Prevalence of bone fractures among children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a significant neurodevelopment disorder among children and adolescents, with 5 % prevalence. Bone fractures account for 25 % of accidents and injuries among all children and adolescents. Considering the characteristics of inattention, hyperactivity, and impulsivity in children with ADHD, it is critical to examine bone fractures among these children. The objective of our meta-analysis was to determine the prevalence of bone fractures among children and adolescents with ADHD. METHODS: We completed a systematic review and meta-analysis using an electronic search of the following databases: CINAHL, EMBASE, PsycINFO, PubMed, and Scopus. The search terms used were: "attention deficit hyperactivity disorder OR attention deficit disorder" and "bone fracture*." We included studies examining patients 18 years or younger who were diagnosed with ADHD and tracked (prospectively or retrospectively) for five or more years. Effect size (es), using a random effects model, was calculated. We registered the review protocol with PROSPERO (CRD42019119527). RESULTS: From 445 records retrieved, 31 full text articles were reviewed and 5 articles met inclusion criteria for meta-analysis. The summary es revealed the prevalence of bone fractures among children and adolescents with ADHD to be 4.83 % (95 % CI: 3.07-6.58 %). The location of bone fractures, using a subset of data, showed a distribution of 69.62 %, 22.85 %, and 7.53 % in the upper limbs, lower limbs, and other anatomical regions, respectively. Another subset of studies revealed a 2.55-fold increase in the prevalence of fractures among the children with ADHD compared to their counterparts. CONCLUSIONS: Awareness of these findings is critical to physicians, parents, and policy makers to create safe environments and provide supports in order to optimize the health and safety of children and adolescents with ADHD.

Patients' and therapists' perspective of integrating home and family work roles into rehabilitation following distal radius fracture.

PURPOSE: To explore distal radius fracture (DRF) patients' and hand therapist/occupational therapist/physiotherapists' perceptions of integrating home and family work roles (HFWR) into rehabilitation. METHODS: Eighteen patients and eleven therapists completed a semi-structured telephone interview three months after DRF. Reflexive thematic analysis of the interviews and triangulation of patients' and therapists' themes was performed. RESULTS: The patient interview yielded five themes: the experience of rehabilitation; predetermined expectations of rehabilitation; incorporating HFWR into therapy sessions; varying patient needs for addressing HFWR; and determination to return to valued activities drives behavioral choices. The therapists' interview yielded five themes: The challenges in integrating HFWR into rehabilitation; HFWR addressed when brought up by a patient; working context and referral sources influence the rehabilitation plan; rehabilitation is not explicitly tailored according to sex and gender; and utilizing HFWR as a rehabilitation strategy is perceived beneficial. CONCLUSIONS: Patients have predetermined rehabilitation expectations primarily focused on mobility and strengthening exercises. Therapists and patients agree that adapting home and family work roles is beneficial but was not a major focus for either therapists' or patients' expectations during therapy. An unfavourable environment, patient budget constraints, and limited time were identified as challenges to integrating family roles.

Therapists should proactively discuss and address home and family work roles with patients with distal radius fractures when appropriate.Therapists should tailor rehabilitation plans according to the individual needs and expectations of the patients.Hospitals and clinics should create an environment conducive to addressing home and family work roles, and resources should be allocated for comprehensive rehabilitation programmes.

What Are Work-Related Predictors of Post-COVID-19 Home and Family Work Roles? A Cross-Sectional Survey.

OBJECTIVE: To determine the extent to which pre-and post-COVID-19 work-related factors can explain post-COVID-19 home and family work roles. METHODS: This study was a cross-sectional survey. The primary outcome measure was the Home and Family Work Roles Questionnaire. Descriptive statistical methods and multiple regression analyses were run. The significant predictors were further probed in a one-way analysis of covariance (ANCOVA) model with a Tukey posthoc correction. RESULTS: In our sample of 1447 participants, the two significant predictors of post-COVID-19 home and family work roles were pre-pandemic paid job status (F [3, 1401] = 5.66, P < 0.001), and pre-COVID-19 home and family work roles (F [1, 1401] = 2509.26, P < 0.001). CONCLUSION: Greater pre-pandemic home and family role responsibilities, full-time and part-time employment pre-COVID-19 were associated with greater post-COVID-19 home and family responsibilities.

Understanding the unpaid work roles amongst households, during COVID-19.

