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Healthcare is moving towards new patterns and models, with an increasing attention paid to prevention. Smart technologies for mobile health care are emerging as new instruments to monitor the state of essential parameters in citizens. A very debated subject in literature is the critical role played by citizens' acceptance and willingness to pay for mobile health technologies, especially whereas the services provided are preventive rather than curative. The adoption of such technologies is, indeed, a necessary condition for the success of mobile personalized health care. In this view, a conceptual framework, grounded on Technology Acceptance Model, is developed to explore the determinants of users' willingness to adopt and pay for a mobile health care application for cardiovascular prevention. Empirical data are collected from a sample of 212 non-hypertensive Italian individuals and analyzed through Structural Equation Modeling. Results confirm that usefulness and ease of use determine both intention to accept and willingness to pay for mobile health smart technologies. Results show also the significant role played by social influence as well the role as antecedents played by technology promptness, innovativeness and prevention awareness. This study offers novel insights to design and promote smart application to improve mobile health care, with implications for researchers and practitioners in health care, research & development, and marketing.

Increasing demand on hospital resources by an ageing population is impacting significantly on the number of beds available and, in turn, the length of time that elderly patients must wait for a bed before being admitted to hospital. This research presents a new methodology that models patient pathways and allows the accurate prediction of patient length of stay in hospital, using a phase-type survival tree to cluster patients based on their covariates and length of stay in hospital. A type of Markov model, called the conditional Coxian phase-type distribution is then implemented, with the probability density function for the time spent at a particular stage of care, for example, the first community discharge, conditioned on the length of stay experienced at the previous stage, namely the initial hospital admission. This component of the methodology is subsequently applied to each cohort of patients over a number of hospital and community stages in order to build up the profile of patient readmissions and associated timescales for each cohort. It is then possible to invert the methodology, so that the length of stay for an observation representing a new patient admission may be estimated at each stage of care, based on the assigned cohort at the initial hospital stage. This approach provides hospital managers with an accurate understanding of the rates with which different groups of patients move between hospital and community care, which may be used to reduce the negative effects of bed-blocking and the premature discharge of patients without a required period of convalescence. This has the benefit of assisting hospital managers with the effective allocation of vital healthcare resources. The approach presented is different to previous research in that it allows the inclusion of patient covariate information into the methodology describing patient transitions between hospital and community care stages in an aggregate Markov process. A data set containing hospital readmission data for elderly patients from the Abruzzo region of Italy is used as a case study in the application of the presented methodology.

Le disuguaglianze tra lavoratori standard e atipici sono tradizionalmente osservate nei rapporti di lavoro, nelle retribuzioni e negli orari. Nel corso degli ultimi tre decenni, tuttavia, la modificazione dei regimi contrattuali in Italia ha determinato un’ulteriore disuguaglianza nell’accesso al sistema della protezione sociale, ovvero all’insieme degli ammortizzatori sociali, e nel futuro trattamento previdenziale. Quest’ultimo aspetto risulta particolarmente problematico per la prevalenza nel lavoro atipico di basse retribuzioni, di occupazioni dal carattere intermittente e piu generale, come per chi e entrato nel mercato del lavoro dopo la prima meta degli anni Novanta, per il passaggio sul piano previdenziale da un sistema retributivo ad uno interamente contributivo e per le difficolta di accedere alla previdenza complementare. L’obiettivo dell’articolo e di analizzare l’evoluzione di queste disuguaglianze e di comprenderne se sia in atto una loro riduzione piuttosto che il loro consolidamento.

In recent years, teachers in Western countries have developed beliefs and attitudes related to working with students with specific learning disabilities (LD) that may be critical in shaping their educational practices with them; however, their beliefs and attitudes differ across political and geographical contexts and may be influenced by specific contextual circumstances and national legislation. This study examines these issues by comparing beliefs and attitudes among 557 primary school teachers from specific areas of three countries (Italy, Spain, and the United States). Results from this study support the hypothesis that, in general, teachers in these areas are sufficiently well informed about students with LD and are in favor of policies supporting these students’ needs. However, substantial differences emerge among countries about the etiology of LD; teachers’ and specialists’ roles in managing LD students; intervention planning, inclusion, and compensatory provisions; and the range of emotional attitudes that teachers exhibit. These differences have implications for intervention and suggest that efforts should be made to increase collaboration and promotion of common policies across countries.

