A Planned Care Approach and Patient Registry to Improve Adherence to Clinical Guidelines for the Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder

Geltman, Paul L.; Fried, Lise E.; Arsenault, Lisa; Knowles, Alice M.; Link, David A.; Goldstein, Joel; Perrin, James M.; Hacker, Karen

doi:10.1016/j.acap.2014.12.002

Cited by 17 publications

(24 citation statements)

References 24 publications

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“…It should also be mentioned that, while the ADHD population in this study was based on ICD-9 diagnoses, there have been significant diagnostic improvements and greater awareness of mental conditions like ADHD in recent years. It is therefore difficult to know for certain whether such conditions are actually increasing or are the result of major diagnostic advancements and greater public awareness [ 120 ]. This is a significant quandary, especially in light of the economic difficulty of the period [ 121 ].…”

Section: Discussionmentioning

confidence: 99%

Glyphosate Use Predicts ADHD Hospital Discharges in the Healthcare Cost and Utilization Project Net (HCUPnet): A Two-Way Fixed-Effects Analysis

Fluegge

2015

PLoS ONE

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There has been considerable international study on the etiology of rising mental disorders, such as attention-deficit hyperactivity disorder (ADHD), in human populations. As glyphosate is the most commonly used herbicide in the world, we sought to test the hypothesis that glyphosate use in agriculture may be a contributing environmental factor to the rise of ADHD in human populations. State estimates for glyphosate use and nitrogen fertilizer use were obtained from the U.S. Geological Survey (USGS). We queried the Healthcare Cost and Utilization Project net (HCUPNET) for state-level hospitalization discharge data in all patients for all-listed ADHD from 2007 to 2010. We used rural-urban continuum codes from the USDA-Economic Research Service when exploring the effect of urbanization on the relationship between herbicide use and ADHD. Least squares dummy variable (LSDV) method and within method using two-way fixed effects was used to elucidate the relationship between glyphosate use and all-listed ADHD hospital discharges. We show that a one kilogram increase in glyphosate use, in particular, in one year significantly positively predicts state-level all-listed ADHD discharges, expressed as a percent of total mental disorders, the following year (coefficient = 5.54E-08, p<.01). A study on the effect of urbanization on the relationship between glyphosate and ADHD indicates that the relationship is marginally significantly positive after multiple comparison correction only in urban U.S. counties (p<.025). Furthermore, total glyphosate use is strongly positively associated with total farm use of nitrogen fertilizers from 1992 to 2006 (p<.001). We present evidence from the biomedical research literature of a plausible link among glyphosate, nitrogen dysbiosis and ADHD. Glyphosate use is a significant predictor of state hospitalizations for all-listed ADHD hospital discharges, with the effect concentrated in urban U.S. counties. This effect is seen even after controlling for individual state characteristics, strong correlations over time, and other significant associations with ADHD in the literature. We draw upon the econometric results to propose unique mechanisms, borrowing principles from soil and atmospheric sciences, for how glyphosate-based herbicides may be contributing to the rise of ADHD in all populations.

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Section: Discussionmentioning

confidence: 99%

Glyphosate Use Predicts ADHD Hospital Discharges in the Healthcare Cost and Utilization Project Net (HCUPnet): A Two-Way Fixed-Effects Analysis

Fluegge

2015

PLoS ONE

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“…The resultant longitudinal databases will allow researchers in Hong Kong to conduct long-term studies on neurodevelopmental disorders such as ADHD and Autism Spectrum Disorder. Although many countries have developed longitudinal cohorts (databases or registries) to systematically collect data on patients with ADHD, 36 Hong Kong lacks a comparable cohort and an evidence-based policy to tackle the challenges of treating patients with ADHD locally. Establishing an ADHD cohort with record-linkage from multiple datasets is essential to investigate the longterm impact of ADHD and inform policymakers on effective management and support of patients through their life trajectory.…”

Section: Open Accessmentioning

confidence: 99%

Linking cohort-based data with electronic health records: a proof-of-concept methodological study in Hong Kong

