Pubmed du 14/02/09

lundi 16 février 2009

1. Bouder JN, Spielman S, Mandell DS. Brief Report : Quantifying the Impact of Autism Coverage on Private Insurance Premiums. J Autism Dev Disord ;2009 (Feb 13)

Many states are considering legislation requiring private insurance companies to pay for autism-related services. Arguments against mandates include that they will result in higher premiums. Using Pennsylvania legislation as an example, which proposed covering services up to $36,000 per year for individuals less than 21 years of age, this paper estimates potential premium increases. The estimate relies on autism treated prevalence, the number of individuals insured by affected plans, mean annual autism expenditures, administrative costs, medical loss ratio, and total insurer revenue. Current treated prevalence and expenditures suggests that premium increases would approximate 1%, with a lower bound of 0.19% and an upper bound of 2.31%. Policy makers can use these results to assess the cost-effectiveness of similar legislation.

2. Carpenter LA, Soorya L, Halpern D. Asperger’s syndrome and high-functioning autism. Pediatr Ann ;2009 (Jan) ;38(1):30-35.

3. Duby JC, Johnson CP. Universal screening for autism spectrum disorders : a snapshot within the big picture. Pediatr Ann ;2009 (Jan) ;38(1):36-41.

4. Galiatsatos P, Gologan A, Lamoureux E. Autistic enterocolitis : Fact or fiction ? Can J Gastroenterol ;2009 (Feb) ;23(2):95-98.

Autism spectrum disorder refers to syndromes of varying severity, typified by impaired social interactions, communicative delays and restricted, repetitive behaviours and interests. The prevalence of autism spectrum disorders has been on the rise, while the etiology remains unclear and most likely multifactorial. There have been several reports of a link between autism and chronic gastrointestinal symptoms. Endoscopy trials have demonstrated a higher prevalence of nonspecific colitis, lymphoid hyperplasia and focally enhanced gastritis compared with controls. Postulated mechanisms include aberrant immune responses to some dietary proteins, abnormal intestinal permeability and unfavourable gut microflora. Two autism spectrum disorder patients with chronic intestinal symptoms and abnormal endoscopic findings are described, followed by a review of this controversial topic.

5. Johnson CP, Myers SM. Autism spectrum disorders : what’s new, and what to do. Pediatr Ann ;2009 (Jan) ;38(1):5-8.

6. Myers SM. Management of autism spectrum disorders in primary care. Pediatr Ann ;2009 (Jan) ;38(1):42-49.

7. Peacock G, Yeargin-Allsopp M. Autism spectrum disorders : prevalence and vaccines. Pediatr Ann ;2009 (Jan) ;38(1):22-25.

8. Pickler L, Elias E. Genetic evaluation of the child with an autism spectrum disorder. Pediatr Ann ;2009 (Jan) ;38(1):26-29.

9. Shulman ST. Autism aspects. Pediatr Ann ;2009 (Jan) ;38(1):3-4.

10. Wegner LM, Macias MM. Services for children and adolescents with autism spectrum disorders : payment issues. Pediatr Ann ;2009 (Jan) ;38(1):57-61.

Primary care physicians have an important role in assuring that children with autism are identified as early as possible and have a medical home providing appropriate care and care coordination. Understanding efficient methods of care and modifying practice habits to minimize services not currently supported by procedural codes will permit the primary clinician to be paid for this medical care. Current medical procedure codes can be legitimately used to bill for care related to developmental and behavioral health needs and consistent use of these codes will help address payment barriers.

11. Yoran-Hegesh R, Kertzman S, Vishne T, Weizman A, Kotler M. Neuropsychological mechanisms of Digit Symbol Substitution Test impairment in Asperger Disorder. Psychiatry Res ;2009 (Feb 10)

Our aim was to investigate the neurocognitive mechanisms recruited by adolescents with Asperger Disorder (AD), in comparison to controls, and to detect the underlying mechanisms during the complex information processing required for the performance of the Digit Symbol Substitution Test (DSST). Male adolescents (n=23 ; mean age 15.1+/-3.6 years) with a DSM-IV diagnosis of AD were compared with a normal male control group with similar demographic characteristics (n=43 ; mean age : 15.1+/-3.6 years). A computerized neurocognitive battery was administered and included : Inspection Time (IT), Finger Tapping Test (FTT), Simple Reaction Time (SRT), Choice Reaction Time (CRT), Digit Running task (DRT), Stroop test and Digit Symbol Substitution Test (DSST). Adolescents with AD performed significantly worse than controls on the DSST. This impaired DSST performance was related to cognitive mechanisms different from those employed by normal controls. Motor slowness and inability to deal with increased amounts of information affected the performance of the AD group, while shifting of attention was the limiting factor in the controls. Both groups were similarly dependent on response selection. This study demonstrated differences in performance in complex cognitive tasks between adolescents with AD and normal controls that may be related to differences in neurocognitive mechanisms underlying information processing. Future neuroimaging studies are needed to clarify the neural network involved in the differences in cognitive performance between AD subjects and normal controls.


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