Rosmarinic acid (RA) is a caffeic acid ester widely used by pharmaceutical and food industry. Its presence in several medicinal plant species and herb has been correlated with their biological activities and health beneficial effects. RA is widely used as additive to preserve foods, and because the chemical synthesis, even possible, remains time consuming and cost inefficient, there is a growing interest in development of biotechnological strategies to produce this compound. RA is abundant within the Lamiaceae family, particularly in plants belonging to genus Salvia. The use of plant tissues and cell cultures may represent an alternative strategy for the production of highly valuable plant metabolites and could be even adopted by pharmaceutical industries to develop new drugs and formulations. Protocols for shoots and calli regeneration, as well as cell cultures have been already established for Salvia officinalis and Salvia dolomitica with the aim to evaluate the content of RA in various tissues at different growth conditions. In particular, S. dolomitica Codd has been shown to be a good model for tissue culture studies due to its flexible propagation under in vitro conditions. The hydroxyphenylpyruvate reductase, SoHPPR, gene encoding a hydroxyphenylpyruvate reductase, a key biosynthetic enzyme of RA pathway, has been characterized in cell cultures of S. officinalis, representing a good target for metabolic engineering strategies.

A novel fuzzy-based approach which combines ELECTRE III along with the Importance-Performance Analysis (IPA) is proposed in the present work to comparatively evaluate the service quality in the public healthcare context. Specifically, ELECTRE III is firstly considered to compare the service performance of examined hospitals in a noncompensatory manner. Afterwards, IPA is employed to support the service quality management to point out improvement needs and their priorities. The proposed approach also incorporates features of the Fuzzy Set Theory so as to address the possible uncertainty, subjectivity and vagueness of involved experts in evaluating the service quality. The model is applied to five major Sicilian public hospitals, and strengths and criticalities of the delivered service are finally highlighted and discussed. Although several approaches combining multi-criteria methods have already been proposed in the literature to evaluate the service performance in the healthcare field, to the best of the authors’ knowledge the present work represents the first attempt at comparing service performance of alternatives in a noncompensatory manner in the investigated context.

Measures of nonlinearity and complexity, such as entropy measures and Lyapunov exponents, have been increasingly employed to characterize dynamical properties in a wide range of biological nonlinear systems, including cardiovascular control. In this chapter, we present recent methodological advances allowing to effectively estimate instantaneous approximate and sample entropy measures, as well as the instantaneous Lyapunov spectrum of a series of stochastic events, i.e., the heartbeats. Because the proposed measures are instantaneously defined by means of probability functions defined within a point-process framework, these indices are able to provide instantaneous tracking of the degree of complexity associated with the physiological system in question. Long-term information is taken into account by expanding the linear, quadratic, and cubic Wiener-Volterra kernels with the orthonormal Laguerre basis functions. Applications on experimental heartbeat interval datasets (i.e., healthy subjects undergoing postural changes and patients with severe cardiac heart failure) are reported.

This chapter reports some recent developments of information-theoretic concepts applied to the description of coupled dynamical systems, which allow to decompose the entropy of an assigned target system into components reflecting the information stored in the system and the information transferred to it from the other systems, as well as the nature (synergistic or redundant) of the information transferred to the target. The decomposition leads to well-defined measures of information dynamics which in the chapter will be defined theoretically, computed in simulations of linear Gaussian systems and implemented in practice through the application to heart period, arterial pressure and respiratory time series. The application leads to decompose the information carried by heart rate variability into amounts reflecting cardiac dynamics, vascular and respiratory effects on these dynamics, as well as the interaction between cardiovascular and cardiorespiratory effects. The analysis of head-up and head-down tilt test protocols demonstrates the relevance of information decomposition in dissecting cardiovascular control mechanisms and accept or reject physiological hypotheses about their activity.