Gao

Leung

et al. 2021

BMJ Open

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ObjectivesData linkage of cohort-based data and electronic health records (EHRs) has been practised in many countries, but in Hong Kong there is still a lack of such research. To expand the use of multisource data, we aimed to identify a feasible way of linking two cohorts with EHRs in Hong Kong.MethodsParticipants in the ‘Children of 1997’ birth cohort and the Chinese Early Development Instrument (CEDI) cohort were separated into several batches. The Hong Kong Identity Card Numbers (HKIDs) of each batch were then uploaded to the Hong Kong Clinical Data Analysis and Reporting System (CDARS) to retrieve EHRs. Within the same batch, each participant has a unique combination of date of birth and sex which can then be used for exact matching, as no HKID will be returned from CDARS. Raw data collected for the two cohorts were checked for the mismatched cases. After the matching, we conducted a simple descriptive analysis of attention deficit hyperactivity disorder (ADHD) information collected in the CEDI cohort via the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale (SWAN) and EHRs.ResultsIn total, 3473 and 910 HKIDs in the birth cohort and CEDI cohort were separated into 44 and 5 batches, respectively, and then submitted to the CDARS, with 100% and 97% being valid HKIDs respectively. The match rates were confirmed to be 100% and 99.75% after checking the cohort data. From our illustration using the ADHD information in the CEDI cohort, 36 (4.47%) individuals had ADHD–Combined score over the clinical cut-off in the SWAN survey, and 68 (8.31%) individuals had ADHD records in EHRs.ConclusionsUsing date of birth and sex as identifiable variables, we were able to link the cohort data and EHRs with high match rates. This method will assist in the generation of databases for future multidisciplinary research using both cohort data and EHRs.

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“…It should also be mentioned that, while the ADHD population in this study was based on ICD-9 diagnoses, there have been significant diagnostic improvements and greater awareness of mental conditions like ADHD in recent years. It is therefore difficult to know for certain whether such conditions are actually increasing or are the result of major diagnostic advancements and greater public awareness [94]. This is a significant quandary, especially in light of the economic difficulty of the period [95].…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Glyphosate Use Predicts Healthcare Utilization for ADHD in the Healthcare Cost and Utilization Project net (HCUPnet): A Two-Way Fixed-Effects Analysis

Fluegge¹

2016

Pol. J. Environ. Stud.

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There has been considerable international study on the etiology of rising mental disorders, such as ADHD, in human populations. As glyphosate is the most commonly used herbicide in the world, we sought to test the hypothesis that glyphosate use in agriculture may be a contributing environmental factor to the increase in healthcare utilization among individuals with diagnosed ADHD.State estimates for glyphosate use and nitrogen fertilizer use were obtained from the USGS. We queried the Healthcare Cost and Utilization Project net (HCUPNET) for state-level hospitalization discharge diagnosis data on all patients for all-listed ADHD cases from 2007 to 2010. The least squares dummy variable (LSDV) method and within the method using two-way fixed effects was used to elucidate the relationship between glyphosate use and all-listed ADHD hospital discharge diagnoses.A 1-kg increase in glyphosate use in one year positively predicts state-level all-listed ADHD discharge diagnoses the following year (coefficient = 5.54E-08, p<.01). A study of the effects of urbanization on the relationship between glyphosate use and ADHD indicates that the relationship is marginally significantly positive in urban U.S. counties (p<.025). Furthermore, total glyphosate use is strongly associated with total farm use of nitrogen fertilizers from 1992 to 2006 (p<.001).Glyphosate use is a significant predictor of state healthcare utilization for ADHD, with the effect concentrated in urban U.S. counties. We draw upon the econometric results to propose unique and exploratory mechanisms, borrowing principles from soil and atmospheric sciences, for how glyphosate-based herbicides may be contributing to the rise of ADHD in all populations.

show abstract

A Planned Care Approach and Patient Registry to Improve Adherence to Clinical Guidelines for the Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder

Cited by 17 publications

References 24 publications

Glyphosate Use Predicts ADHD Hospital Discharges in the Healthcare Cost and Utilization Project Net (HCUPnet): A Two-Way Fixed-Effects Analysis

Glyphosate Use Predicts ADHD Hospital Discharges in the Healthcare Cost and Utilization Project Net (HCUPnet): A Two-Way Fixed-Effects Analysis

Linking cohort-based data with electronic health records: a proof-of-concept methodological study in Hong Kong

Glyphosate Use Predicts Healthcare Utilization for ADHD in the Healthcare Cost and Utilization Project net (HCUPnet): A Two-Way Fixed-Effects Analysis

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