Objective To test our initial hypotheses that the COVID-19 pandemic was associated with: (1) decreases in adaptive behavior and increases in behavioral and emotional problems of children with autism; (2) greater impacts for those who lost specialty services; and (3) greater behavioral and emotional problems for children with autism versus control participants. Method Eligible participants (N=1,158) enrolled in Phase 3 of the multi-site, case-control Study to Explore Early Development (SEED) prior to March 31, 2020, between 2-5 years old and completed follow-up assessments between January-July 2021. Caregivers completed a COVID-19 Impact Assessment Questionnaire, Vineland Adaptive Behavior Scales (VABS), and Child Behavior Checklist (CBCL) for 274 children with autism and 385 control participants. Results Mean VABS communication scores of children with autism decreased significantly (-4.2; standard deviation [SD], 10.5) between pre-pandemic and pandemic periods, while VABS composite (+2.0; SD, 9.0), daily living (+5.5; SD, 11.4), socialization (+2.3; SD, 10.0), and CBCL scores (-3.2; SD, 8.4) improved. In contrast, CBCL scores worsened in population control participants (+3.4; SD, 8.8). Children with autism who missed specialty appointments scored significantly lower on the VABS during the pandemic versus those who did not (VABS Composite 70.6; 95% confidence interval [CI]: 68.8-72.4 vs. 74.5; 95% CI: 71.8-77.2). Conclusion While stay-at-home policies of the pandemic may have beneficially impacted daily living skills, socialization, and behavioral and emotional wellbeing of children with autism, benefits may have occurred at the cost of communication skills. These findings indicate the need for strategies to maintain therapeutic services in future emergency settings.

Purpose To identify cognitive, behavioral, environmental, and other factors that influence physical activity in adults with advanced cancer using qualitative, semi-structured interviews. Methods Eighteen semi-structured interviews were conducted with adults living with stage IV breast, prostate, or colorectal cancer; or multiple myeloma recruited from the University of Wisconsin Carbone Cancer Center. We used the Social Cognitive Theory to design the interview guide and a reflexive thematic approach for analysis. Results Participants were 62 years old on average and currently receiving treatment. Despite reporting numerous barriers to physical activity, most participants discussed engaging in some physical activity. Participants reported difficulties coping with changes in physical functioning especially due to fatigue, weakness, neuropathy, and pain. While cold weather was seen as a deterrent for activity, access to sidewalks was a commonly reported feature of neighborhood conduciveness for physical activity. Regardless of current activity levels, adults with advanced cancer were interested in engaging in activities to meet their goals of gaining strength and maintaining independence. Having a conversation with a provider from their cancer care team about physical activity was seen as encouraging for pursuing some activity. Conclusions Adults living with advanced cancer are interested in pursuing activity to gain strength and maintain independence despite reported barriers to physical activity. To ensure patients are encouraged to be active, accessible resources, targeted referrals, and interventions designed to address their goals are critical next steps. Relevance Integrating conversations about physical activity into oncology care for adults living with advanced cancer is an important next step to encourage patients to remain active and help them improve strength and maintain quality of life and independence.

Objectives To characterize the effect of the actual and potential ability to get rides from others on older adults’ driving reduction at three-year follow up in the United States. Methods We analyzed National Health and Aging Trends Study data from community-dwelling drivers in 2015 (unweighted n = 5,102). We used weighted logistic regression models to estimate whether getting rides from others in 2015 was associated with older adults increasing the number of driving behaviors they avoided, decreasing the frequency with which they drove, or not driving at three-year follow up after adjusting for biopsychosocial variables. We also measured presence of social network members living nearby including household and non-household members and estimated associated odds of driving reduction at three-year follow up. Results Older adults who got rides from others in 2015 had greater odds of reporting no longer driving at three-year follow up compared to those who did not get rides (adjusted Odds Ratio [aOR] = 1.53, 95% Confidence Interval [CI]: 1.11-2.11). We found no statistically significant association between older adults living with others or having more nearby confidantes outside their household and their odds of reducing driving at three-year follow up. Discussion These findings suggest that getting rides from others plays an important role in the transition to non-driving for older adults. Future research should examine whether other aspects of social networks (e.g., type, quality, closer proximity) might also be key modifiable coping factors for older adults transitioning to non-driving.

Background: The atopic march refers to the co-expression and progression of atopic diseases in childhood, often beginning with atopic dermatitis, although children may not progress through each atopic disease. Objective: We hypothesized that future atopic disease expression is modified by atopic dermatitis phenotype, and that these differences result from underlying dysregulation of cytokine signaling. Methods: Children (n=285) were enrolled into the Childhood Origins of ASThma birth cohort and followed prospectively. Rates of atopic dermatitis, food allergy, allergic rhinitis, and asthma were assessed longitudinally from birth to 18 years of age. Associations between atopic dermatitis phenotype and food allergy, allergic rhinitis, asthma, allergic sensitization, exhaled nitric oxide, and lung function were determined. Peripheral blood mononuclear cell responses (IL-5, IL-10, IL-13, IFN-γ) to dust mite, phytohemagglutinin, Staphylococcus aureus Cowan I, and tetanus toxoid were compared among atopic dermatitis phenotypes. Results: Atopic dermatitis at year 1 was associated with an increased risk of food allergy (p=0.004). Both persistent and late-onset atopic dermatitis were associated with an increased risk of asthma (p=<0.001), rhinitis (p<0.001), elevated total IgE (p=<0.001), percentage of aeroallergens with detectable IgE (p<0.001), and elevated exhaled nitric oxide (p=0.002). Longitudinal analyses did not reveal consistent differences in PBMC responses among dermatitis phenotypes. Conclusion: Atopic dermatitis phenotype is associated with differential expression of other atopic diseases. Our findings suggest peripheral blood cytokine dysregulation is not a mechanism underlying this process, and immune dysregulation may be mediated at mucosal surfaces or in secondary lymphoid organs. Keywords: Atopic dermatitis; allergic sensitization; atopic dermatitis phenotypes; atopic march; progression of atopic disease.

Background: Farm exposures in early life reduce the risks for childhood allergic diseases and asthma. There is less information about how farm exposures relate to respiratory illnesses and mucosal immune development. Objective: We hypothesized that children raised in farm environments have a lower incidence of respiratory illnesses over the first two years of life than non-farm children. We also analyzed whether farm exposures or respiratory illnesses were related to patterns of nasal cell gene expression. Methods: The Wisconsin Infant Study Cohort included farm (n=156) and non-farm (n=155) families with children followed to age 2 years. Parents reported prenatal farm and other environmental exposures. Illness frequency and severity were assessed using illness diaries and periodic surveys. Nasopharyngeal cell gene expression in a subset of 64 children at age two years was compared to farm exposure and respiratory illness history. Results: Farm vs. non-farm children had nominally lower rates of respiratory illnesses (rate ratio 0.82 [0.69,0.97]) with a stepwise reduction in illness rates in children exposed to 0, 1, or ≥2 animal species, but these trends were non-significant in a multivariable model. Farm exposures and preceding respiratory illnesses were positively related to nasal cell gene signatures for mononuclear cells and innate and antimicrobial responses. Conclusions: Maternal and infant exposure to farms and farm animals was associated with nonsignificant trends for reduced respiratory illnesses. Nasal cell gene expression in a subset of children suggests that farm exposures and respiratory illnesses in early life are associated with distinct patterns of mucosal immune expression. Keywords: Farm; children; gene expression; nasal epithelial cells; respiratory illness; virus.