This project investigated the diagnosis and psychostimulant treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD) in Manitoba children. These rates were considered according to sex, age, socioeconomic status (SES), geographical region, and comorbidity with learning disabilities (LD) and behavioral disturbances (BD). Data came from the Manitoba Population Health Research Data Repository, a comprehensive collection of administrative, registry, survey and other databases. The research population included all children aged 0 to 19 years in Manitoba (n = 319,506) with a diagnosis of ADHD (n= 9,233), during two Fiscal years (2003/2004 and 2004/2005). The term “gradient” refers to the relationship between SES and health and emphasizes the idea that the change in outcomes is gradual and occurs across the full range of SES. Results from this study indicate that region of residence (urban versus rural) and comorbid BD moderate the SES gradient, as low income, urban dwelling children with a comorbid diagnosis of BD had the highest rates of ADHD diagnoses and prescriptions. Furthermore, whereas age did not moderate the SES gradient, the crude rates indicated that the SES gradient for ADHD diagnoses and prescriptions was most pronounced in urban children 0 to 13 years of age. Otherwise, all main effects tested (sex, age, socioeconomic status, geographical region, and comorbid BD and LD) were significant in both the diagnosis and prescription models for ADHD. Policy considerations that arise out of this study include more stringent diagnostic and prescription treatment practices, additional support resources for children who are most at risk of having ADHD, and increased information about alternate treatment implementation for ADHD. / February 2008

Conduct problems are among the most prevalent psychiatric conditions identified in outpatient mental health centers (Frick 1998b; Kazdin, 1995; Loeber, Burke, Lahey, Waters, & Zera, 2000). Despite a long history of examining risk factors associated with conduct problems, many studies have focused exclusively on adolescent onset conduct problems and few studies have sought to examine relationships among risk factors across several domains. Furthermore, few studies have been conducted to examine protective factors thought to mitigate the risk for children who are thought to be at a high risk of manifesting conduct problems. By gaining an understanding of risk and protective factors associated with early onset conduct problems, clinicians can develop and appropriately target interventions to those children at a high risk of developing conduct problems as well as those who are already displaying symptoms associated with early onset conduct problems. The purpose of the present study was to identify factors associated with an increased risk of early onset conduct problems across several domains and to develop a statistical model describing the relationships among these latter domains and risk factors. Furthermore, the present research used these identified risk factors in order to study factors that may offer protective benefits to children who are at a high risk of developing conduct problems at a younger age. The data used in the present study were from the National Survey of Children's Health database which contained data collected in 2007. These data were analyzed using a confirmatory factor analysis approach and multi-group structural equation modeling techniques. The results showed that living in a poorer quality neighborhood, coming from a lower socioeconomic status, and having a mother who reported overall fair or poorer mental health were all risk factors associated with reported early onset conduct problems. Protective factors identified included having a higher quality parent-child relationship and not having a history of involvement in special education. The implications of these findings are discussed as are future directions for research.

This project investigated the diagnosis and psychostimulant treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD) in Manitoba children. These rates were considered according to sex, age, socioeconomic status (SES), geographical region, and comorbidity with learning disabilities (LD) and behavioral disturbances (BD). Data came from the Manitoba Population Health Research Data Repository, a comprehensive collection of administrative, registry, survey and other databases. The research population included all children aged 0 to 19 years in Manitoba (n = 319,506) with a diagnosis of ADHD (n= 9,233), during two Fiscal years (2003/2004 and 2004/2005). The term “gradient” refers to the relationship between SES and health and emphasizes the idea that the change in outcomes is gradual and occurs across the full range of SES. Results from this study indicate that region of residence (urban versus rural) and comorbid BD moderate the SES gradient, as low income, urban dwelling children with a comorbid diagnosis of BD had the highest rates of ADHD diagnoses and prescriptions. Furthermore, whereas age did not moderate the SES gradient, the crude rates indicated that the SES gradient for ADHD diagnoses and prescriptions was most pronounced in urban children 0 to 13 years of age. Otherwise, all main effects tested (sex, age, socioeconomic status, geographical region, and comorbid BD and LD) were significant in both the diagnosis and prescription models for ADHD. Policy considerations that arise out of this study include more stringent diagnostic and prescription treatment practices, additional support resources for children who are most at risk of having ADHD, and increased information about alternate treatment implementation for ADHD.

