School pressures are driving stimulant use among middle class children.

More six percent of U.S. children regularly take stimulant medication, often in order to help them manage in school. But what factors shape stimulant use amongst adolescents at school? In new research which analyses prescriptions for stimulants in the U.S., Marissa King finds that economically advantaged children are more likely to use stimulants in response to academic pressures, and that states with stricter school accountability policies for pupil performance see greater stimulant use amongst children. Making schools more academic, she writes, appears to encourage school-based stimulant use

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing – providing gifts, information, samples, trips, honoraria and other inducements – to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone

Socioeconomic Status and the Increased Prevalence of Autism in California.

The prevalence of autism has increased precipitously—roughly 10-fold in the past 40 years—yet no one knows exactly what caused this dramatic rise. Using a large and representative dataset that spans the California birth cohorts from 1992 through 2000, we examine individual and community resources associated with the likelihood of an autism diagnosis over time. This allows us to identify key social factors that have contributed to increased autism prevalence. While individual-level factors, such as birth weight and parental education, have had a fairly constant effect on likelihood of diagnosis over time, we find that community-level resources drive increased prevalence. This study suggests that neighborhoods dynamically interact with the people living in them in different ways at different times to shape health outcomes. By treating neighborhoods as dynamic, we can better understand the changing socioeconomic gradient of autism and the increase in prevalence

Age of Diagnosis for Autism: Individual and Community Factors across 10 Birth Cohorts

The incidence of autism rose dramatically between 1992 and 2001, while the age at which children were first diagnosed declined. During this period the size and composition of the autism caseload has changed, but little is known about whether the factors associated with the timing of diagnosis may also have shifted. Using a multilevel analysis strategy, the individual and community-level factors associated with age of diagnosis were modelled across 10 birth cohorts of California children

Estimated Autism Risk and Older Reproductive Age

The prevalence of autism, a developmental disorder characterized by serious impairments in social interaction and language development as well as stereotyped and repetitive behaviors, has increased dramatically over the past 2 decades from approximately 4 to 40 cases per 10 000. The cause of the increase is unknown, as is the etiology of autism. Evidence from twin studies suggests that autism is likely a genetic disorder. However, genetic causes for the vast majority of autism cases have not yet been identified through molecular genetic research. In addition, dozens of previous studies have identified a wide range of perinatal and parental risk factors. Despite these studies, our understanding of even the most basic of these factors, parental age, is muddled

Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis

Objective: To examine the effect of attending a medical school with an active policy on restricting gifts from representatives of pharmaceutical and device industries on subsequent prescribing behavior. Design: Difference-in-differences approach. Setting: 14 US medical schools with an active gift restriction policy in place by 2004. Participants: Prescribing patterns in 2008 and 2009 of physicians attending one of the schools compared with physicians graduating from the same schools before the implementation of the policy, as well as a set of contemporary matched controls. Main outcome measure: Probability that a physician would prescribe a newly marketed medication over existing alternatives of three psychotropic classes: lisdexamfetamine among stimulants, paliperidone among antipsychotics, and desvenlafaxine among antidepressants. None of these medications represented radical breakthroughs in their respective classes. Results: For two of the three medications examined, attending a medical school with an active gift restriction policy was associated with reduced prescribing of the newly marketed drug. Physicians who attended a medical school with an active conflict of interest policy were less likely to prescribe lisdexamfetamine over older stimulants (adjusted odds ratio 0.44, 95% confidence interval 0.22 to 0.88; P=0.02) and paliperidone over older antipsychotics (0.25, 0.07 to 0.85; P=0.03). A significant effect was not observed for desvenlafaxine (1.54, 0.79 to 3.03; P=0.20). Among cohorts of students who had a longer exposure to the policy or were exposed to more stringent policies, prescribing rates were further reduced. Conclusion: Exposure to a gift restriction policy during medical school was associated with reduced prescribing of two out of three newly introduced psychotropic medications

The Spatial Structure of Autism in California, 1993-2001

This article identifies significant high-risk clusters of autism based on residence at birth in California for children born from 1993 to 2001. These clusters are geographically stable. Children born in a primary cluster are at four times greater risk for autism than children living in other parts of the state. This is comparable to the difference between males and females and twice the risk estimated for maternal age over 40. In every year roughly 3% of the new caseload of autism in California arises from the primary cluster we identify-a small zone 20 km by 50 km. We identify a set of secondary clusters that support the existence of the primary clusters. The identification of robust spatial clusters indicates that autism does not arise from a global treatment and indicates that important drivers of increased autism prevalence are located at the local level

Giant Merkel Cell Carcinoma Masquerading as a Benign Cyst on the Buttock of an African American Man

We report a case of a 60-year-old African American man who presented with a 4-year history of a previously asymptomatic, recently enlarging nodule on his left buttock, which was initially presumed to be an epidermoid cyst. Physical examination revealed a large, fixed, subcutaneous tumor, and a biopsy revealed merkel cell carcinoma. Immunohistochemical staining was positive for pankeratin, CAM 5.2, synaptophysin, and CD56 and negative for CK7, CK20, TTF-1, chromogranin, CD3, CD20, CD57, MART1, and HMB 45. The patient underwent wide local excision of the lesion with removal of the fascia overlying the gluteus and full body positron emission tomography (PET) and was found to have Stage IIb disease. He subsequently received adjuvant radiotherapy limited to the tumor bed at a dose of 60 gray

Conformity to masculine norms: Differences between men with and without a disability

There is a noted paucity of quantitative research examining the interrelationship between masculinity and disability. We analyzed a sample of 12,418 men aged 18 to 55 years from the Australian Longitudinal Study on Male Health (the Ten to Men Study) to investigate associations between disability and conformity to norms of masculinity viewed as traditional in Western societies. To assess masculinity, we used the Conformity to Masculine Norms Inventory–22, both as an overall scale and across 11 different subscales. We found little difference between men with and without a disability on the overall masculinity scale; however, differences were observed on subscales. Men with a disability reported greater conformity to Self-Reliance norms and lower conformity to Pursuit of Status, Heterosexual Presentation, and Primacy of Work. These results suggest that men with disabilities reformulate masculinity to assemble a masculine identity that draws on norms such as self-reliance but places less importance on other elements of masculinity seen as traditional in Western societies

Social Influence and the Autism Epidemic

Despite a plethora of studies, we do not know why autism incidence has increased rapidly over the past two decades. Using California data, this study shows that children living very close to a child previously diagnosed with autism are more likely to be diagnosed with autism. An underlying social influence mechanism involving information diffusion drives this result, contributing to 16% of the increase in prevalence over 2000–2005. We eliminate competing explanations (i.e., residential sorting, environmental toxicants, and viral transmission) through seven tests and show that information diffusion simultaneously contributed to the increased prevalence, spatial clustering, and decreasing age of diagnosis