervention preventing PS-AKI. Depending on selected costs and early intervention efficacy, CCL14-directed care led to lower costs and more QALYs (dominating) or was cost-effective at the $50,000/QALY threshold. Assuming the intervention would avoid 10% of PS-AKI complications in AKI stage 2-3 patients identified as true positive resulted in 0.066 additional QALYs and $486 reduced costs. Results were robust to substantial parameter variation. The analysis suggests that in the presence of an efficacious intervention preventing PS-AKI, identifying people at risk using CCL14 in addition to SOC is likely to represent a cost-effective use of resources.

Effects of Omega-3 Polyunsaturated Fatty Acid Supplementation on Allergic Diseases in Pregnant Women and Infant

In Westernized nations, there has been a notable rise in the incidence of allergic diseases, which has been associated with a shortage serving of omega-3 polyunsaturated fatty acids (n-3 PUFAs) in diet. Supplementing with fish oil during pregnancy is being considered as a potential method to prevent allergic diseases in offspring. It may also help modulate allergic inflammation in pregnant women by influencing the synthesis of associated inflammatory mediators. The potential biological mechanisms underlying the allergic response in pregnant women and the potential protection provided to offspring through maternal supplementation of n-3 PUFAs are complex but crucial for understanding medical interventions and trial settings. The objective of this paper is to summarize the proposed mechanisms of allergic response and the anti-inflammatory pathways executed by n-3 PUFAs in both pregnant women and their offspring, drawing from important research findings. However, the efficacy of early intervention in infants through neonatal absorption of n-3 PUFAs is still unclear. The results suggest that n-3 PUFAs-induced protection covers a wide range of allergens, including those from food, house dust, and pets, as well as asthma. Conversely, the consumption of fish oil during childhood appears to have an insignificant effect on immunological disorders.

Exploring the contribution of case study research to the evidence base for occupational therapy: a scoping review

BackgroundCase study research is generating interest to evaluate complex interventions. However, it is not clear how this is being utilized by occupational therapists or how feasible it is to contribute to the evidence base. This scoping review explores case study research within occupational therapy in terms of how it is defined, the methodological characteristics adopted, such as data collection and analysis, and the range of practice contexts in which it is applied. We consider the viability of case study research for contributing to our evidence base.MethodsOpinion, text and empirical studies within an occupational therapy practice context were included. A three-step extensive search following Joanna Briggs Institute methodology was conducted in June 2020 and updated in July 2021 across ten databases, websites, peer-reviewed and grey literature from 2016 onwards. Study selection was completed by two independent reviewers. A data extraction table was developed and piloted and data charted to align with research questions. Data extraction was completed by one reviewer and a 10% sample cross checked by another.ResultsEighty-eight studies were included in the review consisting of (n = 84) empirical case study and (n = 4) non-empirical papers. Case study research has been conducted globally, with a range of populations across different settings. The majority were conducted in a community setting (n = 48/84; 57%) with populations experiencing neurodevelopmental disorder (n = 32/84; 38%), stroke (n = 14/84;17%) and non-diagnosis specific (n = 13/84; 15%). Methodologies adopted quantitative (n = 42/84; 50%), mixed methods (n = 22/84; 26%) and qualitative designs (n = 20/84; 24%). However, identifying the methodology and ‘case’ was a challenge due to methodological inconsistencies.ConclusionsCase study research is useful when large-scale inquiry is not appropriate; for cases of complexity, early intervention efficacy, theory testing or when small participant numbers are available. It appears a viable methodology to contribute to the evidence base for occupation and health as it has been used to evaluate interventions across a breadth of occupational therapy practice contexts. Viability could be enhanced through consistent conduct and reporting to allow pooling of case data. A conceptual model and description of case study research in occupational therapy is proposed to support this.Systematic review registrationOpen Science Framework 10.17605/OSF.IO/PCFJ6.