This project investigated the diagnosis and psychostimulant treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD) in Manitoba children. These rates were considered according to sex, age, socioeconomic status (SES), geographical region, and comorbidity with learning disabilities (LD) and behavioral disturbances (BD). Data came from the Manitoba Population Health Research Data Repository, a comprehensive collection of administrative, registry, survey and other databases. The research population included all children aged 0 to 19 years in Manitoba (n = 319,506) with a diagnosis of ADHD (n= 9,233), during two Fiscal years (2003/2004 and 2004/2005). The term “gradient” refers to the relationship between SES and health and emphasizes the idea that the change in outcomes is gradual and occurs across the full range of SES. Results from this study indicate that region of residence (urban versus rural) and comorbid BD moderate the SES gradient, as low income, urban dwelling children with a comorbid diagnosis of BD had the highest rates of ADHD diagnoses and prescriptions. Furthermore, whereas age did not moderate the SES gradient, the crude rates indicated that the SES gradient for ADHD diagnoses and prescriptions was most pronounced in urban children 0 to 13 years of age. Otherwise, all main effects tested (sex, age, socioeconomic status, geographical region, and comorbid BD and LD) were significant in both the diagnosis and prescription models for ADHD. Policy considerations that arise out of this study include more stringent diagnostic and prescription treatment practices, additional support resources for children who are most at risk of having ADHD, and increased information about alternate treatment implementation for ADHD.

Purpose of review: This article critically reviews the utility of “phenotypes” as behavioral descriptors in aging/HIV research that inform biological underpinnings and treatment development. We adopt a phenotypic redefinition of aging conceptualized within a broader context of HIV infection and of aging. Phenotypes are defined as dimensions of behavior, closely related to fundamental mechanisms, and, thus, may be more informative than chronological age. Primary emphasis in this review is given to comorbid aging and cognitive aging, though other phenotypes (i.e., disability, frailty, accelerated aging, successful aging) are also discussed in relation to comorbid aging and cognitive aging. Recent findings: The main findings that emerged from this review are as follows: (1) the phenotypes, comorbid aging and cognitive aging, are distinct from each other, yet overlapping; (2) associative relationships are the rule in HIV for comorbid and cognitive aging phenotypes; and (3) HIV behavioral interventions for both comorbid aging and cognitive aging have been limited. Summary: Three paths for research progress are identified for phenotype-defined aging/HIV research (i.e., clinical and behavioral specification, biological mechanisms, intervention targets), and some important research questions are suggested within each of these research paths.

The purpose of the study was to investigate the prevalence and effects of vision impairment co-existing with other comorbid conditions. Utilizing the 2008 National Health Interview Survey, the most recent nationally representative data including expanded vision, health conditions, and activity questions, this study examined the effect of vision impairment co-existing with selected comorbid conditions among non-institutionalized older adults age ≥ 55 years. Specifically, this study compared 4 groups: (a) older adults with neither vison impairment nor comorbid conditions, (b) older adults with vision impairment only, (c) older adults with comorbid conditions only, and (d) older adults with both vision impairment and each of the comorbid conditions to examine the prevalence and effect of vision impairment and comorbid conditions on selected mobility and vision activity limitations, and participation restrictions. Using complex sample techniques to conduct frequency analyses and logistic regression procedures, this study compared these groups of older adults to document the likelihood of experiencing mobility and vision activity limitations, and participatory restrictions. These results suggest that older adults reporting vision impairments are a heterogeneous population, overwhelmingly use corrective lenses, and experience substantial mobility and vision activity limitations, and participatory restrictions; however, relatively few report using low vision aids or rehabilitation services. In addition, these results revealed, even when controlling for age, sex, race/ethnicity, marital status, region of residence, and health status, older adults with vision impairment and any of the selected comorbid conditions were statistically significantly more likely to report mobility and vision activity limitations, and participation restrictions. Moreover, when comparing older adults reporting vision impairment co-existing with comorbid conditions older adults reporting either vision impairment only or a comorbid condition only, the results suggest vision impairment had the largest statistically significant effect on the likelihood of mobility or vision activity limitations, or participatory restriction in 29 of the 44 logistic regression analyses. These findings are significant as vision impairment is framed as a public health concern, and can inform improvements in programs and services for older adults. Finally, these findings highlight the need for expanded research examining the effect of specific eye diseases and comorbid conditions among older adults.

