Re-Exposure to Culprit Medication Following Adverse Drug Event Diagnosis in Canadian Emergency Department Patients: A Cohort Study.

PURPOSE: The magnitude of repeat exposures to culprit medications after hospital discharge is not well studied. We combined prospective cohort data with administrative health data to understand the frequency of repeat exposures to culprit medications after discharge and the risk factors for their occurrence. METHODS: This was a retrospective analysis of three prospective cohorts of patients who presented to the hospital with an adverse drug event in British Columbia, from 2008 to 2015 (n = 849). We linked prospectively identified adverse drug events to administrative data to examine patterns of redispensing of culprit medications. We used Cox regression to assess risk factors for re-exposure, and conducted subgroup analyses for essential vs. nonessential medications. RESULTS: Among 849 diagnosed adverse drug events, 45.2% had subsequent culprit medication redispensing within a year of hospital discharge. The factors associated with re-exposures included atrial fibrillation, adverse drug event type (e.g. adverse reaction), culprit medication type, and longer historical duration of medication use. CONCLUSIONS: Re-exposures to culprit medications occurred in almost half of the adverse drug events diagnosed in emergency departments. Many of these were appropriate re-exposures to essential medications for indications in which the risk of uncontrolled disease likely outweighed the risk of a repeat adverse event. More research is needed to understand re-exposures to nonessential medications or medications with safer alternatives.

Using latent variable modelling to identify etiological heterogeneity in preterm delivery.

AIMS: To identify a subgroup of mothers at high risk of preterm delivery, defined by empirical classes of multimorbidity and recurrence across three consecutive births. METHODS: The data were extracted from the perinatal data collection (PDC) of all inpatient live births (n = 435 912) occurring in the Australian state of Queensland between January 2009 and December 2015. Within this data, a total of 7714 primiparous mothers delivered three consecutive singleton live births (total births = 23 142), and comprise the sample for all analyses. RESULTS: The LCA indicated a four-class solution fit the data best at each time point, including (i) a 'normative' or healthy class with little morbidity (including >80% of the sample at each birth); (ii) a preterm, high morbidity class (<2% of the sample); (ii) a delivery morbidity class (4-8% of the sample); and (iii) preterm, low morbidity class (5-6% of the sample). Each group exhibited unique and consistent associations with maternal and pregnancy-related factors across births. After accounting for these factors, the high morbidity class and preterm, low morbidity class strongly predicted these same classes across consecutive births, and from birth 1 to birth 3 (second-order transition). CONCLUSIONS: A small but highly morbid class of neonatal deliveries emerged, exhibiting strong continuity across consecutive births (odds ratios >10), independent of a range of maternal and pregnancy-related factors. This group of women, if subject to further investigation, could provide valuable insight into the aetiology of prematurity and associated morbidity, perhaps providing information to improve birth outcomes among all women.

Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada.

Background: Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes. Methods: In partnership with First Nations researchers, we used linked administrative data to identify Manitoba children (born 2007-2018) served by First Nations and other Manitoba CPS agencies. We compared those taken into OoHC (n = 19,324) with those never in care but with an open CPS file due to child protection concerns (n = 27,290). We used instrumental variable analysis (CPS agency rates of OoHC as the instrument) to obtain odds ratios (aOR) and 95% confidence intervals adjusted for child, maternal, and family factors. Findings: Mean age (yrs ± standard deviation) at first CPS contact for children taken into OoHC was 2.8 ± 3.7 (First Nations) and 3.0 ± 3.8 (other), and for children never in care was 4.5 ± 4.5 (First Nations) and 5.1 ± 4.7 (other). Among children served by a First Nations agency, males made up 50.6% (n = 5496) in OoHC and 51.0% (n = 6579) never in care. Among children served by other agencies, males made up 51.0% (n = 4324) in OoHC and 51.0% (n = 7428) never in care. Odds of teen pregnancy (First Nations aOR 3.69, 1.40-9.77; other aOR 5.10, 1.83-14.25), teen birth (First Nations aOR 3.23, 1.10-9.49; other aOR 5.06, 1.70-15.03), and sexually transmitted infections (other aOR 7.21, 3.63-14.32) were higher for children in care than children never in care, as were odds of being accused (other aOR 2.71, 1.27-5.75), a victim (other aOR 1.68, 1.10-2.56), charged with a crime (other aOR 2.68, 1.21-5.96), or incarcerated (First Nations aOR 3.64, 1.95-6.80; other aOR 1.19, 1.19-8.04). Interpretation: Being in OoHC worsened children's health and legal system outcomes. The importance of reducing the number of children taken into care was emphasized in briefings to provincial and First Nations governments. The government response will be monitored. Funding: Social Sciences and Humanities Research Council (no. 890-2018-0029).

