Pediatric stimulant and selective serotonin reuptake inhibitor prescription trends: 1992 to 1998.

BACKGROUND: Presciption trends have key implications for costs, outcomes, and research, yet few data exist on pediatric selective serotonin reuptake inhibitor (SSRI) trends and associations with stimulant trends. OBJECTIVE: To describe prescription trends for stimulants, SSRIs, and combination prescriptions by age, sex, and race. METHODS: Retrospective population-based analysis of North Carolina Medicaid prescription claims files. PARTICIPANTS: North Carolina Medicaid recipients, 1992 through 1998, aged 1 to 19 years. The population ranged from 342 333 children in 1992 to 581 088 in 1998. MAIN OUTCOME MEASURES: Annual number of prescriptions, patients filling a prescription claim, and prescription prevalence for stimulants and SSRIs. RESULTS: The number of children and adolescents who received stimulants increased from 6407 (24 584 claims) in 1992 to 27 951 (135 057 claims) in 1998. The number of SSRI recipients increased from 510 children (1326 claims) in 1992 to 6984 children (25 392 claims) in 1998. Prescription prevalence in school-aged children 6 to 14 years increased from 4.4% to 9.5% for stimulants during the study period, and from 0.2% to 1.5% for SSRIs. In 1998, stimulant prescription prevalence was highest for white school-aged males (18.3%) vs black females (3.4%) and SSRI prescription prevalence was highest for white school-aged males (2.8%) vs black females (0.6%). Combination pharmacotherapy also increased during 1992 through 1998. CONCLUSIONS: Prevalence of stimulant and SSRI medications has increased during the 1990s, with prescription prevalence in North Carolina Medicaid youth higher than previously reported. Age, sex, and racial differences are apparent and call for further attention. Combination pharmacotherapy also has growing importance.

Pediatrician and family physician prescription of selective serotonin reuptake inhibitors.

OBJECTIVES: Selective serotonin reuptake inhibitor (SSRI) prescriptions for children and adolescents have increased greatly in recent years despite a paucity of demonstrated safety and efficacy data and a lack of clear guidelines for use. Our study sought to describe family physician and pediatrician SSRI prescribing patterns for children and adolescents, identify influences on SSRI prescription variations, and describe the use of SSRI within the overall management of depression and other mental disorders in primary care. DESIGN: A survey was mailed to all 596 active North Carolina general pediatricians and a random sample of 557 family physicians in primary care practice. Family physicians who did not see children in their practice were excluded. The survey instrument consisted of a 4-page questionnaire. Survey items included physician demographics, practice characteristics, general management, volume of pediatric patients with depressive symptoms, prescription of SSRIs for depression and other diagnoses, and potential influences on SSRI prescribing practices. The main outcomes were self-reported physician prescription of SSRIs for children and adolescents. Results were analyzed using chi(2) comparisons and logistic regression. RESULTS: The overall response rate was 66% (55% family physicians and 76% pediatricians). Of the physicians, 72% had prescribed an SSRI for a child or adolescent. Depression was the most common reason for prescribing an SSRI; over two thirds of respondents had prescribed an SSRI for depression in a child 18 years of age or younger. Over half of the physicians reported they had prescribed an SSRI for a diagnosis other than depression in a child 18 years of age or younger. Attention-deficit/hyperactivity disorder was the most frequent use cited other than depression, followed by obsessive-compulsive disorder, aggression, eating disorders, and enuresis. Primary care physicians prescribed SSRIs for adolescents more commonly than for younger children. Only 6% of the respondents had ever prescribed an SSRI for a child younger than 6 years of age. In terms of SSRI prescriptions written for depression in the last 6 months, 32% of the physicians had recently prescribed SSRIs for adolescent patients and 6% for patients younger than 12 years of age. Family physicians were more likely than pediatricians to have recently prescribed SSRIs for adolescent patients (41% vs 26%), but there was no difference in recent SSRI prescriptions for children <12 years of age by physician specialty (4% vs 6%). Prescription of SSRIs was not associated with decreased use of counseling for treatment of depression, but prescription of SSRIs was associated with decreased use of referrals (63% vs 74%). There was no difference in the use of counseling between family physicians and pediatricians (61% vs 59%). However, pediatricians were more likely to use referrals in their usual approach to depression (77% vs 48%) compared with family physicians. More family physicians had prescribed SSRIs for pediatric patients compared with pediatricians (91% vs 58%), and more family physicians had prescribed SSRIs in combination with other psychotropic medications (54% vs 31%). For the majority of respondents, SSRI prescriptions constituted most of the medications used to treat childhood depression (75% of family physicians vs 61% of pediatricians). Family physicians were more likely to report a belief in the safety (63% vs 48%) and effectiveness (40% vs 32%) of SSRIs. Only 8% of physicians reported adequate training in the treatment of childhood depression and just 16% were comfortable with the treatment of depression. There were no specialty differences in training for the treatment of childhood depression; however, more family physicians than pediatricians agreed that they were comfortable with the management of childhood depression (22% vs 11%). (ABSTRACT TRUNCATED)

