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Families' Experiences With Family Navigation Services in the Autism Treatment Network.

家庭在自闭症治疗网络中的家庭导航服务经验。

  • 影响因子:5.00
  • DOI:10.1542/peds.2019-1895I
  • 作者列表:"Crossman MK","Lindly OJ","Chan J","Eaves M","Kuhlthau KA","Parker RA","Coury DL","Zand DH","Nowinski LA","Smith K","Tomkinson M","Murray DS
  • 发表时间:2020-04-01
Abstract

BACKGROUND AND OBJECTIVES:Families of children with autism spectrum disorder (ASD) often experience challenges navigating multiple systems to access services. Family navigation (FN) is a model to provide information and support to access appropriate services. Few studies have been used to examine FN's effectiveness for families of children with ASD. This study used mixed methods to (1) characterize FN services received by a sample of families in the Autism Treatment Network; (2) examine change in parent-reported activation, family functioning, and caregiver strain; and (3) explore families' experiences with FN services. METHODS:Family characteristics and parent outcomes including parent activation, family functioning, and caregiver strain were collected from 260 parents in the Autism Treatment Network. Descriptive statistics and linear mixed models were used for aims 1 and 2. A subsample of 27 families were interviewed about their experiences with FN services to address aim 3. RESULTS:Quantitative results for aims 1 and 2 revealed variability in FN services and improvement in parent activation and caregiver strain. Qualitative results revealed variability in family experiences on the basis of FN implementation differences (ie, how families were introduced to FN, service type, intensity, and timing) and whether they perceived improved skills and access to resources. CONCLUSIONS:Findings suggest FN adaptations occur across different health care delivery systems and may result in highly variable initial outcomes and family experiences. Timing of FN services and case management receipt may contribute to this variability for families of children with ASD.

摘要

背景和目的: 自闭症谱系障碍 (ASD) 儿童的家庭经常遇到导航多个系统以获得服务的挑战。家庭导航 (FN) 是一种提供信息和支持以获得适当服务的模式。很少有研究被用来考察 FN 对 ASD 儿童家庭的有效性。本研究采用混合方法 (1) 表征自闭症治疗网络中家庭样本接受的 FN 服务; (2) 检查父母报告的激活、家庭功能的变化,和照顾者应变; 和 (3) 探索家庭对 FN 服务的体验。 方法: 收集自闭症治疗网络中 260 名父母的家庭特征和父母结局,包括父母激活、家庭功能和照顾者应变。对 aim 1 和 2 使用了描述性统计和线性混合模型。对 27 个家庭的子样本进行了 FN 服务解决 aim 3 的经验访谈。 结果: aims 1 和 2 的定量结果显示 FN 服务的变异性以及父母激活和照顾者应变的改善。定性结果显示,基于 FN 实施差异的家庭经验存在差异 (即,家庭如何被引入 FN 、服务类型、强度和时间) 以及他们是否认为技能提高了,获得了资源。 结论: 研究结果表明 FN 适应发生在不同的医疗保健提供系统中,可能导致高度可变的初始结果和家庭经验。FN 服务的时机和病例管理收据可能有助于 ASD 儿童家庭的这种变异性。

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影响因子:5.83
发表时间:2020-01-22
DOI:10.1523/JNEUROSCI.0786-19.2019
作者列表:["Torretta S","Rampino A","Basso M","Pergola G","Di Carlo P","Shin JH","Kleinman JE","Hyde TM","Weinberger DR","Masellis R","Blasi G","Pennuto M","Bertolino A"]

METHODS::Multiple schizophrenia (SCZ) risk loci may be involved in gene co-regulation mechanisms, and analysis of coexpressed gene networks may help to clarify SCZ molecular basis. We have previously identified a dopamine D2 receptor (DRD2) coexpression module enriched for SCZ risk genes and associated with cognitive and neuroimaging phenotypes of SCZ, as well as with response to treatment with antipsychotics. Here we aimed to identify regulatory factors modulating this coexpression module and their relevance to SCZ. We performed motif enrichment analysis to identify transcription factor (TF) binding sites in human promoters of genes coexpressed with DRD2. Then, we measured transcript levels of a group of these genes in primary mouse cortical neurons in basal conditions and upon overexpression and knockdown of predicted TFs. Finally, we analyzed expression levels of these TFs in dorsolateral prefrontal cortex (DLPFC) of SCZ patients. Our in silico analysis revealed enrichment for NURR1 and ERR1 binding sites. In neuronal cultures, the expression of genes either relevant to SCZ risk (Drd2, Gatad2a, Slc28a1, Cnr1) or indexing coexpression in our module (Btg4, Chit1, Osr1, Gpld1) was significantly modified by gain and loss of Nurr1 and Err1. Postmortem DLPFC expression data analysis showed decreased expression levels of NURR1 and ERR1 in patients with SCZ. For NURR1 such decreased expression is associated with treatment with antipsychotics. Our results show that NURR1 and ERR1 modulate the transcription of DRD2 coexpression partners and support the hypothesis that NURR1 is involved in the response to SCZ treatment.SIGNIFICANCE STATEMENT In the present study, we provide in silico and experimental evidence for a role of the TFs NURR1 and ERR1 in modulating the expression pattern of genes coexpressed with DRD2 in human DLPFC. Notably, genetic variations in these genes is associated with SCZ risk and behavioral and neuroimaging phenotypes of the disease, as well as with response to treatment. Furthermore, this study presents novel findings on a possible interplay between D2 receptor-mediated dopamine signaling involved in treatment with antipsychotics and the transcriptional regulation mechanisms exerted by NURR1. Our results suggest that coexpression and co-regulation mechanisms may help to explain some of the complex biology of genetic associations with SCZ.

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影响因子:6.22
发表时间:2020-01-17
DOI:10.1038/s41386-020-0614-2
作者列表:["Chadha R","Meador-Woodruff JH"]

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