A proposed method for identifying Interfacility transfers in Medicare claims data.

OBJECTIVE: To develop a method of consistently identifying interfacility transfers (IFTs) in Medicare Claims using patients with ST-Elevation Myocardial Infarction (STEMI) as an example. DATA SOURCES/STUDY SETTING: 100% Medicare inpatient and outpatient Standard Analytic Files and 5% Carrier Files, 2011-2020. STUDY DESIGN: Observational, cross-sectional comparison of patient characteristics between proposed and existing methods. DATA COLLECTION/EXTRACTION METHODS: We limited to patients aged 65+ with STEMI diagnosis using both proposed and existing methods. PRINCIPAL FINDINGS: We identified 62,668 more IFTs using the proposed method (86,128 versus 23,460). A separately billable interfacility ambulance trip was found for more IFTs using the proposed than existing method (86% vs. 79%). Compared with the existing method, transferred patients under the proposed method were more likely to live in rural (p < 0.001) and lower income (p < 0.001) counties and were located farther away from emergency departments, trauma centers, and intensive care units (p < 0.001). CONCLUSIONS: Identifying transferred patients based on two consecutive inpatient claims results in an undercount of IFTs and under-represents rural and low-income patients.

Disparities in healthcare costs of people experiencing homelessness in Toronto, Canada in the post COVID-19 pandemic era: a matched cohort study.

BACKGROUND: Evidence is limited about healthcare cost disparities associated with homelessness, particularly in recent years after major policy and resource changes affecting people experiencing homelessness occurred after the onset of the COVID-19 pandemic. We estimated 1-year healthcare expenditures, overall and by type of service, among a representative sample of people experiencing homelessness in Toronto, Canada, in 2021 and 2022, and compared these to costs among matched housed and low-income housed individuals. METHODS: Data from individuals experiencing homelessness participating in the Ku-gaa-gii pimitizi-win cohort study were linked with Ontario health administrative databases. Participants (n = 640) were matched 1:5 by age, sex-assigned-at-birth and index month to presumed housed individuals (n = 3,200) and to low-income presumed housed individuals (n = 3,200). Groups were followed over 1 year to ascertain healthcare expenditures, overall and by healthcare type. Generalized linear models were used to assess unadjusted and adjusted mean cost ratios between groups. RESULTS: Average 1-year costs were $12,209 (95% CI $9,762-$14,656) among participants experiencing homelessness compared to $1,769 ($1,453-$2,085) and $1,912 ($1,510-$2,314) among housed and low-income housed individuals. Participants experiencing homelessness had nearly seven times (6.90 [95% confidence interval [CI] 5.98-7.97]) the unadjusted mean ratio (MR) of costs as compared to housed persons. After adjustment for number of comorbidities and history of healthcare for mental health and substance use disorders, participants experiencing homelessness had nearly six times (adjusted MR 5.79 [95% CI 4.13-8.12]) the expected healthcare costs of housed individuals. The two housed groups had similar costs. CONCLUSIONS: Homelessness is associated with substantial excess healthcare costs. Programs to quickly resolve and prevent cases of homelessness are likely to better meet the health and healthcare needs of this population while being a more efficient use of public resources.

Maternal Reports to the Child Protection System: A Longitudinal Analysis of Multiple Children.

