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Tuesday, November 20, 2018

Nitric Oxide

In The Politics of Autism, I discuss various ideas about what causes the conditionHere is just a partial list of correlatesrisk factors, and possible causes that have been the subject of serious studies:

Key Points
Question  Is prenatal exposure to air pollution a risk factor for autism spectrum disorder? Findings  In this population-based cohort study of 132 256 births, maternal exposure to nitric oxide during pregnancy was associated with increased risk of autism spectrum disorder in offspring.
Meaning  Reducing exposures of pregnant women to environmental nitric oxide may be associated with a reduction in autism spectrum disorder incidence in their children.
Importance  The etiology of autism spectrum disorder (ASD) is poorly understood, but prior studies suggest associations with airborne pollutants.
Objective  To evaluate the association between prenatal exposures to airborne pollutants and ASD in a large population-based cohort.
Design, Setting, and Participants  This population-based cohort encompassed nearly all births in Metro Vancouver, British Columbia, Canada, from 2004 through 2009, with follow-up through 2014. Children were diagnosed with ASD using a standardized assessment with the Autism Diagnostic Interview–Revised and Autism Diagnostic Observation Schedule. Monthly mean exposures to particulate matter with a diameter less than 2.5 µm (PM2.5), nitric oxide (NO), and nitrogen dioxide (NO2) at the maternal residence during pregnancy were estimated with temporally adjusted, high-resolution land use regression models. The association between prenatal air pollution exposures and the odds of developing ASD was evaluated using logistic regression adjusted for child sex, birth month, birth year, maternal age, maternal birthplace, and neighborhood-level urbanicity and income band. Data analysis occurred from June 2016 to May 2018.
Exposures  Mean monthly concentrations of ambient PM2.5, NO, and NO2 at the maternal residence during pregnancy, calculated retrospectively using temporally adjusted, high-resolution land use regression models.
Main Outcomes and Measures  Autism spectrum disorder diagnoses based on standardized assessment of the Autism Diagnostic Interview–Revised and Autism Diagnostic Observation Schedule. The hypothesis being tested was formulated during data collection.
Results  In a cohort of 132 256 births, 1307 children (1.0%) were diagnosed with ASD by the age of 5 years. The final sample size for the PM2.5-adjusted model was 129 439 children, and for NO and NO2, it was 129 436 children; of these, 1276 (1.0%) were diagnosed with ASD. Adjusted odds ratios for ASD per interquartile range (IQR) were not significant for exposure to PM2.5 during pregnancy (1.04 [95% CI, 0.98-1.10] per 1.5 μg/m3 increase [IQR] in PM2.5) or NO2 (1.06 [95% CI, 0.99-1.12] per 4.8 ppb [IQR] increase in NO2) but the odds ratio was significant for NO (1.07 [95% CI, 1.01-1.13] per 10.7 ppb [IQR] increase in NO). Odds ratios for male children were 1.04 (95% CI, 0.98-1.10) for PM2.5; 1.09 (95% CI, 1.02-1.15) for NO; and 1.07 (95% CI, 1.00-1.13) for NO2. For female children, they were for 1.03 (95% CI, 0.90-1.18) for PM2.5; 0.98 (95% CI, 0.83-1.13) for NO; and 1.00 (95% CI, 0.86-1.16) for NO2.
Conclusions and Relevance  In a population-based birth cohort, we detected an association between exposure to NO and ASD but no significant association with PM2.5 and NO2.

Monday, November 19, 2018

Consequences of Vaccine Exemptions: Chickenpox and Measles

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Isaac Stanley-Becker at The Washington Post:
Chickenpox has taken hold of a school in North Carolina where many families claim religious exemption from vaccines.
Cases of chickenpox have been multiplying at the Asheville Waldorf School, which serves children from nursery school to sixth grade in Asheville, N.C. About a dozen infections grew to 28 at the beginning of the month. By Friday, there were 36, the Asheville Citizen-Times reported.
The outbreak ranks as the state’s worst since the chickenpox vaccine became available more than 20 years ago. Since then, the two-dose course has succeeded in limiting the highly contagious disease that once affected 90 percent of Americans — a public health breakthrough.
The school is a symbol of the small but strong movement against the most effective means of preventing the spread of infectious diseases. The percentage of children under 2 years old who haven’t received any vaccinations has quadrupled since 2001, according to the Centers for Disease Control and Prevention.
Like the Disneyland measles outbreak in 2015, the flare-up demonstrates the real-life consequences of a shadowy debate fueled by junk science and fomented by the same sort of Twitter bots and trolls that spread misinformation during the 2016 presidential election. And it shows how a seemingly fringe view can gain currency in a place like Asheville, a funky, year-round resort town nestled between the Blue Ridge and Smoky Mountains.
Chickenpox spreads fast and can have very serious effects.
But not all parents seemed to grasp the gravity of the outbreak. Nor does everyone see the rationale behind vaccines, which some believe — contrary to scientific evidence — cause more severe health issues than they’re meant to cure. The claim of an autism risk, though it has been debunked, has remained a rallying cry of the anti-vaccine movement.