COMPARING THE EFFICACY OF EARLY INTERVENTION AND LATE INTERVENTION FOR AUTISM SPECTRUM DISORDER IN CHILDREN AND ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social interaction, communication, and repetitive behaviors. Early intervention is widely recognized as crucial for improving outcomes in individuals with ASD. However, there is ongoing debate regarding the optimal timing of intervention. This systematic review and meta-analysis aimed to compare the efficacy of early intervention and late intervention for individuals with ASD. The study aimed to synthesize existing evidence and provide a comprehensive analysis of the effectiveness of these two intervention approaches in improving outcomes for children and adults with ASD.
 Methods: A comprehensive search of electronic databases was conducted to identify relevant studies. The search terms included keywords related to ASD, early intervention, late intervention, children, adults, and outcome measures. Studies were selected based on predefined inclusion and exclusion criteria, focusing on randomized controlled trials and comparative studies with adequate sample sizes. The selected studies underwent rigorous quality assessment and data extraction. Meta-analysis was conducted using statistical software to determine the overall efficacy of early intervention and late intervention in improving outcomes related to social interaction, communication, adaptive functioning, and other relevant domains.
 Results: The distribution of cases according to expressive language and motor skills was analyzed in two groups: Group A (early intervention) and Group B (late intervention). The results showed no statistically significant differences in the distribution of cases according to expressive language and motor skills between the two groups. The findings suggested that the timing of intervention may not strongly influence the distribution of these skills in individuals with ASD.
 Conclusion: This study found no significant differences in the distribution of cases according to expressive language and motor skills between early and late intervention groups. These findings are consistent with previous research, indicating that the distribution of these skills may not be strongly influenced by the timing of intervention. However, further research with larger samples and standardized assessment methods is needed to gain a comprehensive understanding of the relationships between intervention timing and the distribution of these skills in individuals with ASD.

Annual Research Review: Early intervention viewed through the lens of developmental neuroscience.

The overarching goal of this paper is to examine the efficacy of early intervention when viewed through the lens of developmental neuroscience. We begin by briefly summarizing neural development from conception through the first few postnatal years. We emphasize the role of experience during the postnatal period, and consistent with decades of research on critical periods, we argue that experience can represent both a period of opportunity and a period of vulnerability. Because plasticity is at the heart of early intervention, we next turn our attention to the efficacy of early intervention drawing from two distinct literatures: early intervention services for children growing up in disadvantaged environments, and children at elevated likelihood of developing a neurodevelopmental delay or disorder. In the case of the former, we single out interventions that target caregiving and in the case of the latter, we highlight recent work on autism. A consistent theme throughout our review is a discussion of how early intervention is embedded in the developing brain. We conclude our article by discussing the implications our review has for policy, and we then offer recommendations for future research.

A Pilot Trial of a Home-Based Parenting Intervention for High-Risk Infants: Effects on and Moderating Role of Effortful Control

Despite the important developmental outcomes associated with effortful control (EC), there is limited research demonstrating the efficacy of early interventions for improving EC and assessing the extent to which a child’s level of baseline EC impacts the outcome of intervention on externalizing problems. This study aims to fill these gaps in the literature by assessing the efficacy of the Infant Behavior Program (IBP), a parenting intervention for infants with elevated levels of behavior problems, in improving infant EC and the moderating effect of baseline infant EC on intervention outcomes. Participants included 60 high-risk 12- to 15-month-old infants and their mothers. Families were randomized to receive the IBP or standard pediatric primary care. Parent-report measures of infant behavior and compliance were examined at baseline, post-intervention, and 3- and 6-month follow-up assessments. Results showed infants who received the IBP displayed significantly higher levels of EC at the post-intervention assessment compared to infants in the control group. Additionally, moderation analyses showed initial levels of EC moderated the effect of the IBP on externalizing problems and compliance, such that infants with higher levels of baseline EC displayed greater decreases in externalizing problems at post-intervention and greater increases in compliance at the 6-month follow-up. While these findings did not survive a false discovery rate correction, they offer preliminary support for the efficacy of the IBP in improving infants’ EC and highlight the importance of considering EC as a factor associated with early intervention outcomes for externalizing problems.

Comparison of early and late intervention for necrotizing pancreatitis: A systematic review and meta-analysis.