Questo contributo si occupa della sovrapposizione tra spazi produttivi e ripro-duttivi che si verifica nel caso dei/delle cittadini/e rumene che vivono e lavorano in uno dei distretti agricoli piu ricchi e rinomati d’Italia, la cosiddetta Fascia Costiera Trasformata (in provincia di Ragusa). Negli ultimi anni, ai braccianti rumeni viene richiesto sempre piu spesso di risiedere in prossimita o all’interno delle aziende agricole, dando vita ad una situazione che potremmo definire di regime del lavoro dormitorio. Questa sistemazione spaziale della manodopera consente agli impren-ditori di ridurre i costi del lavoro, costringendo tuttavia i migranti a vivere in con-dizioni di isolamento e seclusione. Attingendo ai dati raccolti attraverso una ricerca etnografica (osservazione partecipante, shadowing e interviste semi-strutturate) realizzata nei luoghi di vita e di lavoro delle/i braccianti straniere/i, l’articolo si concentrera sul caso della manodopera rumena residente nelle aziende, analizzando in particolare: (1) le implicazioni conseguenti all’assunzione di coppie di lavoratori (e non di single) per quanto riguarda i processi produttivi e riproduttivi; (2) i processi di appropriazione e risignificazione degli spazi di vita e di lavoro da parte dei braccianti stranieri.

Truffles are fungi producing hypogeous fruiting bodies belonging to at least 13 phylogenetically distant orders. The most studied are "true truffles" belonging to the genus Tuber, which is the most economically important group. Truffle fruiting bodies are colonized by bacteria, yeasts, guest filamentous fungi and viruses that, all together, constitute the truffle microbiota. Research on the role of this community has demonstrated that bacteria contribute to truffle aroma. From the ecological point of view, truffle aroma attracts mycophagous animals, which in turn disperse and diffuse truffle spores in the soil, and mediates interactions with microorganisms and plant roots. Truffles have a heterothallic organization, whereby for truffle reproduction it is necessary that strains of opposite mating type meet. Regarding truffle development, the truffle ascocarps use carbon coming from the host plant and not from dead host tissues or soil organic matter as believed so far. In addition to form ectomycorrhizae with a wide diversity of host plants, some truffle species are able to form also arbutoid and orchid mycorrhizas. Knowledge of truffle diversity, traditionally relied on the survey and molecular identification of fruiting bodies, moved over the years towards the survey of mycorrhizas and, recently, on the distribution in soil of the mycelium, with the determination of genets and mating types. The possibility of studying (micro) organisms directly in the field (metagenomics or environmental genomics) and the introduction of high-throughput sequencing techniques (454 pyrosequencing) have given a strong impulse to the study of the microbial communities interacting with truffles and their habitat.

Nonlinear digital signal processing methods addressing system complexity have provided useful computational tools for helping in the diagnosis and treatment monitoring of a wide range of pathologies. In particular, heartbeat complexity measures have been successful in characterizing patients with mental disorders such as Major Depression and Bipolar Disorder. In this chapter, we describe the use of standard complexity measures such as sample entropy and multiscale entropy, as well as instantaneous measures of entropy to characterize pathological mood states when patients undergo affective elicitation or long-term monitoring. Results demonstrate that complexity measures of cardiovascular dynamics can be promising and viable tools to support clinical decision in mental health, improving on the diagnosis and management of psychiatric disorders.

Study of fetal and neonatal heart rate variability offers a powerful tool to monitor, even indirectly, the physiological control mechanisms playing a crucial role in the early development of human life. Moreover, sleep state analysis is a challenging topic as both quality of the sleep and its relationship with neural development and control can provide information potentially useful to the clinical environment. This contribution aims at presenting major advances in heart rate variability analysis in both fetuses and newborn population during sleep. The important role of quantitative multi-parameter analysis methods will be discussed with reference to new monitoring and diagnostic solutions. Results will be presented and discussed showing how sleep dynamics are related to cardiovascular control systems with the major focus of deeper investigating the development of human life in its early stages.

Recent advances in the comprehension of pathogenic mechanisms of human diseases have brought the researchers to the discovery of putative pharmacological targets and the subsequent development of the so-called targeted drugs. In order to maximize their efficacy, as well as that of the other drugs, it is imperative to identify those patients that are more prone to experience a therapeutic benefit. In the pharmacogenetic area, several strategies may be pursued to assay biomarkers. The quantitation of gene expression, the identification of changes in gene and chromosomal sequences, and the evaluation of epigenetic factors may contribute to anticipate drug efficacy and tolerability. At those levels, the number of candidate genes that may be investigated is highly variable, up to the evaluation of the whole human genome. Despite the increasing complexity of pharmacogenetic analyses and their interpretation, some relationships between genetic biomarkers and treatment outcomes may be characterized by suboptimal values of sensitivity and specificity. For that reason, the validation of the biomarkers and their transfer into the clinics are the major challenges.

