Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD.Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining “ADHD” and “prison” keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses.Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7–29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9–47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics.Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.

AimsThe comparative efficacy of Roux‐en‐Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem diabetes remission prediction score uses HbA1c, age and diabetes medications but not diabetes duration. The aim of this study was to compare the DiaRem with the DiaBetter score that includes diabetes duration, upon combined (complete plus partial) 2‐year post‐surgery diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and diabetes remission.MethodsA retrospective single‐centre cohort study of obese people with diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a validation cohort study (173) were undertaken. Diabetes remission, % weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between % weight loss and diabetes remission was investigated using logistic regression.ResultsThe proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95%CI: 0.817–0.916); DiaRem: 0.865 (95%CI: 0.814–0.915), P=0.856]. Two‐year % weight loss was higher post RYGB [26.6 (95%CI: 24.8–28.4)] vs post‐sleeve gastrectomy [20.6 (95%CI: 18.3–22.8), P<0.001]. RYGB had 151% higher odds of diabetes remission [OR 2.51 (95%CI: 1.12–5.60), P=0.025]. This association became non‐significant when adjusted for % weight loss.ConclusionDiaBetter and DiaRem scores predict diabetes remission following both procedures. Two‐year % weight loss plays a key role in determining diabetes remission.

BackgroundMetabolic syndrome (MS) is a condition associated with obesity that identifies individuals with increased cardiovascular risk. Gastric bypass improves several MS components, such as glucose, lipid metabolism and hypertension. The aim of this study was to evaluate the effect of long-limb gastric bypass on the remission of MS criteria associated with morbid obesity.MethodsObese patients who met the “harmonized” criteria for MS (n = 153) that underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) with a long biliopancreatic limb were prospectively evaluated with regards to body weight, body mass index (BMI), percentage of excess BMI lost (% EBMIL), fasting glucose, blood pressure and lipid profile up to 36 months after surgery.ResultsBefore surgery, patients had a BMI of 44.3 ± 0.5 kg/m2; 66% were under anti-diabetic treatment; 78.4% were under anti-hypertensive treatment and 44.3% were under anti-dyslipidemic treatment. After a mean follow-up time of 2.4 ± 0.1 years, MS remission rates were 32.7% at 6 months, 69.7% at 12 months, 63.4% at 24 months, and 59.2% at 36 months; when only 32.9%, 43.4% and 15.8% of patients were still under anti-diabetic, anti-hypertensive and anti-dyslipidemic treatment, respectively. The %EBMIL and BMI were the parameters that showed the highest accuracy to predict the MS remission at all-time points after the surgery.ConclusionsLong limb gastric bypass in obese patients results in significant and sustained weight loss which predicts a high remission rate of MS and allows the discontinuation of drug therapy for several metabolic disturbances in most patients.

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