Postponed open necrosectomy or minimally invasive intervention has become the treatment option for necrotizing pancreatitis. Nevertheless, several studies point to the safety and efficacy of early intervention for necrotizing pancreatitis. Therefore, we conducted a systematic review and meta-analysis to compare clinical outcomes of acute necrotizing pancreatitis between early and late intervention. Literature search was performed in multiple databases for articles that compared the safety and clinical outcomes of early (<4 weeks from the onset of pancreatitis) versus late intervention (≥4 weeks from the onset of pancreatitis) for necrotizing pancreatitis published up to August 31, 2022. The meta-analysis was performed to determine pooled odds ratio (OR) of mortality rate and procedure-related complications. Fourteen studies were included in the final analysis. For open necrosectomy intervention, the overall pooled OR of mortality rate with the late intervention compared with early intervention was 7.09(95% confidence interval [CI] 2.33-21.60; I2 = 54%; P = 0.0006). For minimally invasive intervention, the overall pooled OR of mortality rate with the late intervention compared with early intervention was 1.56 (95% CI 1.11-2.20; I2 = 0%; P = 0.01). The overall pooled OR of pancreatic fistula with the late minimally invasive intervention compared with early intervention was 2.49 (95% CI 1.75-3.52; I2 = 0%; P < 0.00001). These results showed the benefit of late interventions in patients with necrotizing pancreatitis in both minimally invasive procedures and open necrosectomy. Late intervention is preferred in the management of necrotizing pancreatitis.

The Efficacy of Early Interventions for Children with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis.

The superiority of early interventions for children with autism spectrum disorders (ASDs) compared to treatment as usual (TAU) has recently been questioned. This study was aimed to investigate the efficacy of early interventions in improving the cognitive ability, language, and adaptive behavior of pre-school children with ASDs through a systematic review of randomized controlled trials (RCTs). In total, 33 RCTs were included in the meta-analysis using the random effects model. The total sample consisted of 2581 children (age range: 12–132 months). Early interventions led to positive outcomes for cognitive ability (g = 0.32; 95% CI: 0.05, 0.58; p = 0.02), daily living skills (g = 0.35; 95% CI: 0.08, 0.63; p = 0.01), and motor skills (g = 0.39; 95% CI: 0.16, 0.62; p = 0.001), while no positive outcomes were found for the remaining variables. However, when studies without the blinding of outcome assessment were excluded, positive outcomes of early interventions only remained for daily living skills (g = 0.28; 95% CI: 0.04, 0.52; p = 0.02) and motor skills (g = 0.40; 95% CI: 0.11, 0.69; p = 0.007). Although early intervention might not have positive impacts on children with ASDs for several outcomes compared to controls, these results should be interpreted with caution considering the great variability in participant and intervention characteristics.

Systematic review and meta-analysis of the safety and effectiveness of low molecular heparin for severe acute pancreatitis.

Because the effect of low molecular heparin (LMH) on acute ulcer and bleeding complications in patients with severe acute pancreatitis (SAP) is unclear, we investigated the safety and efficacy of early intervention with LMH in patients with SAP. Using the keywords "heparin", "low molecular weight heparin", "pancreatitis", and "severe acute pancreatitis", we searched PubMed, Medline, CNKI, etc. And select the reference documents of the comparative study of traditional treatment and low molecular weight heparin intervention. RevMan was used for the meta-analysis. A total of 8 references were included in the study, and most of them were low risk bias (medium and high quality). Meta-analysis shows that, The MHS between the two groups is statistically heterogeneous. (Chi2=19.59, I2=95%, P<0.00001), Fixed-effects model (FEM) analysis showed that the MHS of experimental subjects was obviously shorter than that of controls (Z=3.24, P=0.001); The acute physiology and chronic health score (APACHE II) of the two groups were heterogeneous (Chi2=7.24, I2=72%, P=0.03); No heterogeneity was found in the amount of bleeding (Chi2=5.83, I2=31%, P=0.21), FEM analysis showed the number of complications in the experimental group was significantly less than that in the control group (Z=2.70, P=0.007). LMH intervention can dramatically reduce the average hospital stay and complications of patients with SAP, improve treatment efficacy, and has high safety.