Antivax organizations such as Texans For Vaccine Choice are push exemptions for students in public schools, and they are also says that state-regulated day care centers should be subject to the same exemptions. An editorial in The Dallas Morning News says "That's madness."
Applying the personal exemption standard to child care facilities would be a dangerous road to take. The CDC recommends that children do not start to get vaccines for measles until they reach at least 12 months of age. Should parents have to risk their kids getting the measles at such a young age from older, unvaccinated children? We don’t believe so.
Texas was one of 25 states last year to report cases of the measles. Medical experts and researchers say that the continued growth in the number of parents not getting their children vaccinated is increasing the risk of a measles outbreak. One doctor said, “It is really not a question of whether these outbreaks will occur but when.”
We should be thankful that technology and medical advances managed to bring us out of the dark ages. It’s remarkable that in the early 1960s, measles cases numbered in the hundreds of thousands. By the early 1990s, measles practically vanished. Now, it’s slowly starting to make a comeback.
Texans For Vaccine Choice is only trying to make things worse, and their position that personal exemptions are allowed for child care facilities is something Texans cannot accept.

Sunday, November 18, 2018

The Autism Caucus Lost Many Members in This Cycle

In The Politics of Autism, I discuss the congressional role in the issue.

The Autism Caucus lost about one-fifth of its House members as a result of retirement, resignation, defeat, or election to other office.

Robert A. Brady (D) (Pennsylvania, District 01) retiring
Michael E Capuano (D) (Massachusetts, District 07) lost primay
Mike Coffman (R) (Colorado, District 06) lost general election
Barbara Comstock (R) (Virginia, District 10) lost general election
Ryan Costello (R) (Pennsylvania, District 06) retiring
Joseph Crowley (D) (New York, District 14) lost primary
John J Duncan Jr. (R) (Tennessee, District 02) retiring
Bob Goodlatte (R) (Virginia, District 06) retiring
Trey Gowdy (R) (South Carolina, District 04) retiring
Gene Green (D) (Texas, District 29) retiring
Darrell Issa (R) (California, District 49) retiring
Sander Levin (D) (Michigan, District 09) retiring
Jason Lewis (R) (Minnesota, District 02) lost general election
Frank LoBiondo (R) (New Jersey, District 02) retiring
Thomas MacArthur (R) (New Jersey, District 03) lost general election
Patrick Meehan (R) (Pennsylvania, District 05) resigned
Luke Messer (R) (Indiana, District 06) lost primary
Rick Nolan (D) (Minnesota, District 08) retiring
Erik Paulsen (R) (Minnesota, District 03) lost general election
Ileana Ros-Lehtinen (R) (Florida, District 27) retiring
Pete Sessions (R) (Texas, District 32) lost general election
Scott W Taylor (R) (Virginia, District 02) lost general election
Pat Tiberi (R) (Ohio, District 12) resigned
Tim Walz (D) (Minnesota, District 01) elected governor of Minnesota
Kevin Yoder (R) (Kansas, District 03) lost general election

In the Senate, Democrat Joe Donnelly of Indiana lost the general election

Kyrsten Sinema (D) (Arizona, District 09) left her House seat to run for the Senate, where she will probably remain in the Caucus.

Saturday, November 17, 2018

The West and the Antivax Movement

At The Conversation, Dr. Peter Hotez writes about the antivax movement.
Together with colleagues from Baylor College of Medicine and Texas Children’s Hospital, where I work, we did an in-depth study of kindergarten schoolchildren who receive vaccine exemptions across the country. Currently, 18 states allow nonmedical vaccine exemptions for either “conscientious objector” or “philosophical/personal belief” reasons. We were able to obtain information on 14 of those states.
A clear picture emerged: Vaccine exemptions are on the rise in 12 of the states we looked at. Indeed, anti-vaccine activities appear to be more of a western phenomenon, especially in the Pacific Northwest (Idaho, Oregon and Washington) and the American Southwest (Arizona, Missouri, Oklahoma, Texas and Utah).
What exactly is going on in the West, where many parents shun vaccines and take their children out of vaccination programs? Researchers are still at the early stages of understanding the reasons behind the anti-vaccine movement. A couple of these states, Oklahoma and Texas, host well-organized political action committees that lobby their legislatures and even raise campaign funds for candidates to endorse anti-vaccine positions. These committees appeal to parental fears of unwarranted government interference.
What’s more, some studies suggest that vaccine refusal is linked to affluence, and possibly with affluence there is greater access to the internet. There are now hundreds of anti-vaccine websites on the internet, many of which still allege that vaccines cause autism or that autism is a form of “vaccine injury,” neither of which is true.
The anti-vaccine movement also effectively uses social media to share their message. Some studies show that anti-vaccine social media has created an “echo chamber” effect that strongly reinforces negative attitudes towards vaccines.