Child maltreatment can affect multiple children in a family, yet its occurrence and chronicity has been often assessed by focusing on a single child. Although this approach provides valuable insights, considering the experiences of all children in a family may provide a more complete understanding of maltreatment dynamics. Using linked birth and child protection system (CPS) records from California, we analyzed 20 years of data on 194,514 first-time mothers to document the prevalence, timing, and chronicity of maternal CPS reporting across multiple children. Mothers were categorized by the number of live childbirths: one (25.7%), two (36.2%), three (20.9%), and four or more (17.2%). Overall, 33.0% of mothers were reported to CPS, increasing from 18.5% for mothers with one child to 63.1% for those with four or more children. For mothers with two or more children, more than 70% experienced an initial CPS report only after the second child's birth. Our findings have implications for understanding the dynamics of maternal reports to CPS, emphasizing the need for lasting and family-focused interventions.

Human echinococcosis incidence in Canada: A retrospective descriptive study using administrative hospital and ambulatory visit data, 2000-2020.

Background: Echinococcosis is a zoonotic disease caused by the ingestion of tapeworm eggs shed by canids. The potential recent establishment of a more virulent European-type strain may be impacting human echinococcosis in Canada, yet information is limited. Objective: Administrative hospital and ambulatory visit data were used to provide a baseline of human echinococcosis cases in Canada between 2000-2020. Methods: Canadian Institute of Health Information's Discharge Abstract Database, Hospital Morbidity Database and National Ambulatory Care Reporting System were combined to identify cases. Risk ratios (RR) by demographic factors and cumulative incidences (CIN) over place and time were calculated. Results: A total of 806 echinococcosis cases were identified in Canada between 2000-2020, for a mean annual CIN of 1.3 cases per million population. Over the two decades, the mean annual CIN of cases increased nationally (1.3-1.4 cases per million), in the Northwest Territories (6.3-9.1 cases per million), in Alberta (1.5-2.4 cases per million) and in the Atlantic provinces (0.2-0.6 cases per million). Those from the Territories had the highest risk of echinococcosis (RR 17.1; 95% confidence interval: 8.7-33.7). Conclusion: Though explanations are multifactorial, the new European-type strain may have a role in the small absolute increase in echinococcosis CIN in Canada observed over the study period. The CIN is likely underestimated and the validity of administrative data for analyzing zoonoses warrants investigation. Though this study contributes important awareness and a baseline, improved data are needed to clarify the effects of the new strain and inform public health response.

Direct Economic Burden of Cubital Tunnel Surgery in the United States: Total Payments and Components of Cost.

PURPOSE: Despite its widespread prevalence, the cost of cubital tunnel syndrome (CuTS) in the United States to patients and insurers is not well understood. The purpose of this study was to quantify the direct payments associated with operative treatment of CuTS. We hypothesized that CuTS represents a substantial cost to the payer in facility fees, surgeon fees and other expenses. METHODS: Utilizing the MarketScan database of insured patients (commercial and Medicaid), we identified a cohort of 41,777 patients aged 18-64 years with surgically treated CuTS from 2006 to 2018. We estimated the median 90-day payments from encounters associated with cubital tunnel release (CuTR) and/or ulnar nerve transposition surgery by summing all payments for claims within 90 days after the index surgery. Published estimates of the annual number of cubital tunnel surgeries were used to calculate the annual expenditure. RESULTS: Of 41,777 patients, the median (interquartile range [IQR]) values of total direct payments were $5,522 [$3,426, $9,541]. With an estimated 94,645 cases/year, this leads to an annual payment of more than $522 million. Index facility payments (median[IQR] $2,555 [$1,359, $4,708] were the highest, followed by index provider payments ($1,691 [$1,328, $2,217]). The median index surgeon payment (median[IQR] $905 [$707, $1,184]) represented just over half of the provider payments. Post-operative care had a median [IQR] payment of $377 ($424, $1,987). Limitations of claims databases prevented assessment of other indirect costs associated with cubital tunnel surgery. CONCLUSIONS: Payments for the surgical treatment of CuTS from the index surgery to 90 days post-operatively have an estimated median of $5,522 per patient, totaling $52 million annually. Index facility fees are responsible for more than 46% of payments, while index payments to surgeons represent approximately 16%. Defining this data is critical to understanding one component of the economic impact of CuTS. LEVEL OF EVIDENCE: Level IV.