Optimizing scalable, technology-supported behavioral interventions to prevent opioid misuse among adolescents and young adults in the emergency department: A randomized controlled trial protocol

Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16–30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder.Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625NCT Registration: NCT04550715

Early intervention with Kan Jang® to treat upper-respiratory tract infections: A randomized, quadruple-blind study

Background and aimAndrographis paniculata and Eleutherococcus senticosus preparations and their fixed combination, called Kan Jang®, are traditionally used for relieving symptoms of upper-respiratory tract infections (URTIs). This study aimed to assess the efficacy of early intervention with Kan Jang® on the relief and duration of inflammatory symptoms during the acute phase of the disease. Experimental procedureA total of 179 patients with URTI symptoms received six Kan Jang® (daily dose of andrographolides: 60 mg) or placebo capsules a day for five consecutive days in this randomized, quadruple-blinded, placebo-controlled, two-parallel-group phase II study. The primary efficacy outcomes were the decrease in the acute-phase duration and the mean URTI symptoms score (sore throat, runny nose, nasal congestion, hoarseness, cough, headache, and fatigue). ResultsEarly intervention with Kan Jang® significantly increased the recovery rate and reduced the number of sick leave days by >21% (0.64/day) relative to that observed in the placebo group (2.38 vs. 3.02 days, p = 0.0053). Kan Jang® significantly alleviated all URTI symptoms starting from the second day of treatment. A superior anti-inflammatory effect of Kan Jang® to that of placebo was also observed on the white blood cell count (p = 0.007) and erythrocyte sedimentation rate (p = 0.0258). Treatment with Kan Jang® was tolerated well. ConclusionThis study demonstrates that early intervention with Kan Jang® capsules reduces the recovery duration of patients by 21% and significantly relieves the severity of typical URTI symptoms.

Η πρώιμη παρέμβαση στην περίπτωση της ΔΕΠ-Υ στο πλαίσιο του βιοψυχοκοινωνικού μοντέλου

The aim of this paper is to provide evidence regarding the necessity and the effectiveness of early intervention for ADHD, by reviewing the most important international early intervention programs for ADHD and by presenting a relevant program implemented in Greece, based on the multi-level approach in developmental psychopathology. These programs are underpinned theoretically by the biopsychosocial epigenetic model which claims that ADHD is not just the outcome of structural and functional neurobiological deficits but results from the dynamic interplay among genetic, neurophysiological, neurochemical, and environmental factors, affecting brain structure and function early in the process of development. Early intervention focuses on those processes that take place very early in development and have a causal relationship with ADHD, with the aim of modifying the underlying neurophysiology and producing generalized long-lasting change. The efficacy of early intervention mainly lies in the fact that it takes place during a period when brain plasticity is great. Plasticity is an intrinsic property of the brain that ensures dynamic modifications at multiple levels of neural organization, allowing the brain to process, encode, and implement new knowledge. Although this neuronal development is to a great extent genetically programmed, it is widely acknowledged that environment also plays a major role through the process of epigenesis by moderating gene expression with subsequent alterations in brain structure and function and allowing even modification of certain deficient structures.

Efficacy of early intervention on the bowel damage and intestinal surgery of Crohn\u2019s disease, based on the L\xe9mann index

BackgroundClinicians aim to prevent progression of Crohn’s disease (CD); however, many patients require surgical resection because of cumulative bowel damage. The aim of this study was to evaluate the impact of early intervention on bowel damage in patients with CD using the Lémann Index and to identify bowel resection predictors.MethodsWe analyzed consecutive patients with CD retrospectively. The Lémann Index was determined at the point of inclusion and at follow-up termination. The Paris definition was used to subdivide patients into early and late CD groups.ResultsWe included 154 patients, comprising 70 with early CD and 84 with late CD. After follow-up for 17.0 months, more patients experienced a decrease in the Lémann Index (61.4% vs. 42.9%), and fewer patients showed an increase in the Lémann Index (20% vs. 35.7%) in the early compared with the late CD group. Infliximab and other therapies reversed bowel damage to a greater extent in early CD patients than in late CD patients. Twenty-two patients underwent intestinal surgery, involving 5 patients in the early CD group and 17 patients in the late CD group. Three independent predictors of bowel resection were identified: baseline Lémann index ≥ 8.99, disease behavior B1, and history of intestinal surgery.ConclusionsEarly intervention within 18 months after CD diagnosis could reverse bowel damage and decrease short-term intestinal resection. Patients with CD with a history of intestinal surgery, and/or a Lémann index > 8.99 should be treated aggressively and monitored carefully to prevent progressive bowel damage.