Friday, November 16, 2018

Keeping All Students Safe Act

In The Politics of Autismdiscuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

A release from Senator Chris Murphy (D-CA):
U.S. Senator Chris Murphy (D-Conn.), a member of the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee, joined U.S. Representatives Don Beyer (VA-8) and Bobby Scott (VA-3), ranking member of the U.S. House of Representatives Committee on Education and the Workforce, and U.S. Senator Patty Murray (D-Wash.), ranking member of HELP, on Wednesday in introducing the Keeping All Students Safe Act to protect students from the dangers of seclusion and restraint at school.

The legislation would make it illegal for any school receiving taxpayer dollars to seclude children. The legislation also limits the use of physical restraint to instances when it is necessary for the safety of students and teachers. The bill would establish minimum safety standards in schools, require states to monitor the law’s implementation, and increase transparency and oversight to prevent future abuse of students.
The legislation refers to key facts and findings that reveal a concerning history of seclusion and restraint of students in schools, including a 2009 Government Accountability Office (GAO) investigation that revealed hundreds of incidents of child abuse in schools as a result of seclusion and restraint practices that disproportionately impacted children with disabilities and children of color.
FACT SHEET: Keeping All Students Safe Act
SECTION BY SECTION: Keeping All Students Safe Act

Thursday, November 15, 2018

Public Charge

In The Politics of Autism, I explain how the issue connects with so many other issues.  Immigration is an example.

Zaidee Stavely at EdSource:
Hundreds of thousands of immigrant parents in California may disenroll their children from health insurance, food stamps and other federally subsidized programs because they fear that receiving these benefits will make it impossible for them to become permanent residents in the United States.
Their fears have been triggered by new regulations proposed by the Trump administration that expand the number of benefits that immigration officers can take into account in deciding whether to deny an immigrant permanent residence in the United States. Federal law allows immigration officials to deny green cards to immigrants if authorities decide they are likely to become a “public charge” — someone who relies excessively on government benefits to survive.

The draft regulations are currently open for public comments until Dec. 10th.
Administrators at community clinics, school-based health centers and agencies serving children say some parents in California are already choosing not to enroll or withdrawing their children from health and nutrition programs.
A parent asked First 5 Alameda, an agency that supports families with small children, to stop seeking early intervention services from a local school district for their toddler with autism.

Wednesday, November 14, 2018

House Committees

The Autism Society explains how the switch to Democratic control will affect committees in the House of Representatives:
Budget and Appropriations
Rep. John Yarmuth of Kentucky will likely take the helm of the Budget Committee. This committee has jurisdiction over the budget resolution. The change likely means the budget will not be used to force changes to important programs like Medicaid, Medicare and Social Security. Yarmuth has said he hopes to mark up a fiscal 2020 budget resolution that will reflect Democratic spending priorities such as infrastructure, education, job training, and clean energy.
Rep. Nita Lowey of New York is slated to chair the powerful Appropriations Committee. This committee decides where the money allocated from the Budget Resolution will be used to fund specific programs. The Subcommittee on Labor, HHS, Education will be chaired by Rep. Rosa DeLauro of Connecticut. This committee has jurisdiction over spending decisions most autism and other disability programs.
Energy and Commerce/Health Care
Rep. Frank Pallone Jr. of New Jersey is in line to be the next chairman of the Energy and Commerce Committee currently led by Rep. Greg Walden of Oregon. This Committee works on important issues like health care, including Medicaid. Under the leadership of Pallone, the House will push back on any attempts to repeal the Affordable Care Act or to make cuts to Medicaid; and could introduce bills to strengthen the ACA marketplaces and begin reviewing bills to provide universal health care. Rep. Pallone is also the author of a bill to provide long-term care to seniors and people with disabilities that may now get attention by the committee. This committee will also be responsible for reauthorizing the Autism CARES Act, one of the Autism Society’s biggest priorities for 2019 when the law is set to expire.
Ways and Means
The Chairmanship of the Ways and Means Committee will likely be Richard Neil of Massachusetts. This committee is responsible for tax and some health care programs. It is unclear at this time what tax bills will be considered. On health, top priorities include shoring up the Affordable Care Act exchanges and lowering the cost of prescription drugs. The retirement of Rep. Sander M. Levin (D-MI), opens up the top spot on the Health Subcommittee. California Rep. Mike Thompson is currently the panel’s most senior member and likely to take that seat.
Education and the Workforce
Rep. Robert Scott of Virginia is expected to chair the Education and Workforce Committee. This committee will be responsible for the reauthorization of the Higher Education Act (HEA) and any other education and employment bills. Scott authored an HEA bill (AIM Higher Act) that would promote the inclusion of students with autism. This committee will also likely to take up a bill to reduce the use of restraints and seclusion in schools. Bipartisan bills in development related to increasing opportunities for competitive, integrated employment may also be considered in this committee in the new Congress. Rep. Virginia Foxx of North Carolina is expected to remain on the committee as the ranking minority member.
Judiciary Committee
Rep. Jerrold Nadler of New York is poised to become the next chairman of the Judiciary Committee. This committee has jurisdiction over our civil rights laws, including the Americans with Disabilities Act. Nadler was an opponent of HR 620, a bill that would weaken the ADA.