Twenty-year trends of potentially avoidable hospitalizations for hypertension in Switzerland.

We assessed the trends, characteristics, and consequences of potentially avoidable hospitalizations (PAH) for hypertension in Switzerland, for the period 1998 to 2018. Data from 117,507 hospitalizations (62.1% women), minimum age 20 years. Hospitalizations with hypertension as the main cause for admission were eligible. PAH for hypertension was defined according to the Organization for Economic Cooperation and Development criteria. The age-standardized rates of PAH for hypertension increased from 43 in 1998 to 81 per 100,000 in 2004, to decrease to 57 per 100,000 inhabitants in 2018. Compared to non-PAH, patients with PAH for hypertension were younger, more frequently women (66.9% vs. 56.7%), non-Swiss nationals (15.9% vs. 10.9%), were more frequently admitted as an emergency (78.9% vs. 59.5%), and by the patient's initiative (33.1% vs. 14.1%). Patients with PAH had also fewer comorbidities, as per the Charlson's index. Patients with PAH for hypertension were more frequently hospitalized in a semi-private or private setting, stayed less frequently in the intensive care unit (4.6% vs. 7.3%), were discharged more frequently home (91.4% vs. 73.0%), and had a shorter length of stay than patients with non-PAH for hypertension: median and [interquartile range] 5 [3-8] vs. 9 [4-15] days. In 2018, the total costs of PAH were estimated at 16.5 million CHF, corresponding to a median cost of 4936 [4445-4961] Swiss Francs per stay. We conclude that in Switzerland, PAH have increased, represent a considerable fraction of hospitalizations for hypertension, and carry a non-negligible health cost.

Effect of Cost-Exemption Policy on Treatment Interruption in Patients With Newly Diagnosed Pulmonary Tuberculosis in South Korea.

BACKGROUND: In 2021, South Korea had the highest incidence rate (49 per 100 000 population) and the third highest mortality rate (3.8 per 100 000 population) due to pulmonary tuberculosis (TB) among Organization for Economic Co-operation and Development countries. Notably, premature interruption of TB treatment interferes with TB control efforts. Therefore, we examined the effect of the co-payment waiver on treatment interruption and mortality among patients with pulmonary TB in South Korea. METHODS: Patients who had newly treated TB in South Korea from 2013 to 2019 were selected from the nationwide data of the entire Korean National Health Insurance Service (NHIS) population. The effects of policy implementation on treatment adherence and mortality rates depending on treatment interruption history were evaluated. RESULTS: In total, 73 116 and 1673 patients with drug-susceptible (DS) and multidrug-resistant (MDR) pulmonary TB, respectively, were included in the final study population. After implementing the cost-exemption policy, the treatment interruption rate tended to decrease in the continuation phase in the DS-TB group (slope change: -0.097, P=.011). However, it increased in the intensive phase in the MDR-TB group (slope change: 0.733, P=.001). MDR-TB patients were likely to experience an interruption of TB treatment (adjusted odds ratio [aOR], 6.04; 95% CI, 5.43-6.71), and treatment interruption history was a significant risk factor for 1-year and overall mortality rates (adjusted hazard ratios [aHRs]: 2.01, 95% CI, 1.86-2.18 and 1.77, 95% CI, 1.70-1.84, respectively) in the DS-TB group. CONCLUSION: Implementing the cost-exemption policy effectively reduced the treatment interruption rate among patients with DS pulmonary TB.

Trends in Prevalence and Incidence of Epilepsy and Drug-Resistant Epilepsy in Children: A Nationwide Population-Based Study in Korea.