Clinical Outcomes of Early Treatment With Doxycycline for 89 High-Risk COVID-19 Patients in Long-Term Care Facilities in New York.

RationaleDue to the cluster and associated comorbidities in residents of long-term care facilities (LTCFs), COVID-19-associated morbidity and mortality are significantly increased. Multiple therapeutic options, including hydroxychloroquine (HCQ) and azithromycin (AZI), were tried initially to treat moderate to severe COVID-19 and high-risk patients in LTCFs, but they were abandoned due to unfavorable reports. As a less toxic option, we initiated treatment with doxycycline (DOXY) very early in the course of illness. DOXY has antiviral, cardioprotective, immunomodulatory, and anti-inflammatory properties, but the efficacy of early intervention with DOXY in high-risk COVID-19 patients in LTCFs is unknown.ObjectiveThe goal of this retrospective study is to describe the clinical outcomes of high-risk COVID-19 patients with moderate to severe symptoms in LTCFs after early intervention with DOXY.DesignCase-series analysisSettingLTCFs in New YorkParticipantsThis observational study examines 89 patients who were diagnosed with COVID-19 from March 18 to May 13, 2020.ExposureAll patients who were diagnosed with COVID-19 received DOXY and regular standard of care within 12 hours of the onset of symptoms. Additionally, four patients received meropenem, three patients received Zosyn, two patients received linezolid, and two patients received Bactrim DS. Four patients were on chronic ventilator support. No patients received any steroids or any other antiviral or immunomodulatory agents. The majority of the patients received zinc and calcium supplements as well.Main outcomes and measuresAssessed measures were patients’ characteristics, fever, shortness of breath (SOB), cough, oxygen saturation/pulse oximetry (POX), radiologic improvements, laboratory tests, DOXY side effects, hospital transfers, and death.ResultsEighty-nine (89) high-risk patients, who developed a sudden onset of fever, cough, SOB, and hypoxia and were diagnosed with COVID-19, were treated with DOXY (100 mg PO or intravenous (IV) for seven days) and regular standard of care. Eighty-five percent (85%) of patients (n=76) demonstrated clinical recovery that is defined as resolution of fever (average 3.7 days, Coeff = -0.96, p = 0.0001), resolution of SOB (average 4.2 days), and improvement of POX: average 84% before treatment and average 95% after treatment (84.7 ± 7% vs. 95 ± 2.6%, p = 0.0001). Higher pre- and post-treatment POX is associated with lower mortality (oxygen saturation (Spo2) vs. Death, Coeff = -0.01, p = 0.023; post-Spo2 vs. Death, Coeff = -0.05, p = 0.0002). Within 10 days of symptom onset, 3% of patients (n=3) were transferred to hospital due to clinical deterioration and 11% of patients (n=10) died. The result was followed for 30 days from the onset of symptoms in each patient.ConclusionEarly treatment with DOXY for high-risk patients with moderate to severe COVID-19 infections in non-hospital settings, such as LTCFs, is associated with early clinical recovery, decreased hospitalization, and decreased mortality.

Effects of Substance Misuse and Family History of Substance Use Disorder on Delay Discounting in Adolescents and Young Adults with Attention-Deficit/Hyperactivity Disorder

Background: Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often co-occur. Both disorders are characterized by impulsive choice. However, little is known about the effects of substance misuse (SM) and family history of SUD (FH) on impulsive choice in ADHD-SUD comorbidity. Impulsive choice is also linked to callous-unemotional (CU) traits, which are suggested to play a role in ADHD-SUD comorbidity. Our aim was to examine the effects of (1) FH and (2) SM on impulsive choice, while exploring the role of CU traits. Methods: Impulsive choice was assessed with the delay discounting (DD) task. We compared task performance across (1) ADHD patients and controls with or without FH of SUD (ADHD FH+: n = 86; ADHD FH−: n = 63; control FH+: n = 49; control FH−: n = 72; mean age of the whole sample [n = 270]: 16.39, SD: 3.43) and (2) family history-matched ADHD groups with and without SM and controls (ADHD + SM: n = 62; ADHD-only: n = 62; controls: n = 62; mean age of the whole sample [n = 186]: 18.01, SD: 2.71). Effects of CU traits were explored by adding this as a covariate in all analyses. Results: (1) There was no main effect of FH on DD. (2) We found increased DD in ADHD + SM compared to ADHD-only and no difference between ADHD-only and controls. Finally, increased DD was associated with increased callous traits only in ADHD FH+ and control FH+. Conclusions: In adolescents and young adults with ADHD, high impulsive choice might only be present in those with comorbid SM and in an FH+ subgroup with high callous traits. This suggests that impulsive choice in ADHD might result from (1) effects of SM and (2) a combined effect of SUD vulnerability and high callousness. Future studies should investigate efficacy of early interventions, targeting CU traits.

