Children's relative age in class and use of medication for ADHD: a Danish Nationwide Study

Background: Previous studies from North America and Iceland have shown that the youngest children within a grade are up to twice as likely to be diagnosed and treated for attention-deficit/hyperactivity disorder (ADHD) compared with their older classmates. We aimed to investigate whether younger age in class is associated with an increased probability of being prescribed medication for ADHD among school-aged children in Denmark. Methods: We followed all Danish children between 2000 and 2012 from 1st through 6th grade (7–12 years). Among children who started school on their age-assigned grade level, we estimated the prevalence proportion ratio (PPR) of receiving ADHD medication between the youngest children in class (born in October–December) and the oldest in class (born in January–March), specified by grade level, calendar year and gender. As a sensitivity analysis, we added children not on their age-assigned grade level to the main calculations. Results: We identified 932,032 eligible children for the main analysis, of whom 17.3% were among the youngest and 26.5% among the oldest in class. In total, 1.2% eligible children filled at least one prescription for ADHD medication in 2000–2012. The average PPR over the study period was 1.08 (95% CI, 1.04–1.12) and remained stable across subgroups and sensitivity analyses. Overall, 40% of children born October–December had entered school a year after their age-assigned grade level. Conclusions: Contrary to previous study results, we observed almost no relative age effect on medication use for ADHD among children in Denmark. We postulate that this may be due to the high proportion of relatively young children held back by 1 year in the Danish school system and/or a generally low prevalence of ADHD medication use in the country

Risk scoring systems for adults admitted to the emergency department: a systematic review

<p>Abstract</p> <p>Background</p> <p>Patients referred to a medical admission unit (MAU) represent a broad spectrum of disease severity. In the interest of allocating resources to those who might potentially benefit most from clinical interventions, several scoring systems have been proposed as a triaging tool.</p> <p>Even though most scoring systems are not meant to be used on an individual level, they can support the more inexperienced doctors and nurses in assessing the risk of deterioration of their patients.</p> <p>We therefore performed a systematic review on the level of evidence of literature on scoring systems developed or validated in the MAU. We hypothesized that existing scoring systems would have a low level of evidence and only few systems would have been externally validated.</p> <p>Methods</p> <p>We conducted a systematic search using Medline, EMBASE and the Cochrane Library, according to the PRISMA guidelines, on scoring systems developed to assess medical patients at admission.</p> <p>The primary endpoints were in-hospital mortality or transfer to the intensive care unit. Studies derived for only a single or few diagnoses were excluded.</p> <p>The ability to identify patients at risk (discriminatory power) and agreement between observed and predicted outcome (calibration) along with the method of derivation and validation (application on a new cohort) were extracted.</p> <p>Results</p> <p>We identified 1,655 articles. Thirty were selected for further review and 10 were included in this review.</p> <p>Eight systems used vital signs as variables and two relied mostly on blood tests.</p> <p>Nine systems were derived using regression analysis and eight included patients admitted to a MAU. Six systems used in-hospital mortality as their primary endpoint.</p> <p>Discriminatory power was specified for eight of the scoring systems and was acceptable or better in five of these. The calibration was only specified for four scoring systems. In none of the studies impact analysis or inter-observer reliability were analyzed.</p> <p>None of the systems reached the highest level of evidence.</p> <p>Conclusions</p> <p>None of the 10 scoring systems presented in this article are perfect and all have their weaknesses. More research is needed before the use of scoring systems can be fully implemented to the risk assessment of acutely admitted medical patients.</p

Use of symptom-relieving drugs before and after surgery for urinary incontinence in women:a cohort study

OBJECTIVE: To describe the use of symptom-relieving drugs (antimuscarinic drugs or duloxetine) before and after surgery for urinary incontinence (UI); and for those with use of antimuscarinic drugs or duloxetine before surgery, to estimate the risk of being a postoperative user, relative to those without use before surgery. DESIGN: A historical population-based cohort study. SETTING: Denmark. PARTICIPANTS: Women ≥18 years with a first-time surgical procedure for UI from the county of Funen, Denmark between 1 January 1996 and 31 December 2006, extended to the Region of Southern Denmark from 1 January 2007 to the end of 2010. For these women, data on redeemed prescriptions ±365 days of date of surgery were extracted. MAIN OUTCOME MEASURES: Effect of preoperative use of antimuscarinic drugs or duloxetine on the risk of being a postoperative user of these drugs. RESULTS: Of 2151 women with a first-time surgical procedure for UI, 358 (16.6%) were preoperative users of antimuscarinic drugs or duloxetine and 1793 were not (83.4%). A total of 110 (30.7%) of the preoperative users also redeemed prescriptions for these drugs within 0–60 days after surgery, and 152 (42.5%) of the preoperative users redeemed prescriptions for these drugs within 61–365 days after surgery. Among preoperative non-users, 25 (1.4%) and 145 (8.1%) redeemed prescriptions within 0–60 and 61–365 days after surgery, respectively. Presurgery exposure to antimuscarinic drugs or duloxetine was a strong risk factor of postoperative drug use, both within 0–60 days (adjusted OR=33.0, 95% CI 20.0 to 54.7) and 61–365 days (OR=7.2, 95% CI 5.4 to 9.6). CONCLUSIONS: A substantial number of women will continue to be prescribed symptom-relieving drugs after surgery for UI within a year of follow-up. Only a minority of preoperative non-users initiated usage of symptom-relieving drugs after surgery. Compared with other factors included in the regression model, preoperative use of antimuscarinic drugs or duloxetine was the strongest risk factor for postoperative use