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The popular belief that the extended family is no longer an important part of British life is not borne out by this study. Grandparents played a significant role in the care of their young grandchildren. The modest behavioural sequelae of extensive grandparental care differ from those reported for group-based day care.

AIMThe aim of the present study was to describe the prescription of medications for attention-deficit hyperactivity disorder (ADHD) in the UK between 1995 and 2015. METHODSUsing the Clinical Practice Research Datalink (CPRD), we defined a cohort of all patients aged 6-45 years, registered with a general practitioner between January 1995 and September 2015. All prescriptions of methylphenidate, dexamphetamine/lisdexamphetamine and atomoxetine were identified and annual prescription rates of ADHD were estimated using Poisson regression. RESULTSWithin a cohort of 7 432 735 patients, we identified 698 148 prescriptions of ADHD medications during 41 171 528 person-years of follow-up. Usage was relatively low until 2000, during which the prescription rate was 42.7 [95% confidence interval (CI) 20.9, 87.2] prescriptions per 10 000 persons, increasing to 394.4 (95% CI 296.7, 524.2) in 2015, corresponding to an almost 800% increase (rate ratio 8.87; 95% CI 7.10, 11.09). The increase was seen in all age groups and in both sexes but was steepest in boys aged 10-14 years. The prescription rate in males was almost five times that of females. Methylphenidate remained the most prescribed drug during the 20-year study period, representing 88.9% of all prescriptions in the 6-24-year-old group, and 63.5% of all prescriptions in adults (25-45 years of age). CONCLUSIONSPrescription rates of ADHD medications have increased dramatically in the past two decades. This may be due, at least in part, to both an increase in the number of patients diagnosed with ADHD over time and a higher percentage of those patients treated with medication. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-aged children. WHAT THIS STUDY ADDS• Prescription rates of ADHD medications have increased dramatically in the UK in the past two decades, particularly in children and adolescents.• This increase is likely to relate to both an increase in the number of patients diagnosed with ADHD over time and a higher percentage of patients treated with medications. Longer duration of use of ADHD drugs, as well as more frequent off-label use, may also contribute to the increasing prescription rates. IntroductionAttention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-aged children, characterized by symptoms of inattention, impulsivity and hyperactivity [1]. Symptoms may persist beyond childhood and some individuals are not diagnosed with ADHD until adulthood [2].In the past few decades, an increased prevalence of ADHD and use of ADHD medications has been observed in several countries [3][4][5][6][7][8][9], including the UK [10], raising concerns about possible overdiagnosis and inappropriate prescription of ADHD medications. In this context, in July 2013 the National Institute for Health and Care Excellence (NICE) issued a reminder to avoid methylphenidate in children and young people with moderate...

Paranoia may be a significant concern during adolescence, but there has been little research on excessive mistrust in young people. In this longitudinal study we set out to test the predictive ability of a number of cognitive, affective, and social factors in the early development of paranoia in a clinical adolescent population. Thirty four help-seeking adolescents, aged 11-16 years, reporting paranoid thoughts and attending mental health services were recruited. Self-report and interview assessments of paranoia were conducted at baseline. Measures relating to a cognitive model of persecutory delusions were completed. Paranoia was reassessed after three months with thirty three participants. Significant predictors of paranoia persistence were anxiety, depression, worry, negative self-beliefs, perceptual anomalies, insomnia, affective reactivity, bullying, and cyber victimization. No effect was found for reasoning bias or negative perceptions of academic ability, social competence, and physical appearance. In conclusion, many of the maintenance factors implicated in adult paranoia are likely to prove important in the early development of paranoia in young people. Further experimental and treatment studies are now needed to examine the causal role of these factors in the occurrence of paranoia in adolescents.

SUMMARYTo study the effect of ultraviolet (UV) light ou the development of age-related cataract, a community based cross-sectional study was undertaken in two villages in the mountainous Northern Areas of Paki stan. The relative UV light exposure was calculated by the UK Universities Global Atmospheric Modelling Program using the variables direct sunlight hours per day, latitude and ground reflectivity. A total of 797 subjects (410 men, 387 women) over the age of 40 years from both villages were examined for the presence of cataract. The prevalence of cataract increased with age (p<0.001) and was significantly higher in women at all ages (p<0.01). There was no significant difference in the overall prevalence of cataract between the two villages.The male popUlation in each village was subdivided into those who worked predominantly indoors and those who worked predominantly outdoors. All women worked outdoors. There was no significant difference in the prevalence of cataract between the male outdoor workers in the two villages. The indoor workers in the village with higher UV light exposure (Hunza) had a significantly higher cataract prevalence (p<0.001) than the indoor workers in the village with lower UV light exposure (Nomoi). In the village with lower UV light exposure (Nomoi), the male outdoor workers had a significantly higher prevalence of cataract than the male indoor workers (p<0.001). There was no significant difference in the prevalence of cataract between the male indoor and outdoor workers in the village with Itigher UV light exposure (Hunza). Overall, these results are not strongly supportive of UV light being