Benefícios no uso de intervenção precoce em crianças com transtorno do espectro autista (TEA): uma revisão integrativa

O autismo pode ser definido como um déficit persistente na comunicação e interação social em múltiplos contextos, além de padrões restritos e repetitivos de comportamentos, interesses e atividades. Para tal tendo como objetivo geral avaliar as produções científicas sobre os benefícios da intervenção precoce no tratamento de crianças com TEA. Trata-se de uma revisão integrativa de literatura tendo como questão norteadora: “Quais os benefícios no uso de intervenção precoce em crianças com Transtorno do Espectro Autista? utilizando a estratégia PICO com uso dos descritores e palavras-chave, foram consultadas as bases de dados Bireme, CINAHL e PubMed. Treze estudos foram incluídos nesta revisão. Os estudos abordavam sobre a eficácia das intervenções precoces no desenvolvimento de habilidades e amenização dos sintomas decorrente do transtorno e da importância dos pais/ cuidadores na aplicação das intervenções. Quanto aos benefícios destacou-se o aumento da capacidade de aprendizagem, socialização, competências linguísticas, bem como a diminuição do estresse e melhores estratégias de enfrentamento por parte dos pais. Conclui-se que as intervenções precoces propiciam benefícios clínicos e educacionais, a cada intervenção deve-se estimular uma determinada área afetada pelo TEA, aumentando essa estimulação no decorrer do progresso da criança e em cada habilidade, sendo muito importante para obter resultados significativos o tempo, a frequência e a intensidade das intervenções.

Variables that Predict the Potential Efficacy of Early Intervention in Reading in Down Syndrome

espanolSe sabe que en el sindrome de Down (SD) se producen alteraciones a nivel cognitivo y del lenguaje que afectan la adquisicion de habilidades academicas y de lectura. El objetivo de este trabajo ha sido conocer que variables neuropsicologicas predicen la eficacia potencial de la intervencion temprana en la lectura en esta poblacion con un programa que se usa tradicionalmente con la misma. En el estudio participaron 38 ninos con SD de alrededor de 5 anos que estaban inmersos en un programa de cuidado de la primera infancia, de los cuales 20 estaban inmersos en un programa de lectura. Como resultados, se observan diferencias significativas a nivel neurocognitivo y linguistico, especialmente en el primero en el grupo experimental, con logros en lectura y escritura a edades tempranas. Ademas,hay dos variables que predicen la adquisicion de la lectura. En conclusion, se comprueba la efectividad del programa de lectura y sus beneficios a nivel neuropsicologico y psicolinguistico en el desarrollo de este grupo de ninos con SD a una edad temprana. EnglishIt is known that alterations in Down syndrome (DS) occur at cognitive and language levels that affect the acquisition of reading and academic skills. The aim of this study is to know which neuropsychological variables predict the potential efficacy of early intervention in reading in this population with a program traditionally used with this population. Thirtyeight children of around 5 years of age with DS who were immersed in an early childhood care program participated in the study, 20 of them were immersed in a reading program. Significant differences were found at neurocognitive and linguistic level, especially in the experimental group at neurocognitive level, with achievements in reading and writing at early ages. In addition to this, two variables were found to predict reading acquisition. As conclusion, the effectiveness of the reading program and its benefits at neuropsychological and psycholinguistic levels in the development of this group of children with DS at an early age was revealed

Early Intervention Efficacy in COPD

Early Intervention Efficacy in COPD