Population-based data on drug-resistant epilepsy (DRE) are lacking. This retrospective study aimed to determine the prevalence and incidence of pediatric epilepsy and DRE in South Korea using health insurance claims data from the Health Insurance Review and Assessment Service (2013-2022). Epilepsy and DRE prevalence and incidence in children <18 years old were estimated over time and by age and sex. Results showed that the age-standardized prevalence and incidence rates of epilepsy increased. The age-standardized prevalence rate of DRE increased, while the age-standardized incidence rate remained unchanged. The standardized prevalence rate of DRE was 0.26 per 1000 persons, and the average standardized incidence rate of DRE was 0.06 per 1000 persons. The prevalence rate of DRE gradually increased with age, with age 0 demonstrating the highest incidence rate. The prevalence of generalized DRE was the highest across all ages, and incidence was the highest at 0 years. Conversely, the incidence of focal DRE did not change with age. Our study revealed a stable incidence rate of DRE in Korea, despite increased prevalence. DRE incidence was the highest in the first year of life, with the generalized type being the most prevalent.

Youth mental health care use during the COVID-19 pandemic in Alberta, Canada: an interrupted time series, population-based study.

BACKGROUND: During the COVID-19 pandemic, youth had rising mental health needs and changes in service accessibility. Our study investigated changes in use of mental health care services for Canadian youth in Alberta before and during the COVID-19 pandemic. We also investigated how youth utilization patterns differed for subgroups based on social factors (i.e., age, gender, socioeconomic status, and geography) previously associated with health care access. METHODS: We used cross-sectional population-based data from Alberta, Canada to understand youth (15-24 year) mental health care use from 2018/19 to 2021/22. We performed interrupted time series design, segmented regression modeling on type of mental health care use (i.e., general physician, psychiatrist, emergency room, and hospitalization) and diagnosis-related use. We also investigated the characteristics of youth who utilized mental health care services and stratified diagnosis-related use patterns by youth subgroups. RESULTS: The proportion of youth using mental health care significantly increased from 15.6% in 2018/19 to 18.8% in 2021/22. Mental health care use showed an immediate drop in April 2020 when the COVID-19 pandemic was declared and public health protections were instituted, followed by a steady rise during the next 2 years. An increase was significant for general physician and psychiatrist visits. Most individual diagnoses included in this study showed significant increasing trends during the pandemic (i.e., anxiety, adjustment, ADHD, schizophrenia, and self-harm), with substance use showing an overall decrease. Mortality rates greatly increased for youth being seen for mental health reasons from 71 per 100,000 youth in 2018/19 to 163 per 100,000 in 2021/22. In addition, there were clear shifts over time in the characteristics of youth using mental health care services. Specifically, there was increased utilization for women/girls compared to men/boys and for youth from wealthier neighborhoods. Increases over time in the utilization of services for self-harm were limited to younger youth (15-16 year). CONCLUSIONS: The study provides evidence of shifts in mental health care use during the COVID-19 pandemic. Findings can be used to plan for ongoing mental health needs of youth, future pandemic responses, and other public health emergencies.

Estimating the Prevalence of Dementia in New Zealand Using Capture-Recapture Analysis on Routinely Collected Health Data.

OBJECTIVES: Community based dementia prevalence studies are expensive and resource intensive. Aotearoa New Zealand (NZ) has never had a community based dementia prevalence study representing all major ethnic groups. In recent years, dementia prevalence estimates have been derived from routinely collected health data but issues of underdiagnosis and undercoding limit their utility. Capture-recapture techniques can estimate the number of dementia cases missing from health datasets by modelling the ascertained overlaps between linked data sources. METHODS: Three routinely collected national health data sets-interRAI, Public hospital discharges, and Pharmaceuticals-were linked and all prevalent cases of dementia in NZ for the year 1 January 2021-31 December 2021 were identified. Capture-recapture analysis fitted eight loglinear models to the data, with the best fitting model used to estimate the number of prevalent cases missing from all three datasets. RESULTS: We estimated that almost half (47.8%) of dementia cases are not present in any of the three datasets. Dementia prevalence increased from 3.7% to 7.1% (95% CI 6.9%-7.4%) in the NZ 60+ population and from 4.9% to 9.2% (95% CI 8.9%-9.6%) in the NZ 65+ population when missing cases were included. Estimates of missing cases were significantly higher (p < 0.001) in Maori (49.2%), Pacific peoples (50.6%) and Asian (59.6%) compared to Europeans (46.4%). CONCLUSIONS: This study provides updated estimates of dementia prevalence in NZ and the proportion of undiagnosed dementia in NZ, highlighting the need for better access to dementia assessment and diagnosis.

