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Eating Issues Common in People With Autism



Eating Issues Common in People With Autism

By Cara Murez
HealthDay Reporter

TUESDAY, May 4, 2021 (HealthDay News) — While it’s well established that autism and certain eating issues go hand in hand, does gender also play a role?

Apparently it does, according to Swedish researchers who set out to better understand whether being male or female influenced eating issues in people who have autism.

The study found that autistic traits predicted eating problems, but the link was more pronounced particularly among girls or women. These issues around eating might increase the risk of social isolation for females with autism, the researchers also found.

“We didn’t study the potential genetic difference between males and females, but we did look at this association between autism and eating problems. And we wanted to know if that was different between females and males,” said study author Karl Lundin Remnelius, a PhD student at Karolinska Institutet in Stockholm.

The specific eating problems that were noted by females involved social settings, Remnelius said.

“These items were, for example, ‘I find it difficult to eat with friends’ or ‘I find it difficult to eat in school or in a workplace or in a restaurant,'” Remnelius said. “And we actually saw when we looked closer at this subscale that it was only these social items that autistic females report or had higher scores in.”


The study also found that autistic traits predicted increased eating problems. This may not be that autism also causes eating problems but that certain genetic factors could be responsible for both, Remnelius said.

“We don’t know if this is causal, is autism causing eating problems, or if there might be some other factor that might be influencing both autism and eating problems. One thing could be that some of the genes that increase the likelihood of a person having autism might also increase the likelihood of a person having eating problems,” Remnelius said.

“Sometimes you describe that as genetic confounding, so it’s not really autism causing eating problems,” he said. “It’s more that people who have autism also have a sort of higher likelihood of having eating problems.”


The study included nearly 200 identical and fraternal twins between the ages of 15 and 33, including 28 individuals diagnosed with autism, who were all part of the Roots of Autism and ADHD Twin Study in Sweden. The study looked at associations across the whole sample and then within the twin pairs.


Participants reported their eating issues in a questionnaire that covered eating problems in a broad way, Remnelius said. Participants also had neurodevelopmental assessments, and researchers collected parent-reported autistic traits information.

Eating problems included selective eating, sensory sensitivity concerning food and symptoms of eating disorders.

These social eating problems might limit females from having opportunities for social interaction, Remnelius suggested, saying there should be more research on the issue.

The findings were presented Monday at the International Society for Autism Research virtual annual meeting. Such research is considered preliminary until published in a peer-reviewed journal.

The study confirms results seen before, said Pamela Feliciano, scientific director of SPARK (Simons Powering Autism Research), who was not involved with this study.

Past research has shown a link between autism or having autistic traits and having eating selectivity. Cognitive inflexibility can be a risk factor for disordered eating, she said.

The idea that there is a gender difference in eating issues is interesting and a new aspect that needs to be understood more, Feliciano said.


“I do think that becomes important,” she said. “If a kid with autism will only eat three things, it will be really hard for that kid to integrate into social situations.”

It can also be hard for families to have experiences when eating is so limited, Feliciano said. Therapy can help change this by slowly building a person’s eating repertoire.

Many parents of children who have autism report selective eating, she noted. Some children will eat only fewer than five foods or only food of a certain color.

“It’s complicated. I think the repetitive behavior, the tendency for repetitive behavior and wanting to do the same thing over and over again plays into it, but there’s also — and research has shown this — is a sensory component of it,” Feliciano explained. “So, if kids have a sensory sensitivity to loud noises and can’t stand it, eating a crunchy food is going to be painful to them.”


More information

The Autism Society is a research organization that offers information on autism.

SOURCES: Karl Lundin Remnelius, PhD student, Karolinska Institutet and Center for Neurodevelopmental Disorders at Karolinska Institutet, Stockholm, Sweden; Pamela Feliciano, PhD, Simons Powering Autism Research (SPARK), New York City, International Society for Autism Research virtual annual meeting, May 3, 2021

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House bill seeks to protect providers from pandemic liability lawsuits



House bill seeks to protect providers from pandemic liability lawsuits

A bipartisan group of members of the U.S. House of Representatives has re-introduced a piece of legislation that aims to protect healthcare workers from lawsuits related to the pandemic.

Under the Coronavirus Provider Protection Act, healthcare professionals would not be liable for harm caused by care or withholding services due to the pandemic. This includes providers practicing outside of their normal area or with a lack of resources “attributable to the pandemic.”

“If communities shut down physicians offices or reschedule elective surgeries, that causes adverse health outcomes in patients beyond a physician’s control,” said Dr. Susan Bailey, president of the American Medical Association.

During the pandemic, many physicians had to limit their services in order to follow government guidelines related to the pandemic, including policies regarding shelter-in-place and restricted elective procedures.

