New Autism research Challenges traditional views

The traditional view of high end Autism has been that it arises in large part because of problems that the Autistic person has with responding to others - that the Autistic have an impaired ability to comprehend "the other".

Recent research findings published in the journal Neuron by Baylor College of Medicine researchers now turn this traditional view upside down.

The research appears to show that individuals with high end of the autism spectrum disorder actually have an inability to model "self" which causes a disability in understanding the world as a whole.

Dr. P. Read Montague Jr., professor of neuroscience, and director of the Human Neuroimaging Lab and the Computational Psychiatry Unit at BCM used a functional magnetic resonance imaging (fMRI) scanner to scan the brains of "high functioning" autistic individuals. The research found a "signature" in the brain that identified those with autism. This level of activity correlated with the severity of the autistic symptoms. The less activity - the more serious the symptoms. This could result in a test which would speed diagnosis.

The team used a technique called hyperscanning, developed in Montague's laboratory, which allowed them to scan two brains simultaneously while the research subjects played a trust game.
One player received an amount of money and then had to send whatever amount he or she wanted to the other player via a computer message. This amount is then tripled the second player then decides how much of this tripled amount to send back. The game is played over several rounds.

Previous work had shown that an area called the cingulate cortex was where most of the activity occured during the trust game.

The researchers compared the brain responses of normal subjects with "high functioning" autistic subjects and found that the autistic subjects did not play the game differently from their partners, who were taken from a population of similar teens without autism. Both groups of subjects made similar amounts of money overall and round by round.

However, the scans revealed that the the autistic youngsters' "self" responses were dim compared to normal subjects and the more severe the autistic symptoms the dimmer the response.

It was clear that the Autistic subjects cognitively understood the game but had a very low level of 'self' response which correlated with the severity of their autism.

"To have a good self concept, you have to be able to decide if the shared outcome is due to the other person or due to you," said Montague. "If people can't see themselves as a distinct entities at deeper levels, there is a disconnect."

Chris and Uta Frith (University College London) writing in the journal Neuron said, "This is an exciting result because it suggests that some mechanisms of social interaction are intact in these high-functioning cases. What is the critical difference between the self phase and the other phase? We believe that the simple distinction of self versus other is not adequate. "It involves higher-order mentalizing: you care what another person thinks of you, and even further, you care that the other person trusts you. You would not do this when playing against a computer. In autism there is no difference".

Further research to test the "model of self" aspects of Autism are anticipated which may throw light on the contribution of this deficit with people who are less high functioning. This research may also suggest intriguing possibilities for other ways in which to help people with autistic spectrum disorder.

Research published February 7, 2008, journal Neuron, (Cell Press. )

Autism Publications

Bristol Care Home Abuse Closure

Care regulator,The Commission for Social Care Inspection (CSCI) has applied for an emergency court order and closed Overnhill House, Downend, near Bristol. The care home for elderly people was shut because of concerns about the safety of residents following a period of monitoring.

Questions remain however about why there has so far been no police involvement given the nature of the concerns raised about what went on at the Overnhill home.

CSCI reported there had been complaints that one resident had been dragged across a room, that another had heavy bruising, concerns about issues about medication being administered and concerns about staffing levels .

All 10 people living at the Care Home were moved. The Owners, Danny Purgaus and Patricia Purgaus have not made any comment.

The home which has 14 beds was registered in 1992 and offered residential care for elderly people with dementia or Alzheimer's disease.

A CSCI spokesperson said, "The decision to close a care home is never taken lightly and is usually the last resort after every effort has been made to get the owners to improve standards and comply with legal requirements. We know all too well the impact that closure can have on the people who live there, their families and their carers, as well as members of the staff."

Bristol City Council said the authority had responded to concerns about the welfare of the residents and had found new residential placements for them.

An Avon and Somerset Police spokesperson confirmed that there has so far been no police involvement in the case.

The lack of police involvementy raises serious issues given the reports from CSCI that the complaints inluded the suggestion of at least one resident being dragged across the floor and the suggestion of heavy bruising on another.

Care Home residents are entitled not only to the protection afforded to them by a regulator such as CSCI - which appears to have acted firmly in this case. Care Home residents are also entitled to the protection afforded by the criminal law and it is clear that the police must investigate the possible abuse that may have taken place in this home.