This chapter aims at providing a brief overview of the main aspects in cardiovascular physiology that have encouraged and justified the use of advanced nonlinear signal processing methodologies for the study of the cardiovascular system. This system, in fact, constantly adapts to changes in internal and external conditions to maintain blood pressure homeostasis through complex and dynamic feedback mechanisms that simultaneously affect several processes such as heart rate, cardiac output, blood pressure, respiration, peripheral resistance etc. Therefore, there is a need for nonlinear, non-stationary, and multivariate approaches to assess cardiovascular interactions and their causal structure in health and disease.

Tra le eredita della crisi economica internazionale del 2008 possiamo annoverare il ravvivarsi in Italia del dibattito sulla pluralizzazione del welfare e la riconfigurazione dei rapporti tra pubblico e privato quali soluzioni per trovare risposta all’espansione dei bisogni sociali sempre piu eterogenei e individualizzati, fra i quali spiccano quelli della long term care (Ltc). In questo scenario le organizzazioni mutualistiche hanno acquisito crescente rilievo, contribuendo a fare emergere il loro apporto ai processi innovazione dei sistemi di welfare. L’articolo si interroga sulle ragioni e il senso dell’attenzione che il mutualismo sta catalizzando e getta una luce sul contributo specifico delle societa di mutuo soccorso (Sms o mutue), utilizzando il settore della Ltc come banco di prova per riflettere su alcune delle problematiche che si situano oggi alla base del welfare: la socializzazione dei rischi, l’aggregazione e la mediazione della domanda sociale, l’integrazione dell’offerta pubblico-privata, il reperimento e l’allocazione delle risorse.

The technological advances in the robotic and ICT fields represent an effective solution to address specific societal problems to support ageing and independent life. One of the key factors for these technologies is the integration of service robotics for optimising social services and improving quality of life of the elderly population. This chapter aims to underline the barriers of the state of the art, furthermore the authors present their concrete experiences to overcome these barriers gained at the RoboTown Living Lab of Scuola Superiore Sant'Anna within past and current projects. They analyse and discuss the results in order to give recommendations based on their experiences. Furthermore, this work highlights the trend of development from stand-alone solutions to cloud computing architecture, describing the future research directions.

As a recent product of nanotechnology, nanoscale transducers have been invoked as revolutionary tools of interaction between the macroscopic and the microscopic worlds, which can most probably offer their best intriguing opportunities in sensing and acting on the living matter at the level of its basilar subunits. This chapter briefly revises the main concepts related to the function and applications of transducers, going from macro-to-microscale, in order to promote the full comprehension of the spill over deriving from the future exploitation of boron nitride nanotubes (BNNTs) as bionanotransducers. BNNTs are piezoelectric nanomaterials. As such, they are entitled to reversibly transform mechanical into electrical energy in the micro domain. This chapter is mainly focused on the application of these nanotubes as bionanoactuators; in particular, the findings of a novel method that exploits ultrasounds as a mechanical energy for BNNT triggering at intracellular level is reviewed and discussed. BNNT nanotransducers are capable of stimulating electrically sensitive cells, such as neural, muscular, and bony cells, thus paving the way to the development of novel therapies for functional impairments and degenerative diseases.

This paper aims to improve the performance of clinical processes using clinical pathways (CPs). The specific goal of this research is to develop a decision support tool, based on a simulation-optimization approach, which identify the proper adjustment and alignment of resources to achieve better performance for both the patients and the health-care facility. When multiple perspectives are present in a decision problem, critical issues arise and often require the balancing of goals. In our approach, meeting patients’ clinical needs in a timely manner, and to avoid worsening of clinical conditions, we assess the level of appropriate resources. The simulation-optimization model seeks and evaluates alternative resource configurations aimed at balancing the two main objectives—meeting patient needs and optimal utilization of beds and operating rooms. Using primary data collected at a Department of Surgery of a public hospital located in Genoa, Italy. The simulation-optimization modelling approach in this study has been applied to evaluate the thyroid surgical treatment together with the other surgery-based CPs. The low rate of bed utilization and the long elective waiting lists of the specialty under study indicates that the wards were oversized while the operating room capacity was the bottleneck of the system. The model enables hospital managers determine which objective has to be given priority, as well as the corresponding opportunity costs.