Background: Worldwide, the COVID-19 pandemic has had a rapid disruption on work, social activities and family life. Pre-pandemic norms suggested that women spend more time in unpaid work roles and with childcare, while men spend more time in paid work roles. This study aims to understand: 1) the distribution of unpaid work roles within households, and 2) if there are certain factors that explain the unpaid work roles within a household during the pandemic. Methods: This study used a cross-sectional survey of people across the globe, during the pandemic. The survey, administered through a virtual platform of Qualtrics, consisted of the following sections: (a) consent, (b) location and job description (c) marital status and household numbers (d) age, sex, and gender (e) unpaid work roles and family responsibilities. Descriptive statistics and percentages were reported for all the data regarding the study variables. A multivariable regression model was used to understand which factors may explain the changes in unpaid work roles recalling before and during the pandemic. Results: This survey was completed by 1847 participants. The mean age was 30 years old (standard deviation of 13.3). The majority of participants identified themselves as women (76.0%) and single (62.1%). The multivariable linear regression indicated that marital status (single, common-law, married, divorced), higher number of household members (1-8,12), older age, higher number of dependent children, and gender (female) were positive and significant predictors of baseline changes in unpaid work role scores, explaining 50% of the variance (R2 = 0.50). Discussion: All households experienced a significant increase in the amount of unpaid work roles during the pandemic. However, older women who were in a relationship and experienced additional household members such as dependent children or sick older adults, were faced with more changes in unpaid work roles during COVID-19, than other individuals.

An intersectional approach to identifying factors associated with anxiety and depression following the COVID-19 pandemic.

The COVID-19 pandemic is impacting mental health, with some populations bearing a greater burden. In this cross-sectional online study, we examined the personal and intersectional factors associated with increased symptoms of anxiety and depression following the COVID-19 pandemic. We assessed pre- and post-pandemic levels of anxiety and depressive symptoms using the Generalized Anxiety Disorder-2 (GAD-2) and Patient Health Questionnaire-9 (PHQ-9) scales, respectively. The study included 1847 participants, with an age range of 18 to 79 years and representing 43 countries. Variables with significance (p < 0.05) in predicting post-pandemic GAD-2 and PHQ-9 scores were pre-pandemic scores on the same scales, an interaction between increasing age and non-man gender, and an interaction between non-man gender and having children. Health practitioners, psychiatrists, and policy makers need to be aware and respond to the mental health burden of the pandemic on women and other gendered individuals, especially those who care for children.

What are the mental health changes associated with the COVID-19 pandemic in people with medical conditions? An international survey.

OBJECTIVES: The COVID-19 pandemic has negatively impacted mental health worldwide but there is paucity of knowledge regarding the level of change in mental health in people with a medical condition (physical/psychiatric). The objectives of this study were (1) to compare the change in mental health in people with and without medical conditions, (2) to assess the change in various types of medical conditions, (3) to evaluate the association between change in mental health and number of comorbidities, and (4) to investigate the influence of receiving treatment and activity limitation imposed by the medical condition(s). DESIGN: Cross-sectional. SETTING: Online international survey. PARTICIPANT: English-speaking adults (age ≥18) were included in the study, with no exclusions based on sex/gender or location. 1276 participants (mean age 30.4, 77.7% female) were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Pre and during COVID-19 pandemic symptoms of anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-9) were assessed. The Self-Administered Comorbidity Questionnaire was used to collect data regarding medical conditions.Repeated-measures analysis of covariance (objectives 1, 2 and 4) and Pearson's correlation coefficient (objective 3). RESULTS: 50.1% of participants had a medical condition. During the COVID-19 pandemic, compared with people with no medical condition, people with both psychiatric and physical conditions experienced significantly higher symptoms of anxiety (12%, p=0.009) and depression (9.4%, p<0.001). Although not statistically significant, the increase in anxiety and depression occurred across seven major categories of conditions. An association was found between having a higher number of medical conditions with higher anxiety and depression symptoms (r=0.16 anxiety, r=0.14 depression, p<0.001). Receiving treatment and being functionally limited by the disease did not have a significant impact on the amount of change (p>0.05). CONCLUSIONS: During the COVID-19 pandemic, people who had a combination of psychiatric and physical conditions experienced greater symptoms of anxiety and depression. Patients with chronic diseases may need extra support to address their mental health as a result of the pandemic.

The role of sex and gender in the changing levels of anxiety and depression during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Several studies have assessed the impact of the COVID-19 pandemic on anxiety and depression, but have not focused on the role of sex and gender. This study compared changes in the levels of anxiety and depression (pre- and post-COVID) experienced by individuals of various sexes and genders. METHODS: We used a cross-sectional online survey that assessed pre- and post-COVID symptoms of anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-9). General linear modeling (fixed model factorial analysis of variance) was used to evaluate changes in anxiety and depression between pre- and post-pandemic periods and explore differential effects of sex and gender on those changes. RESULTS: Our study included 1847 participants from 43 countries and demonstrated a percentage increase of 57.1% and 74.2% in anxiety and depression, respectively. For the Generalized Anxiety Disorder-2 scale (maximum score 6), there was a mean increase in anxiety by sex for male, female, and other of 1.0, 1.2, and 1.4, respectively; and by gender for man, woman, and others of 0.9, 1.3, and 1.6, respectively. For the Patient Health Questionnaire-9 (maximum score 27), there was a mean increase in depressive symptoms by sex for male, female, and other of 3.6, 4.7, and 5.5 respectively; and by gender for man, woman, and others of 3.3, 4.8, and 6.5, respectively. CONCLUSION: During COVID-19, there was an increase in anxiety and depressive symptoms for all sexes and genders, with the greatest increases reported by those identifying as non-male and non-men.