Abuse of residents in care homes must be seen not only as a regulatory matter but also as a matter for possible criminal prosecution. Only when the State acts both to close such homes and to prosecute abusers will people in Care Homes feel truly protected.

Improving care for older people: Regulation and Inspection'

Driving Improvement in care services for older people explored at national conference.
Findings from Inspection and Regulation highlighted to help improve practice.

Shona Robison MSP, Minister for Public Health, addressed delegates at a national conference in Edinburgh today (29 January 2008). The National conference, ‘Improving care for older people: messages from regulation and inspection' explored how the findings of Inspection and regulation activity can help to improve practice in the care and support for older people in Scotland.

The event at the Edinburgh International Conference Centre (EICC) was jointly organised by the Scottish Social Services Council (SSSC), the Care Commission and the Social Work Inspection Agency (SWIA).

Over 150 delegates, including care service managers, heads of community care planning, people who use services and carers, shared experiences and discussed how the quality of life for people living in care homes can be improved.

Leaders from the SSSC, the Care Commission and SWIA spoke about how they work together to drive improvement through regulation and inspection. Delegates also participated in seminars and workshops on achieving quality through partnership, promoting nutrition in care homes and grading for improvement.

Shona Robison MSP, Minister for Public Health, said: "I am delighted to speak at this joint event organised by the three inspection and regulatory bodies with key responsibilities for the quality of care and the care workforce. Older people in Scotland with care needs deserve the best possible standards of care and support. The Scottish Government has demonstrated its commitment to older people, for example by making dementia a national priority and increasing Free Personal and Nursing Care payments. The work of the inspection and regulatory bodies plays a vital role in identifying and promoting good practice and in improving standards of care. This joint event is an important opportunity for care professionals to share knowledge and expertise."

Speakers at the conference included Professor Mary Marshall, who lectures and writes about dementia and is a member of the Independent Funding Review of Free Personal Care, Alexis Jay, Chief Social Work Inspector, Carole Wilkinson, Chief Executive, SSSC and Jacquie Roberts, Chief Executive, Care Commission.

MRSA in Care Homes and Nursing Homes

Methicillin-resistant Staphylococcus aureus (MRSA) is not only a dangerous, sometimes fatal and difficult to treat disease for hospital patients but also a significant concern in care home settings where residents often have nursing needs. Despite this surprisingly few studies have examined how to prevent MRSA spread among elderly residents in Care Homes according to Carmel Hughes, lead author of a recent review of the subject.

( Check here for other MRSA related publications)

MRSA Risk Factors
The usual antibiotics, like penicillin do not work with the organism MRSA and the problems it causes are compounded by the fact that it spreads very easily, often on the hands of health care workers. Elderly Care Home (Nursing Home) residents can be particularly vulnerable not only because the risk of infection increases with advancing age but also because a proportion of residents will have periods in an out of hospital where they may either pick up or pass on the bug.

In addition to these factors residents in nursing homes also live in close proximity to each other, are often on multiple medications, are susceptible to pressure sores and often have catheters. All of these are factors which facilitate MRSA infection.

The reviewers searched for randomized and controlled clinical trials that focused on infection control interventions in nursing homes. "We found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people," they report.

Hospitals have isolation facilities and greater access to infection control expertise compared to Care Homes and infection control training is not routinely available in nursing homes.

MRSA control measures in Care Homes
Care Homes (nursing homes) can and must still learn lessons from the existing research; which has been mostly hospital focussed.

MRSA intervention in Care Homes / Nursing Homes should include screening of recently admitted residents to the nursing homes possibly with the assistance of attending GP's. A thorough approach might also need to take account of residents who have periods of hospital admission and the possibility that they may aquire MRSA during these periods.

Staff training in the importance of hand washing and high standards of cleaning and decontamination is very important as are mechanisms to ensure the staff follow such routines. Identifying specific members of staff to take responsibility for promoting and monitoring infection control measures may also help.

Carmel Hughes is a professor of primary care pharmacy at Queen's University Belfast in Northern Ireland. The Cochrane Library is an international organization that evaluates medical research.
Reference: Hughes CM, Smith MBH, Tunney MM. Infection control strategies for preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people (Review). The Cochrane Database of Systematic Reviews 2008, Issue 1.

Scotland National Rape Crisis Helpline launched

Scotland will pioneer the first national rape helpine to offer support and information to anyone affected by sexual violence. The Scottish national rape helpline which is being launched today will provide support to victims and help for friends and relatives. The Rape Crisis Scotland helpline will be open seven days a week from 6pm until midnight. The freephone number is 08088 01 03 02.