The relationship between 'school readiness' and later persistent absenteeism.

Post-pandemic school absence is an increasing concern for governments worldwide. Absence is associated with poor academic outcomes and long-term illness (physical and mental). Absenteeism increases the risk of financial difficulties in adulthood and involvement in the criminal justice system. We hypothesized that early childhood problems might be an antecedent of absenteeism. We tested this hypothesis by investigating the pre-pandemic association between school readiness and persistent absenteeism using a population-linked dataset. Analyses included 62,598 children aged 5-13 years from the Connected Bradford database (spanning academic years 2012/13 to 2019/20). Special educational needs status, English as an Additional Language status, socioeconomic status, sex and ethnicity were covariates significantly associated with persistent absenteeism. Children who were not 'school ready' had increased odds of being persistently absent later in their education journey after controlling for these covariates. School readiness was associated with even greater odds of being persistently absent over two or more years. These findings show (i) the seeds of absenteeism are sown early in childhood; (ii) absenteeism shows the hallmark of structural inequities; and (iii) the potential of 'school readiness' measures to identify children at risk of long-term disengagement from the education system.

Characterizing timeliness of recommended vaccinations among privately-insured children in the United States, 2009-2019.

BACKGROUND: The Advisory Committee on Immunization Practices (ACIP) recommends early childhood vaccinations, but knowledge is limited about the magnitude and timing of vaccine delay for each recommended dose on a population level. We sought to characterize longitudinal patient-level patterns of early childhood vaccination schedule adherence. METHODS: Using the Merative MarketScan Commercial Database (2009-2019), we identified commercially-insured infants who received at least one timely dose of a 2-month recommended vaccine. We categorized the number of recommended vaccines administered on the same date at 2, 4, 6, and 12-15 months of age (grace period: -7, +21 days). A Sankey diagram illustrated the number of vaccines received concomitantly during each age window and depicted transitions to different states over time (e.g., no vaccine delay to vaccine delay). For each vaccine dose, we estimated the cumulative incidence of receipt. RESULTS: Among 1,239,364 eligible children, 28% of infants aged 4 months and 38% of infants aged 6 months did not receive timely, concomitant administration of all recommended vaccines. The number of timely vaccines received concomitantly and age at receipt varied most for doses recommended during the second year of life. Children with a previously delayed (versus timely) dose consistently experienced longer time to subsequent dose. CONCLUSIONS: National coverage improved over time for all recommended vaccine doses under study, most notably for measles, mumps, and rubella. However, many children do not receive vaccines on schedule. Interventions to maintain adherence to the recommended schedule are needed early in life.

Prevalence of Common Child Mental Health Disorders Using Administrative Health Data and Parent Report in a Prospective Community-Based Cohort from Alberta, Canada: Prévalence des troubles communs de santé mentale de l'enfant à l'aide des données de santé administratives et des rapports des parents dans une cohorte prospective communautaire d'Alberta, Canada.

OBJECTIVE: Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. METHODS: Data from a prospective pregnancy cohort was linked with provincial administrative health data for children in Alberta, Canada. We report the positive agreement, negative agreement, and Cohen's Kappa of parent-reported child diagnoses provided by a health professional ("parent report"), exceeding a clinical cut-off on a standardized questionnaire completed by parents (the Behavior Assessment System for Children, 3rd edition ["BASC-3"]), and cumulative inpatient, outpatient, or physician claims diagnoses ("administrative data"). RESULTS: Positive and negative agreement for administrative data and parent-reported ADHD diagnoses were 70.8% and 95.6%, respectively, and 30.5% and 94.9% for administrative data and the BASC-3, respectively. For emotional disorders, administrative data and parent-reported diagnoses had a positive agreement of 35.7% and negative agreement of 96.30%. Positive and negative agreement for emotional disorders using administrative data and the BASC-3 were 20.0% and 87.4%, respectively. Kappa coefficients were generally low, indicating poor chance-corrected agreement between these data sources. CONCLUSIONS: The data sources highlighted in this study provide disparate agreement for the prevalence of ADHD and emotional disorder diagnoses in young children. Low Kappa coefficients suggest that parent-reported diagnoses, clinically elevated symptoms using a standardized questionnaire, and diagnoses from administrative data serve different purposes and provide discrete estimates of mental health difficulties in early childhood.Plain Language Title: Prevalence of child mental health disorders according to different data sources in Canada.