Bailey said the constant shift in directives put physicians at greater risk for “frivolous lawsuits causing emotional stress and financial burdens.”

This latest bill is the most recent effort by Rep. Lou Correa (D-CA) to push forward legislation expanding protections for providers at risk of costly lawsuits during the public health emergency. His first attempt failed to pass the House in May 2020. More than 100 state and national medical organizations supported the bill.

The Medical Professional Liability Organization released a statement saying that this “targeted civil liability protection” will recognize the continued sacrifices healthcare personnel have made throughout the year.

Federal protections already exist under President Donald Trump’s CARES Act and the Volunteer Protection Act of 1997. However, immunity has been broadened to providers administering countermeasures such as antiviral drugs and vaccines.

Experts say not enough data is available to determine whether the recent public health emergency has sparked a notable rise in medical liability lawsuits, but more than 30% of reported premiums for medical liability coverage have increased over the last year, according to an analysis by AMA.

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Labs preparing for increase in POC, homest testing post-pandemic



Labs preparing for increase in POC, homest testing post-pandemic

COVID-19 has driven an uptick in healthcare delivery approaches like telemedicine and point-of-care, home, and direct-to-consumer testing, a shift that some observers believe could continue to accelerate even after the pandemic is over.

It is a trend that has a potential downside for traditional labs as increased POC and DTC testing could cut into their business. It is also, though, a pattern that fits with the industry’s move even pre-pandemic toward more patient-centered models of testing and sample collection and one that some in the business suggest could ultimately expand the overall demand for testing.

During a recent 360Dx roundtable on the post-vaccine testing landscape, Nathan Ledeboer, medical director of clinical microbiology and molecular diagnostics at Froedtert Hospital and the Medical College of Wisconsin, said that he believed that the shift to at-home testing and self-collection “precipitated as a result of COVID is going to fundamentally reshape the diagnostics industry and healthcare in general,” and added that he thought this reshaping would prove to be one of the major impacts of the pandemic.

His fellow panelists, Elizabeth Marlowe, senior scientific director and head of R&D for Quest Diagnostics Infectious Disease, Mara Aspinall, professor of practice at Arizona State University, and Kelly Wroblewski, director, infectious disease at the Association of Public Health Laboratories, were largely in agreement with Ledeboer’s comments.

At the American Clinical Laboratory Association’s annual meeting in March, panelists discussing trends in the lab business likewise predicted an increase in at-home testing and self-collection, with, for instance, Dorothy Adcock, the chief medical officer and senior VP at Laboratory Corporation of America, saying that COVID-19 was driving a “paradigm shift” toward home testing.

Speaking recently to 360Dx, Jay Wohlgemuth, chief medical officer and physician executive at Quest Diagnostics, echoed these sentiments, saying that he was “in total agreement that the pandemic accelerated a focus on what I would call consumer-centric care.”

A consumer-centric model, he said, “says that the first place testing and engagement with healthcare should be done is in the home, and then if you can’t get it done in the home, maybe you go to a community-based location like a patient service center or a Walmart. And then you go into the hospital or health system when you really need an intervention.”

Wohlgemuth said Quest was “investing heavily in home-based self-collection kits with telemedicine services.” He noted that the company recently inked collaborations with the telemedicine firms Catapult Health and 98point6 that incorporate self-collection for lab testing as part of employer-sponsored health screenings.

“We’ve certainly seen overall market trends that show us that people want us to meet them where they are at,” said Greg Bokar, general manager of point-of-care testing at Opko Health subsidiary BioReference Laboratories.

“What we’ve learned through the pandemic is that people want flexibility, they want convenience, they want things to come to their house,” said Natalie Cummins, chief commercial officer at BioReference. “And so what we believe is that the trend toward convenience even post-pandemic is going to continue.”

With that in mind, BioReference launched in January its Scarlet Health product, a digital platform that allows patients to schedule phlebotomy or other specimen collection services at their home or office. Home and concierge phlebotomy services are nothing new and are widely available. Cummins, however, indicated that BioReference believes such services could move from being relatively niche offerings to a commonly used approach for sample collection.

“We believe we can be efficient and it will offer people flexibility with this mobile alternative to having to go to the bricks-and-mortar service center,” she said. “We believe that the Scarlet model is really going to be the model that is in demand as we are coming out of the pandemic.”

In 2019, Northwell Health Labs launched a mobile app called LabFly that similarly allows users to schedule home or workplace sample collection and then view their lab results. The service costs $20 per visit and is available throughout Northwell Health’s service area of New York City, Long Island, and Westchester County. Northwell now plans to market the app to outside health systems, said Mike Eller, assistant VP of business development at Northwell Health Labs.

He said the system developed the app as a way to provide better sample collection coverage for its patients without having to build new service centers in the expensive New York City real estate market.

