Retrospective observational study on the impact of the Covid-19 pandemic on the prescription of medications for the treatment of Attention Deficit/Hyperactivity Disorder. Comparison of a European and an American cohort

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychological disorder that affects the development of children and adolescents. The causes are not fully known although the origin of the disorder appears to depend on a combination of environmental, social, biochemical, and genetic factors. There is substantial evidence the Covid-19 pandemic caused an increase in mental disorders and therefore in spending related to the treatment of diseases.

METHOD

We conducted a retrospective cohort study in two international centers of very different origins and cultures, one in Europe (Italy) and one in Central America (Costa Rica), to assess the impact of the Covid-19 pandemic on ADHD medication prescriptions and its costs. The analysis resulting from mining the databases in each individual nation allowed for the actual amounts of defined daily dose (DDD) prescribed and dispensed between the years 2019 and 2022 of methylphenidate and atomoxetine.

RESULTS

The data show that the Italian ADHD medications DDDs and expenditure are aligned with the results in Costa Rica. It was found that from the year 2019 to the year 2022, both methylphenidate and atomoxetine prescriptions grew steadily, confirming a much higher incidence of the condition than in pre-pandemic periods.

CONCLUSIONS

Our study shows that the global pandemic had an influence on the increase in the number of ADHD medication prescriptions. Individuals with ADHD are a population of individuals who may be particularly vulnerable to the distress caused by the pandemic, restrictions, and severe physical removal measures that have occurred in recent years.

[The assessment of the nutritional status in patients with a resectable digestive tumor]

PROPOSAL

Tumoural disease leads to multifactorial cancerous cachexia. There are still few data available on the onset of this syndrome in operable patients, despite the repercussions on prognosis and the indication of nutritional support.

GOAL

In this prospective study, we are considering the assessment of nutritional status in the light of the Chang protocol in with gastrointestinal tumours patients, as well as the possible differences depending on the location of the tumour, its progress, and the onset of septic complications. With this approach, we attempt to specify the indication of postoperative nutritional support.

MATERIALS AND METHOD

The nutritional assessment protocol existing in the Department was reviewed as applied to 105 patients affected by oesophageal, gastric, pancreatic and colo-rectal cancer. This protocol included the ideal weight percentage (%IW), tricipital fold (TSF), arm muscle circumference (AMC), total albumin and lymphocytes (Chang protocol), as well as urea nitrogen. The database used was created in File Maker Pro running on a Macintosh computer and supported by the StatView programme for the statistical analysis of the results.

RESULTS

There were 61 colo-rectal, 18 gastric, 17 oesophageal and 9 pancreatic carcinomas. There was some degree of malnutrition in 52.4% of patients but it was not severe in any case. An outstanding result is the percentage of ideal weight in excess of 100% on average in all of the groups, with little variation in the arm muscle circumference, as is the lower tricipital fold in the oesophageal and pancreatic cases. Albumin was significantly lower in gastric carcinoma cases and lymphocytes showed a correlation with the progress of the tumour and also with the onset of septic complications. The excretion of urea nitrogen did not reveal significant differences. In stages I and II, the patients were normally nourished or with marasmus, so that the only malnutrition found was of the kwashiorkor type and combined with stages III and IV.

CONCLUSIONS

There is 52.4% of malnutrition in our surgically resectable digestive oncology patients using the Chang protocol, not susceptible of preoperative renourishment. This is found irregularly depending on the location and stage of the tumour. The total lymphocytes prior to surgery represented an independent variable which correlated with septic complications.