Knowing the prevalence of mental health difficulties in young children is critical for informing mental health policy and decision-making. Yet, different sources yield different estimates and we do not know how these estimates compare. In the current study, we examine the agreement among three different information sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. To estimate the prevalence of mental disorders, we asked parents if their child had ever been diagnosed, we asked parents to complete a questionnaire using clinical symptom cut-offs for diagnosis, and we looked at data collected in the health care system to see if a child was ever diagnosed by a healthcare provider. We found that for ADHD, parent report that their child had received a diagnosis and their child having received a diagnosis in the healthcare system were similar. There were larger differences between a parent report of elevated symptoms on a questionnaire and whether they had been diagnosed by a healthcare provider. For emotion disorders, there were larger differences between parent report that their child had received a diagnosis and whether one was documented in the health record. Overall, there was somewhat low agreement between these three sources of data. We conclude that the different sources of data used in this study provide different estimates of ADHD and emotional disorder diagnoses in children. Therefore, when trying to understand the burden of child mental health disorders in young children, it is important to consider multiple sources to obtain a comprehensive picture of the issue.

Recognition patterns of acute kidney injury in hospitalized patients.

Background: Acute kidney injury (AKI) during hospitalization is associated with increased complications and mortality. Despite efforts to standardize AKI management, its recognition in clinical practice is limited. Methods: To assess and characterize different patterns of AKI diagnosis, we collected clinical data, serum creatinine (sCr) levels, comorbidities and outcomes from adult patients using the Hospital Discharge Form (HDF). AKI diagnosis was based on administrative data and according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria by evaluating sCr variations during hospitalization. Additionally, patients were categorized based on the timing of AKI onset. Results: Among 56 820 patients, 42 900 (75.5%) had no AKI, 1893 (3.3%) had AKI diagnosed by sCr changes and coded in the HDF (full-AKI), 2529 (4.4%) had AKI reported on the HDF but not meeting sCr-based criteria (HDF-AKI) and 9498 (16.7%) had undetected AKI diagnosed by sCr changes but not coded in the HDF (KDIGO-AKI). Overall, AKI incidence was 24.5%, with a 68% undetection rate. Patients with KDIGO-AKI were younger and had a higher proportion of females, lower comorbidity burden, milder AKI stages, more frequent admissions to surgical wards and lower mortality compared with full-AKI patients. All AKI groups had worse outcomes than those without AKI, and AKI, even if undetected, was independently associated with mortality risk. Patients with AKI at admission had different profiles and better outcomes than those developing AKI later. Conclusions: AKI recognition in hospitalized patients is highly heterogeneous, with a significant prevalence of undetection. This variability may be affected by patients' characteristics, AKI-related factors, diagnostic approaches and in-hospital patient management. AKI remains a major risk factor, emphasizing the importance of ensuring proper diagnosis for all patients.

Long-Term Care Use Among Older Migrants in the Netherlands: What to Expect in the Next Decade?