“We think this is going to be part of our arsenal moving forward,” he said. “We would like to start to really integrate more with telemedicine and provide physicians and patients with solutions where they can basically have their healthcare done at home.”

Laboratories, especially large national labs, have for a number of years been focusing more on patient convenience in response to factors including increased interest in wellness and health monitoring applications and a need to compete for consumers as health insurers moved away from exclusive lab contracts.

Quest and Labcorp both launched consumer-initiated testing services—QuestDirect and Pixel by LabCorp, respectively—in late 2018. BioReference launched a consumer-initiated service, Mylabology, in 2019.

Smaller labs have also been moving into the direct-to-consumer test market, with SARS-CoV-2 testing accelerating their entry into this part of the testing business.

In an interview last year, Joe Nollar, assistant VP of product development at San Diego-based revenue cycle management and lab informatics firm Xifin, said that he saw the COVID-19 pandemic add to the demand for DTC testing and direct-to-patient reporting of test results that has been building in the industry for years.

“The market is obviously trending toward offering a lot more direct-to-consumer testing,” he said. “The last few years, some of our clients have been doing direct-to-consumer testing for carrier screening or genetic health risks and pharmacogenetics, and I think that it is definitely expanding into more routine testing.”

With DTC testing and home sampling, labs are still in the loop, as these tests are ultimately done in a traditional laboratory. True at-home testing, however, could conceivably cut into the lab business. Such a dynamic appears to be in effect currently with regard to SARS-CoV-2 testing, where volumes for lab-based molecular testing have dropped significantly in recent months while rapid antigen testing sales are on the rise.

Jon Harol, founder and president of Holly Springs, North Carolina-based lab consulting firm Lighthouse Lab Services, said that home tests could “eat into certain lines of [traditional lab] testing.”

He said, though, that he believed home tests are more likely to take advantage of new and expanding demand for testing than displace traditional lab tests.

“I think it creates a bigger pie,” he said. “Traditionally, people have gone in and gotten their physical once a year and run a lot of panels. But people do want more data, and if there is an easy way to monitor some of their levels more frequently than that, I think there is definitely a portion of the population that would do that, even if it is at a cash expense.”

“But I don’t think it’s like a one-for-one where if they test at home they are not going to go get their physical or something,” Harol added. “I think just that more testing will happen.”

BioReference’s Cummins said that the company expected increasingly available home and POC testing would primarily attract patients who historically had not done regular lab testing.

“We look at the population who might receive a point-of-care test as an additional population to the group that is being tested in the laboratory,” she said. “We don’t necessarily see a shift on the point-of-care side from the work that is coming into the laboratory, whether that be [sexually transmitted infections] or [gastrointestinal] or respiratory. We look at it as a population that maybe historically didn’t pursue care.”

Cummins said, though, that while BioReference doesn’t see home and POC testing as cutting into its traditional lab business, the pandemic has pushed it to move into the POC space.

“Prior to the pandemic, point-of-care testing honestly wasn’t even a part of our portfolio, and I would say that [was true of] probably many laboratories out there,” she said.

BioReference has incorporated POC rapid testing as part of its COVID-19 strategy, particularly for screening applications, an area where BioReference has been particularly active, having established relationships to do surveillance testing for sports leagues including the National Football League, the National Basketball Association, the Women’s National Basketball Association, Major League Soccer, the National Hockey League, and Major League Baseball.

On the company’s Q1 call, BioReference’s executive chairman, Jon Cohen, said it has performed 270,000 COVID POC tests to date and is working to rapidly expand its POC testing capacity.

“Point-of-care devices are expected to play a larger role in COVID testing,” he said. “We have validated multiple point-of-care platforms and have developed proprietary software to deliver the report result in a timely fashion in order to provide customized solutions for many different industries.”

Cummins said the pandemic has also opened the company’s eyes to the possibility of using POC testing for other disease states and “the valuable role it can play in healthcare in general.”

Bokar said the company’s experience partnering with what he called “nontraditional medical providers” like the NBA and others had led it to begin exploring other nontraditional settings like college campuses and travel hubs where it could offer POC testing.

“It’s an area where we don’t necessarily believe there is as much testing as there could be, so there is an opportunity to open up an additional market,” he said, citing, as a potential example, providing rapid POC STI testing on college campuses.

“I think we will really tether to what the true benefits of point-of-care are and find use cases that best answer to those, but I think without a doubt we believe that point-of-care testing will be something that will continue to grow in the market as consumers really demand to be met where they are at.”

Quest is already one of the country’s largest POC test providers, offering such testing out of its 160 rapid response labs, Wohlgemuth said.

He indicated that the company would also consider entering the home testing market, noting that, if in the future it sees value in delivering in-home POC testing, “then we will absolutely provide that service as a part of what we do.”

