Teresa To

Bio: Teresa To is an academic researcher from University of Toronto. The author has contributed to research in topics: Population & Cohort study. The author has an hindex of 4, co-authored 4 publications receiving 80 citations. Previous affiliations of Teresa To include Ontario Ministry of Health and Long-Term Care & Hospital for Sick Children.

Aftercare, emergency department visits, and readmission in adolescents.

Abstract: Objective U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. Method We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately. Results We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-score–based matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.05–1.42), and readmission (HR = 1.38, 95% CI=1.14–1.66), but not ED visits (HR = 1.14, 95% CI=0.95–1.37). Conclusions Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use.

Predictors of psychiatric aftercare among formerly hospitalized adolescents.

Abstract: Objective: Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization. Method: We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge. Results: Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P Language: en

Correlates of methylphenidate use in canadian children : A cross-sectional study

Abstract: Objectives: This study aimed to estimate the prevalence of methylphenidate (MPH) use among Canadian children aged 2 to 11 years, from 1994–1995 to 1998–1999 and to identify sociodemographic, child, and parent–family correlates are identified. Methods: Cross-sectional data collections from the National Longitudinal Survey of Children and Youth (NLSCY) for 1994–1995, 1996–1997, and 1998–1999 were used and samples weighted up to population levels (n = 17 814 in 1994–1995, 13 575 in 1996–1997, and 18 980 in 1998–1999). Logistic regression identified correlates of parent-reported MPH use in each time period. Results: MPH use by Canadian children increased from 1.33% (95% confidence interval [CI], 1.17% to 1.50%) in 1994–1995 to 1.60% (95%CI, 1.42% to 1.78%) in 1998–1999. Use among school children aged 6 to 11 years increased from 1.94% (95%CI, 1.68% to 2.20%) in 1994–1995 to 2.42% (95%CI, 2.14% to 2.71%) in 1998–1999. Use of MPH increased among girls, from 0.52% (95%CI, 0.32% to 0.67%) in 1994–1995 to 0.97% (95%CI, 0.77% to 1.17%) in 1998–1999. For a child with parent-reported hyperactivity, the odds ratios for using MPH were 6.30 (95%CI, 4.94 to 8.90) in 1994–1995 and 12.54 (95%CI, 9.74 to 16.16) in 1998–1999. Age 6 to 11 years, male sex, and absence of parental alcohol use were significant correlates of MPH use in all time periods. Parental smoking correlated with MPH use in 1994–1995 and in 1998–1999. Conclusions: Less than 2% of Canadian children used MPH between 1994 and 1999. Some increase in use occurred among school-aged children and girls. Parent-reported hyperactivity was the most important correlate of MPH use.

Evaluating the Hyperactivity/Inattention Subscale of the National Longitudinal Survey of Children and Youth.

Abstract: Background High scores on the National Longitudinal Survey of Children and Youth Hyperactivity/Inattention Subscale (NLSCY H/I Scale) have been used to indicate severe inattention and overactivity representing Attention Deficit/Hyperactivity Disorder (ADHD) symptoms. However, a threshold on the scale has not been identified for use as an epidemiological marker for clinically significant disorder. Data and methods The NLSCY H/I Scale is evaluated in a subsample of the cycle 1 NLSCY population (n=10,498), weighted to represent 2.36 million children aged 6 to 11 in 1994/1995. Logistic regression measured the association of scores on the scale against three potential criteria, adjusting for age, sex and socioeconomic status: 1) current methylphenidate use, 2) diagnosed emotional disorder, and 3) functional impairment. Sensitivity analyses identified threshold scores where false positives and false negatives were most nearly equivalent. The preferred criterion provides the greatest area under the Receiver Operating Characteristic (ROC) curve and the highest specificity at the identified threshold. Results Current methylphenidate use and diagnosed emotional disorder yielded essentially identical models, with thresholds of 14 or more and nearly overlapping ROC curves. High scores on the NLSCY H/I Scale are associated with current methylphenidate use and diagnosed emotional disorder. Interpretation The parent-reported NLSCY H/I Scale can be used in population studies as a highly specific indicator of clinically significant ADHD symptoms.

The global market for ADHD medications.

Abstract: Little is known about the global use and cost of medications for attention deficit hyperactivity disorder (ADHD). Global use of ADHD medications rose threefold from 1993 through 2003, whereas global spending (2.4 billion US dollars in 2003) rose ninefold, adjusting for inflation. Per capita gross domestic product (GDP) robustly predicted use across countries, but the United States, Canada, and Australia showed significantly higher-than-predicted use. Use and spending grew in both developed and developing countries, but spending growth was concentrated in developed countries, which adopted more costly, long-acting formulations. Promoting optimal prescription and monitoring should be a priority.

Prevalence of Prescribed Attention-Deficit Hyperactivity Disorder Medications and Diagnosis among Canadian Preschoolers and School-Age Children: 1994–2007:

Abstract: Objective:To describe trends in the prevalence of prescribed attention-deficit hyperactivity disorder (ADHD) medication by Canadian preschoolers and school-age children and to compare these with tr...