Primary care role in the management of childhood depression: a comparison of pediatricians and family physicians.

OBJECTIVE: To provide a self-described assessment of pediatricians' and family physicians' management of childhood depression. DESIGN: Mail survey of 595 general pediatricians and 557 family physicians in North Carolina. RESULTS: The response rate was 66%. Most primary care physicians used referral (65%) and counseling (61%) for management of childhood depression. Family physicians used medications more commonly (18% vs 9%), and pediatricians referred patients more commonly (77% vs 48%). In logistic regression analysis, physicians comfortable with management of depression (odds ratio [OR], 4.8: 2.7-8.4), physicians who believed that antidepressants are more effective than counseling (OR, 2.6: 1.4-4.8), and family physicians (OR, 2.2: 1.9-4.1) were more likely to have used medications for childhood depression. CONCLUSIONS: Most primary care physicians refer pediatric patients with depression; however, practice patterns vary by specialty and other factors. Future studies must consider the role of primary care and evaluate how interspecialty variations affect costs and outcomes of childhood depression.

Production of consistent crush lesions of murine skeletal muscle in vivo using an electromechanical device.

The crush model of injury in skeletal muscle is widely used in the investigation of tissue degeneration and regeneration. Previously, such trauma has been induced by using forceps to crush the muscle, commonly applying sufficient pressure to bring the mid-arms of the forceps together. This report introduces a reliable electromechanical device designed to generate reproducible focal lesions in skeletal muscle of mice. The tibialis anterior was crushed in 17 young adult mice. Two days after injury, the muscles were examined microscopically. By morphometric analysis, it was determined that the volumes of the lesions produced were similar (mean 0.499 mm3 +/- 0.098, range 0.278 - 0.601 mm3), and that the full extent of the damaged muscle was easily distinguished and readily quantifiable. This will allow a more precise comparison in future investigations into regenerative differences between age groups, satellite cell activation and the inflammatory response.

Repair of the rotator cuff. A comparison of results in two populations of patients.

One hundred and seven shoulders of 103 consecutive patients were evaluated after primary repair of the rotator cuff. Twenty-four patients were receiving Workers' Compensation, and the other seventy-nine were not. Preoperative and postoperative evaluation of both groups included subjective assessment of pain, function, and patient satisfaction as well as objective assessment of the strength and active range of motion of the shoulder. The shoulder-rating scale of the University of California at Los Angeles was used to determine over-all success rates. The duration of follow-up ranged from twenty-four to sixty-eight months (mean, forty-five months). The two groups were comparable with regard to the age and sex of the patients, the size of the tear of the rotator cuff, and the preoperative strength, pain, and active range of motion of the shoulder. Over-all, a successful result was achieved in eighty-nine of the 107 shoulders. Of the twenty-four shoulders of patients who were receiving Workers' Compensation, thirteen (54 per cent) were rated good or excellent, compared with seventy-six (92 per cent) of the eighty-three shoulders of patients who were not receiving Workers' Compensation. Ten (42 per cent) of the twenty-four patients who were receiving Workers' Compensation returned to full activity, compared with seventy-four (94 per cent) of the seventy-nine patients who were not.