He added, though, that “oftentimes the value of having an immediate result is not so large. The value is having the result and then having a telemedicine visit or physician help you interpret it.”

“But we’re very open to providing as part of our services home kits that including point-of-care testing,” he said.

This story first appeared in our sister publication, 360Dx, which provides in-depth coverage of in vitro diagnostics and the clinical lab market.

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Pfizer COVID-19 shot expanded to US children as young as 12



Pfizer COVID-19 shot expanded to US children as young as 12

U.S. regulators on Monday expanded the use of Pfizer’s COVID-19 vaccine to children as young as 12, offering a way to protect the nation’s adolescents before they head back to school in the fall and paving the way for them to return to more normal activities.

Shots could begin as soon as Thursday, after a federal vaccine advisory committee issues recommendations for using the two-dose vaccine in 12- to 15-year-olds. An announcement is expected Wednesday.

Most COVID-19 vaccines worldwide have been authorized for adults. Pfizer’s vaccine is being used in multiple countries for teens as young as 16, and Canada recently became the first to expand use to 12 and up. Parents, school administrators and public health officials elsewhere have eagerly awaited approval for the shot to be made available to more kids.

“This is a watershed moment in our ability to fight back the COVID-19 pandemic,” Dr. Bill Gruber, a Pfizer senior vice president who’s also a pediatrician, told The Associated Press.

The Food and Drug Administration declared that the Pfizer vaccine is safe and offers strong protection for younger teens based on testing of more than 2,000 U.S. volunteers ages 12 to 15. The agency noted there were no cases of COVID-19 among fully vaccinated adolescents compared with 16 among kids given dummy shots. More intriguing, researchers found the kids developed higher levels of virus-fighting antibodies than earlier studies measured in young adults.

The younger teens received the same vaccine dosage as adults and had the same side effects, mostly sore arms and flu-like fever, chills or aches that signal a revved-up immune system, especially after the second dose.

Pfizer’s testing in adolescents “met our rigorous standards,” FDA vaccine chief Dr. Peter Marks said. “Having a vaccine authorized for a younger population is a critical step in continuing to lessen the immense public health burden caused by the COVID-19 pandemic.”

Pfizer and its German partner BioNTech recently requested similar authorization in the European Union, with other countries to follow.

The latest news is welcome for U.S. families struggling to decide what activities are safe to resume when the youngest family members remain unvaccinated.

“I can’t feel totally comfortable because my boys aren’t vaccinated,” said Carrie Vittitoe, a substitute teacher and freelance writer in Louisville, Kentucky, who is fully vaccinated, as are her husband and 17-year-old daughter.

The FDA decision means her 13-year-old son soon could be eligible, leaving only her 11-year-old son unvaccinated. The family has not yet resumed going to church, and summer vacation will be a road trip so they do not have to get on a plane.

“We can’t really go back to normal because two-fifths of our family don’t have protection,” Vittitoe said.

President Joe Biden said Monday’s decision marked another important step in the nation’s march back to regular life.

“The light at the end of the tunnel is growing, and today it got a little brighter,” Biden said in a statement.

Pfizer is not the only company seeking to lower the age limit for its vaccine. Moderna recently said preliminary results from its study in 12- to 17-year-olds show strong protection and no serious side effects. Another U.S. company, Novavax, has a COVID-19 vaccine in late-stage development and just began a study in 12- to 17-year-olds.

Next up is testing whether the vaccine works for even younger children. Both Pfizer and Moderna have begun U.S. studies in children ages 6 months to 11 years. Those studies explore whether babies, preschoolers and elementary-age kids will need different doses than teens and adults. Gruber said Pfizer expects its first results in the fall.

Outside of the U.S., AstraZeneca is studying its vaccine among 6- to 17-year-olds in Britain. And in China, Sinovac recently announced that it has submitted preliminary data to Chinese regulators showing its vaccine is safe in children as young as 3.

Children are far less likely than adults to get seriously ill from COVID-19, yet they represent nearly 14% of the nation’s coronavirus cases. At least 296 have died from COVID-19 in the U.S. alone, and more than 15,000 have been hospitalized, according to a tally by the American Academy of Pediatrics.

That’s not counting the toll of family members becoming ill or dying — or the disruption to school, sports and other activities so crucial to children’s overall well-being.

The AAP welcomed the FDA’s decision.

“Our youngest generations have shouldered heavy burdens over the past year, and the vaccine is a hopeful sign that they will be able to begin to experience all the activities that are so important for their health and development,” said AAP President Dr. Lee Savio Beers in a statement.

Experts say children must get the shots if the country is to vaccinate the 70% to 85% of the population necessary to reach what’s called herd immunity.

In the meantime, the Centers for Disease Control and Prevention says unvaccinated people — including children — should continue taking precautions such as wearing masks indoors and keeping their distance from other unvaccinated people outside of their households.

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