Mental Health Service Use Among Children and Youth in Ontario: Population-Based Trends Over Time.

Abstract: Objective:Little is known about mental health service use among Canadian children and youth. Our objective was to examine temporal trends in mental health service use across different sectors of th...

Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment

Abstract: Objectives (1) Compare effectiveness and adverse events of interventions (pharmacological, psychosocial, or behavioral, and the combination of pharmacological and psychosocial or behavioral interventions) for preschoolers at high risk for attention deficit hyperactivity disorder (ADHD); (2) compare long-term effectiveness and adverse events of interventions for ADHD among persons of all ages; and (3) describe how identification and treatment for ADHD vary by geography, time period, provider type, and sociodemographic characteristics, compared with endemic prevalence. Data Sources MEDLINE®, Cochrane CENTRAL, EMBASE, PsycInfo, and ERIC (Education Resources Information Center) were searched from 1980 to May 31, 2010. Reference lists of included studies and gray literature were searched manually. Review Methods Reviewers applied preset criteria to screen all citations. Decisions required agreement between two independent reviewers, with disagreements regarding inclusion or exclusion resolved by a third. The Effective Public Health Practice Project (EPHPP) process was used to evaluate internal validity of publications regarding interventions for preschoolers at high risk of ADHD and long-term outcomes following interventions for ADHD in persons of all ages. Overall strength of the evidence (SOE) was assessed using the GRADE approach, accounting for risk of bias and study design, consistency of results, directness of evidence, and degree of certainty regarding outcomes of interest. Results Of included studies, only a subset could be pooled statistically using meta-analytic techniques. For the first objective, we rated as “good” quality eight studies of parent behavior training (PBT) with 424 participants. These demonstrated high SOE for improving child behavior (standardized mean difference [SMD] = −0.68; 95-percent confidence interval [CI], −0.88 to −0.47). A single “good” quality study of methylphenidate (MPH) with 114 preschool children provided low SOE for improving child behavior (SMD = −0.83; 95-percent CI, −1.21 to −0.44). Adverse effects were present for preschool children treated with MPH; adverse effects were not mentioned for PBT. For the second objective, the majority of studies were open extension trials without continuation of untreated comparison groups. Evidence from the single “good” quality study of MPH demonstrated low SOE for reduction of symptoms, with SMD = −0.54 (95-percent CI, −0.79 to −0.29). Evidence from the single “good” quality study of atomoxetine demonstrated low SOE for reduction of symptoms, with SMD = −0.40 (95-percent CI, −0.61 to −0.18). Evidence from the single “good” quality study of combined psychostimulant medication with behavioral/psychosocial interventions provided low SOE, with SMD = −0.70 (95-percent CI, −0.95 to −0.46). Safety reports for pharmacological interventions derived from observational studies on uncontrolled extensions of clinical trials, as well as from administrative databases, provided inconclusive evidence for growth, cerebrovascular, and cardiac adverse effects. Evidence that psychostimulant use in childhood improves long-term outcomes was inconclusive. For the third objective, a discussion of contextual issues and factors relating to underlying prevalence and rates of diagnosis and treatment was included. Population-based data were relatively scarce and lacked uniform methods and settings, which interfered with interpretation. The available evidence suggested that underlying prevalence of ADHD varies less than rates of diagnosis and treatment. Patterns of diagnosis and treatment appeared to be associated with such factors as locale, time period, and patient or provider characteristics. Conclusions The SOE for PBT as the first-line intervention for improved behavior among preschoolers at risk for ADHD was high, while the SOE for methylphenidate for improved behavior among preschoolers was low. Evidence regarding long-term outcomes following interventions for ADHD was sparse among persons of all ages, and therefore inconclusive, with one exception. Primary school–age children, mostly boys with ADHD combined type, showed improvements in symptomatic behavior maintained for 12 to 14 months using pharmacological agents, specifically methylphenidate medication management or atomoxetine. Other subgroups, interventions, and long-term outcomes were under-researched. Evidence regarding large-scale patterns of diagnosis and treatment compared with endemic rates of disorder was inconclusive.

Rural Latinos’ Mental Wellbeing: A Mixed-Methods Pilot Study of Family, Environment and Social Isolation Factors

Abstract: Upon immigration to the rural areas in the US, Latino families may experience cultural, geographic, linguistic and social isolation, which can detrimentally affect their wellbeing by acting as chronic stressors. Using a community engagement approach, this is a pilot mixed-method study with an embedded design using concurrent qualitative and quantitative data. The purpose of this study is to evaluate family and social environments in terms of protective factors and modifiable risks associated with mental well-being in Latino immigrants living in rural areas of Florida. Latino immigrant mother and adolescent dyads were interviewed by using in-depth ethnographic semistructured interviews and subsequent quantitative assessments, including a demographic questionnaire and three structured instruments: the Family Environment Scale Real Form, the SF-12v2™ Health Survey and the short version (eight items) of PROMIS Health Organization Social Isolation. This mixed-method pilot study highlighted how family, rural, and social environments can protect or impair wellbeing in rural Latino immigrant mother and adolescent dyads.