Neither Scotland or the rest of the UK currently have a national helpline. Current funding levels only allow volunteers to handle phone lines for a few hours two or three days a week. This poor provision was despite the fact that reported rapes north of the Border had risen 8-per cent.

Women who were desperately in need of advice and support often had to leave messages on the answerphones because the helplines were not open. It was feared that this could be deterring women from reporting crimes such as domestic abuse cases.

Scotland's conviction rate for rape is among of the worst in Europe at approx 4-per cent. Reported rapes rose from 596 in 1997-98 to 900 in 2004-05 an 8-per cent increase.

Crerar Review: Public Scrutiny in Scotland

The Report by Professor Lorne Crerar of the “Independent review of regulation, audit, inspection and complaints handling of public services in Scotland” was published on Tuesday 25th September 2007 on http://www.scrutinyreview.org/

The Crerar review concludes there is widespread agreement that Scotland’s scrutiny system is too complex, costly and burdensome on public bodies. From the evidence gathered, Crerar finds that the scrutiny system doesn’t necessarily scrutinise the right things, has grown in a piecemeal fashion and requires strategic co-ordination.

The Crerar report short to medium term recommendations

• a radical increase in the sharing of information and co-ordination
between bodies.
• a renewed focus on users of services
• involving service users in standards setting
• an increased role for parliament
• fewer scrutiny organisations
• accessible reports by scrutiny bodies
• proportionality - focusing on poorer performing service providers and higher risk situations

Crerar Report - One scrutiny body for all?

In the longer term the report proposes moving to one national scrutiny body, one audit body, and one complaints handling body for the whole public sector.

Crerar report - other recommendations

The Crerar report also recommends that –
• Core risk criteria should be agreed by Ministers and agreed by Parliament to assess the need for current and future scrutiny
• Ministers should redistribute resources and functions from within NHS QIS,
the Scottish Government’s Health Directorates and the Care Commission in relation to private hospitals and related treatment – to an independent external scrutiny organisation
• All external scrutiny organisations should have one “status” with clearly defined lines of accountability to Parliament and to Ministers.
• Where scrutiny is needed, if there is more than one existing organisation, only one should be asked to do the work and be fully responsible and accountable. Creating a new scrutiny organisation should not be an option.

Crerar Report: Principles of scrutiny

The focus should shift to self assessment, supported by risk based, proportionate
external scrutiny. As service provider performance management improves in quality
and ability to reassure users, public and elected members, scrutiny can become
more proportionate to the risks, which in turn frees up delivery organisations to focus
further on improving their front line services. The scrutiny framework should –
􀂃 focus on the needs of the people who use services being scrutinised,
􀂃 drive improvement,
􀂃 ensure that public money is used as efficiently and effectively as possible.
The principles behind the system are for a simplified scrutiny landscape, with a
proportionate and co-ordinated approach.

Crerar Report: The future for Scrutiny bodies

The report does not make specific recommendations in relation to the future of particular scrutiny bodies as this was not the remit of the review. However the report does recommend that in the longer term there should be the development of one scrutiny body and this will have implications for a number of existing bodies.

Crerar Report: A Risk based and Outcome focussed approach to Scrutiny?

The report argues strongly for scrutiny which is risk based and which moves away from scrutinising inputs and processes and towards measuring outcomes.

The full report can be downloaded at http://www.scotland.gov.uk/Resource/Doc/82980/0053065.pdf

Healthcare associated infections study

National Healthcare Associated Infections (HAI) Point Prevalence Survey

This survey, carried out by Health Protection Scotland, is the most
comprehensive study ever undertaken into the extent of infections in Scotland
and leads the way in HAI research in Europe.

The survey recorded the presence of all types of infections in one day for every patient in every acute hospital. The survey found that the prevalence of HAI was 9.5 per cent in acute hospitals
and 7.3 per cent in community hospitals and the cost of these infections was approx. £183m per
year.
The study found that the highest numbers of HAI in acute hospitals were present in care of the elderly, medical and surgical wards.
The HAI task force will take these findings forward and is focusing on the following areas:
• examining the case for introducing an MRSA screening programme - targeting skin and soft tissue infections
• reducing blood stream infections
• ensuring additional surveillance data are put to use in the areas of general medicine and care of the elderly.