Controlled ovarian stimulation is a mainstay of assisted reproductive technologies and leads to optimal follicular growth and steroidogenesis in the majority of cases. Nonetheless, some women defined as “hyporesponders” require higher amount of exogenous gonadotrophin to achieve an adequate number of oocytes retrieved despite an apparently good prognosis. Clinical observational trials suggest that hyporesponse to exogenous gonadotrophins, including initial poor response, could be a genetically determined trait with specific genotype profile associated with this condition. Specifically, mutation and polymorphisms involving luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and their receptors LH-R and FSH-R have been thoroughly investigated. Among all the mutations discovered, it seems that that carriers of common LH variant and FSH receptor Ser/680 variants require higher doses of exogenous FSH to achieve a normal ovarian response.

Although exogenous FSH is the main regulator of follicular growth in stimulated cycles, LH plays a key role in promoting steroidogenesis and follicle development. Stimulation protocols with LH supplementation are mandatory in patients with hypogonadotropic hypogonadism who do not achieve adequate steroidogenesis by stimulation with FSH alone, but resume adequate estrogen production by LH supplementation. In normogonadotropic women undergoing controlled ovarian stimulation (COS), the hypogonadotropic state after GnRH analogues is short in duration, and the resting levels of LH are usually sufficient for promoting optimal follicular development. An increased body of evidence otherwise indicates that at least three subgroups of normogonadotropic patients indeed seem to benefit from the addition of LH activity to the stimulation protocol: (1) patients >35 years, (2) patients with a decreased ovarian reserve/poor response to COS (poor responders), and (3) patients with an initial poor response to rec-hFSH (hyporesponders). Possible reasons for a beneficial effect of LH activity supplementation include the biological aging of the ovary and pharmacogenetics involving the LH molecule and its receptor. The three gonadotropins containing LH activity are human menopausal gonadotropin (hMG), with 1:1 ratio of FSH/LH in which LH activity is driven by hCG; recombinant human LH (rec-LH), with only LH activity driven by pure LH; and a combination of recombinant FSH and recombinant LH, with 2:1 ratio of pure FSH/LH activity. In addition to the higher purity and specific activity of rec-hLH compared with hMG, LH activity is markedly different at the molecular and functional levels between these gonadotropins. The choice of the type of gonadotropin preparations containing LH activity should be considered when tailoring COS with LH supplementation because they may influence cycle outcome.

Pre-term birth (PTB) is a major health challenge to-day. Perinatal mortality is increased more than three times and PTB is the leading cause of short and long-term neonatal/infant morbidity. Many are the risk factors, previous PTB, cervical effacement or dilatation on clinical vaginal examination or shortening of the length of the cervical canal on ultrasound are major predisposing factors.

Aims: To review the impact of female genital malformations as well as their different types on pregnancy outcome. Methods: Pertinent studies were identified through a computer Medline, Embase and Cochrane Library search. Uterine defects were grouped into five classes, according to the new ESHRE/ESGE Classification of Female Genital Malformations. Only data on untreated congenital uterine anomalies, apart for metroplasty in bicornuate uterus, were taken into account in accordance to the objective of the issue. Clinical implications: Those uterine malformations that cannot be surgically treated (Hemi-uterus and Bicorporeal uterus with double cervix – AFS Unicornuate and Didelphys uteri) are associated with poor reproductive performances, increased abortion rates and lower live birth rates, eventhough a successful pregnancy is possible. On the opposite, septate uterus, hypoplastic uterus (AFS “T-shaped” ) and partial unification defects (AFS bicornuate uterus) are associated to the worst reproductive outcomes when untreated and to the higher reproductive performances after surgery. Open issue: The hypoplastic uterus (T-shaped/Uterus Infantilis) is an old/new congenital pathology to be taken into account, both for its increasing incidence and damage of reproductive outcome and for the promising results of hysteroscopic surgery in those patients.

