Rising Trends of Childhood Attention-Deficit/Hyperactivity Disorder in a Large Integrated Healthcare Delivery System in Southern California, 2010-2021.

OBJECTIVE: To evaluate trends of attention-deficit/hyperactivity disorder (ADHD) diagnosis rates among children aged 5-17 years over the past decade (2010-2021) and to investigate whether there have been differences in temporal changes based on race and ethnicity, sex, or income. STUDY DESIGN: Childhood ADHD diagnosis was ascertained from electronic health records using International Classification of Diseases ninth revision (314.xx) and International Classification of Diseases tenth revision (F90.x) codes. Data were stratified by child's sex, race and ethnicity, and household income, and rates of ADHD were estimated before and after adjustment for potential confounders. RESULTS: The overall ADHD diagnosis rates increased from 3.5% in 2010 to 4.0% in 2021. ADHD diagnosis was most prevalent among White children (6.1%), then Black (4.6%), Other/multiple (3.7%), Hispanic (3.1%), and Asian/Pacific Islander (PI) (1.7%). ADHD was also highly prevalent among boys (73.3%) or family income≥$70,000 (50.0%). ADHD diagnosis increased among Black (4.2% to 5.1%), Hispanic (2.8% to 3.6%), and Asian/PI children (1.5% to 2.0%) but remained stable for White (6.2% to 6.1%) and Other/multiple race/ethnic children (3.7% to 3.7%). Increases in the prevalence among girls were also observed. CONCLUSION: The prevalence of ADHD in children has risen with the largest increases observed for Black, Hispanic, and Asian/PI children. Rates among less affluent families and girls have also been increasing, narrowing the gaps in diagnosis rates previously observed. These increases may reflect improvements in screening and provision of care among demographics where ADHD has been historically underdiagnosed.

Economically Optimal Rate for Nutrient Application to Maize in the Semi-deciduous Forest Zone of Ghana.

Low inherent nitrogen (N), phosphorus (P), and potassium (K) contents of smallholder farms limit maize grain yield. Maize grain yield response to N, P, and K mineral fertilizer application and economically optimal rates for nitrogen (EORN), phosphorus (EORP), and potassium (EORK) were evaluated on a Ferric Acrisol within the semi-deciduous forest zone of Ghana. The nutrient rates evaluated were N (0, 30, 60, 90, and 120 kg N ha-1), P (0, 30, 60, and 90 kg ha-1 P2O5), and K (0, 30, 60 and 90 kg ha-1 K2O). The treatments were arranged in a randomized complete block with three replications using an incomplete factorial design. Nutrient responses were determined using asymptotic quadratic-plus plateau functions. The best nitrogen rate for all P and K levels was 60 kg ha-1, which gave grain yield of 5 t ha-1 . Nitrogen uptake, N agronomic and N recovery efficiencies peaked at 60 kg N ha-1 while N partial factor productivity declined with increasing N application rate. Cost to grain price ratios (CP) were 1.29, 1.65, and 1.65 for N, P, and K, respectively. The EORN was 61 kg ha-1, 32% less than the recommended 90 kg N ha-1 for maize production in the semi-deciduous forest zone of Ghana. Nitrogen application had the lowest CP ratio, making its application economically profitable than P and K. The findings suggest that the application of N at 61 kg N ha-1 to maize is economically profitable than at higher application rates. However, further studies should be conducted on farmers' fields to validate the results obtained.