Non-Surgical Root Canal Treatment (NSRCT) is performed to save the teeth with infected root canal system. A number of factors affect the long term survival of NSRCT. There is limited evidence correlating the survival rate of NSRCT in older adults with existing comorbid conditions and comparing them with the survival rate of NSRCT in younger adults. The primary objective of this study was to analyze the survival of non-surgical root canal therapy in older adults with comorbid conditions. Data was collected from patients' charts retrospectively to analyze the factors affecting the survival rate of NSRCT in permanent teeth in patients aged 18 and above and analyzed to compare the comorbid conditions in older adults and young adults. Factors including gender, prevailing coronary heart disease, diabetes, cancer, cancer therapy, and tobacco habits that may influence the long-term survival of endodontically treated teeth were analyzed statistically using a follow up data for five years. Survival analysis was the statistical method of choice to analyze the results given the focus of the clinical question on failure of endodontic treatment. Kaplan-Meier survival estimates were calculated for 5-year survival of endodontically treated teeth (with 95% confidence intervals). Teeth that had been retreatment, periapical surgery or extraction were considered as having had a complication, i.e., a failure. Analysis using the Kaplan-Meier method requires that actual date of failure (as indicated in description of project) as well as the date of initial endodontic treatment were available in the data set. The dates of re-treatment were considered as the date of failure for the purpose of statistical analysis. The statistical analysis showed that there was no significant association between age and root canal survival but there was a possible association between NSRCT failure and the presence of diabetes and tobacco habits.

There is a paucity of research that has examined co-occurring oppositional defiant disorder and generalized anxiety disorder (ODD+GAD) symptoms and oppositional defiant disorder and separation anxiety disorder (ODD+SAD) symptoms among children. To address this gap, I investigated multiple explanations for the co-occurrence of ODD+GAD and ODD+SAD. Specifically, I investigated whether (a) GAD symptoms prospectively predicted ODD symptoms and SAD symptoms prospectively predicted ODD symptoms (Explanation 1), (b) ODD symptoms prospectively predicted GAD symptoms and ODD symptoms prospectively predicted SAD symptoms (Explanation 2), and (c) shared risk processes accounted for the co-occurrence of ODD+GAD and ODD+SAD (Explanation 3). Participants were an ethnic minority, inner-city sample of first through fourth grade children (N = 88, 51% male) and their primary caregivers. I used data collected at the baseline and 1-year follow-up assessments of the Child Health and Behavior Study, a longitudinal survey of families residing in North Philadelphia. Findings provided support for Explanation 2 and Explanation 3 in the development of co-occurring ODD+GAD symptoms and support for Explanation 3 in the development of co-occurring ODD+SAD symptoms. This study contributes to the extant literature by providing the first empirical examination of these multiple explanations in an ethnic minority, inner city sample of children. / Psychology

The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantly correlated with lifetime ADHD diagnosis. Given the high lifetime prevalence of ADHD in Manitoba young adults, significant socioeconomic correlates for diagnosis, and multitude of adverse health and social outcomes in this population, further investigation into the trajectory of this relatively unexplored population is recommended. Furthermore, continued measurement of the provision and success of additional resources will ultimately be necessary for enhancing the health status of all Canadian adults living with ADHD.

The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantly correlated with lifetime ADHD diagnosis. Given the high lifetime prevalence of ADHD in Manitoba young adults, significant socioeconomic correlates for diagnosis, and multitude of adverse health and social outcomes in this population, further investigation into the trajectory of this relatively unexplored population is recommended. Furthermore, continued measurement of the provision and success of additional resources will ultimately be necessary for enhancing the health status of all Canadian adults living with ADHD.