The Authors present a new methodological approach in stochastic regime to determine the actual costs of an healthcare process. The paper specifically shows the application of the methodology for the determination of the cost of an Assisted reproductive technology (ART) treatment in Italy. The reason of this research comes from the fact that deterministic regime is inadequate to implement an accurate estimate of the cost of this particular treatment. In fact the durations of the different activities involved are unfixed and described by means of frequency distributions. Hence the need to determine in addition to the mean value of the cost, the interval within which it is intended to vary with a known confidence level. Consequently the cost obtained for each type of cycle investigated (in vitro fertilization and embryo transfer with or without intracytoplasmic sperm injection), shows tolerance intervals around the mean value sufficiently restricted as to make the data obtained statistically robust and therefore usable also as reference for any benchmark with other Countries. It should be noted that under a methodological point of view the approach was rigorous. In fact it was used both the technique of Activity Based Costing for determining the cost of individual activities of the process both the Monte Carlo simulation, with control of experimental error, for the construction of the tolerance intervals on the final result.

Background and Purpose The purpose of this study was to evaluate the efficacy of a preventive ergonomic intervention, which was provided by physical therapists, on spinal and upper-extremity work-related posture and symptom complaints of workers who use video display terminals (VDT). Subjects Two hundred employees who spent at least 20 hours per week at a VDT were randomly divided into 2 groups. Group E received the ergonomic intervention and an informative brochure, and group I received only the brochure. Methods Both groups were evaluated at the beginning of the study and at a follow-up 5 months later. The following tools were used: a pain drawing and the Rapid Entire Body Assessment (REBA) method to assess spinal and upper-extremity work-related posture. Results Group E had a lower REBA score and reduced lower back, neck, and shoulder symptoms compared with group I. Discussion and Conclusion The results suggest that a personalized preventive ergonomic intervention can improve spinal and upper-extremity work-related posture and musculoskeletal symptoms for workers who use VDTs.

The application of deep brain stimulation (DBS) for the treatment of Parkinson's disease offered a direct ldquoinsightrdquo into the human electrical activity in subcortical structures. The analysis of the oscillatory activity [local field potentials (LFPs)] disclosed the importance of rhythms and of interactions between rhythms in the human basal ganglia information processing. The aim of this study was to investigate the existence of possible nonlinear interactions between LFP rhythms characterizing the output structure of the basal ganglia, the globus pallidus internus, by means of bispectral analysis. The results of this study disclosed that the rhythms expressed in the globus pallidus internus of the untreated parkinsonian patient are not independent and, in particular, the low-beta (13-20 Hz) band generates harmonics that are included in the high-beta (20-35 Hz) band. Conversely, in the dystonic globus pallidus, as well as in the parkinsonian globus pallidus after dopaminergic medication (i.e., in the more ldquonormalrdquo condition), the rhythms are substantially independent and characterized by a strong activity in the low-frequency band that generates a second harmonic (4-14 Hz), mostly included in the same band. The interactions between rhythms in the human globus pallidus are therefore different in different pathologies and in different patient's states. The interpretation of these interactions is likely critical for fully understanding the role of LFP rhythms in the pathophysiology of human basal ganglia.

The factor structure, internal consistency, and convergent validity of the Autism Diagnostic Interview-Revised (ADI-R) algorithm items were examined in a sample of 226 youngsters with pervasive developmental disabilities. Exploratory factor analyses indicated a three-factor solution closely resembling the original algorithm and explaining 38% of the variance, with one significant discrepancy: Unlike the algorithm, all nonverbal communication items were associated with the Social factor. Internal consistencies of domain scores ranged from .54 to .84. Correlations between ADI-R domain and total scores and instruments assessing adaptive behavior, psychopathology, and autism were examined. They indicated some similarities between constructs, but also that the ADI-R measures autism in a unique fashion.

244 U of stimulants in the treatment of children in the United States increased steadily between 1989 and 1996 (1,2), but little is known about how this trend is related to combination pharmacotherapy in which stimulants are used with other psychotropic agents. Stimulants may be prescribed alone or with other medications for the treatment of attention-deficit hyperactivity disorder (ADHD). There are indications that combined psychopharmacotherapy with stimulants is on the rise (3). It has been estimated from data from the National Ambulatory Medical Care Survey (NAMCS), an annual survey of a representative sample of U.S. office-based physician practices (4), that a stimulant is prescribed during 83 percent of physician office visits for the treatment of ADHD; in 10 percent of these visits, additional psychotropic medications are prescribed (2). Because these data were pooled across eight years, however, trends in such combined pharmacotherapy cannot be determined. To explore whether combined pharTrends in Combined Pharmacotherapy With Stimulants for Children