The number of older adults in the Netherlands is growing rapidly, and an increasing share of them is foreign-born. This may have implications for long-term care (LTC) demand. This study provides insights into older migrants' current and future use of LTC provisions under the Dutch long-term care act (LTCA). We distinguish three types of LTC and six groups of older migrants and analyze register data of all foreign-born older adults. Descriptive statistics for the 2016-2022 period and logistic regression analyses show considerable heterogeneity regarding the LTC-services used and the origin of care users. Most notably, Moroccan and Turkish older adults are least likely to use residential care and more likely to use personal care budgets. By combining our models' results with population projections, we project that older migrants' use of home-based care and personal budgets will increase rapidly in the next decade. Migrants with western and Surinamese origin will most often use LTC. Although the demand for residential care will rise less markedly, residential care will remain most used by older migrants under the LTCA. The rising demand for home-based care calls for policy efforts accommodating flexibility, room for differences, and grounds for establishing trustworthy relationships between all involved actors.

Variation in Excess Mortality Across Nursing Homes in the Netherlands During the COVID-19 Pandemic.

OBJECTIVES: Nursing home residents constituted a vulnerable population during the COVID-19 pandemic, and half of all cause-attributed COVID-19 deaths occurred within nursing homes. Yet, given the low life expectancy of nursing home residents, it is unclear to what extent COVID-19 mortality increased overall mortality within this population. Moreover, there might have been differences between nursing homes in their ability to protect residents against excess mortality. This article estimates the number of excess deaths among Dutch nursing home residents during the pandemic, the variation in excess deaths across nursing homes, and its relationship with nursing home characteristics. DESIGN: Retrospective, use of administrative register data. SETTING AND PARTICIPANTS: All residents (N = 194,432) of Dutch nursing homes (n = 1463) in 2016-2021. METHODS: We estimated the difference between actual and predicted mortality, pooled at the nursing home level, which provided an estimate of nursing home-specific excess mortality corrected for resident case-mix differences. We show the variation in excess mortality across nursing homes and relate this to nursing home characteristics. RESULTS: In 2020 and 2021, the mortality probability among nursing home residents was 4.0 and 1.6 per 100 residents higher than expected. There was considerable variation in excess deaths across nursing homes, even after correcting for differences in resident case mix and regional factors. This variation was substantially larger than prepandemic mortality and was in 2020 related to prepandemic spending on external personnel and satisfaction with the building, and in 2021 to prepandemic staff absenteeism. CONCLUSIONS AND IMPLICATIONS: The variation in excess mortality across nursing homes was considerable during the COVID-19 pandemic, and larger compared with prepandemic years. The association of excess mortality with the quality of the building and spending on external personnel indicates the importance of considering differences across nursing home providers when designing policies and guidelines related to pandemic preparedness.

Characteristics and outcome of hospitalized patients with heart failure stratified for chronic kidney disease.

AIMS: Heart failure (HF) and chronic kidney disease (CKD) place significant challenges on the healthcare system, and their co-existence is associated with shared adverse outcomes. The multinational CaReMe project was initiated to provide contemporary, real-world epidemiological data on cardiovascular and reno-metabolic diseases. Utilizing data from the German CaReMe cohort, we characterize a multicentric HF population and describe in-hospital outcomes stratified for co-morbid CKD. METHODS AND RESULTS: This retrospective, observational study analysed administrative data from inpatient cases hospitalized in 87 German Helios hospitals between 1 January 2016 and 31 August 2022. The first hospitalization of patients aged ≥18 years with a primary discharge diagnosis of HF, based on ICD-10 codes, were considered the index cases, and subsequent hospitalizations were considered as readmissions. Baseline characteristics and outcomes were stratified for co-morbid CKD using ICD-10-encoding from the index cases. Cox regression was utilized for readmission endpoints and in-hospital mortality. In total, 174 829 index cases (mean age 79 ± 15 years, 49.9% female) were included; of these, 55.0% had coexisting CKD. Patients with CKD were older, suffered from worse HF-related symptoms, had a higher co-morbidity burden, and in-hospital mortality was increased at index and during follow-up. Prevalent CKD was associated with higher rehospitalization rates and was an independent predictor for in-hospital death. CONCLUSIONS: Within this HF inpatient cohort from a multicentric German database, CKD was diagnosed in more than half of the patients and was associated with increased in-hospital mortality at baseline and during follow-up. Rehospitalizations were observed earlier and more frequently in patients with HF and co-morbid CKD.