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Antonucci R, Vacca N, Biasia B, Locci C, Dore MP, Pes GM, Bitti A. Impact of COVID-19 Pandemic and Associated Restrictions on Vitamin D Status in a Large Cohort of Italian Children and Adolescents. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:65. [PMID: 38256326 PMCID: PMC10819361 DOI: 10.3390/medicina60010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Vitamin D is synthesized in the skin upon sunlight exposure, showing variations with season and latitude. We aimed to investigate the influence of age, sex, and season on vitamin D status in a large pediatric cohort during the COVID-19 pandemic period and the corresponding pre-pandemic period. Materials and Methods: Retrospective data concerning subjects aged < 18 years were extracted anonymously from the large database of a reference laboratory hospital (Sassari, Northern Sardinia, Italy). Serum 25-hydroxyvitamin D [25(OH)D] levels measured during the pre-pandemic period (1 March 2018 to 30 September 2019) were compared with those detected during the pandemic period (1 March 2020 to 30 September 2021). Results: A total of 2317 samples from subjects aged < 18 years were included in the analysis, 1303 (47.9% females) of which were collected in the pre-pandemic period and 1014 (51.3% females) in the pandemic period. No significant differences in 25(OH)D levels were found between the two periods, whereas, in children aged < 2 years, levels were higher than those in children aged 11-16 years (p < 0.05). Monthly levels of 25(OH)D between pre-pandemic and pandemic periods did not differ, although significant differences were detected across months (p < 0.0001). Similarly, 25(OH)D values did not differ significantly between males and females in both periods. Marked seasonal variations were observed in males and females across all age groups. Conclusions: Serum vitamin D levels and their season-related variations were not significantly affected by the COVID-19 pandemic and associated restrictions in a large cohort of Italian children and adolescents.
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Affiliation(s)
- Roberto Antonucci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Nadia Vacca
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Beatrice Biasia
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Cristian Locci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maria Pina Dore
- Internal Medicine Section, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (G.M.P.)
| | - Giovanni Mario Pes
- Internal Medicine Section, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (G.M.P.)
| | - Angela Bitti
- Laboratory of Azienda Ospedaliero-Universitaria, 07100 Sassari, Italy
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VIČIČ V, PANDEL MIKUŠ R. Vitamin D Supplementation During COVID-19 Lockdown and After 20 Months: Follow-Up Study on Slovenian Women Aged Between 44 and 66. Zdr Varst 2023; 62:182-189. [PMID: 37799414 PMCID: PMC10549253 DOI: 10.2478/sjph-2023-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction The main objective was to assess the impact of the COVID-19 pandemic on vitamin D supplementation habits and their changes in the follow-up, 20 months after the study in Slovenian premenopausal and postmenopausal women. Methods A cross-sectional study was conducted between March and May 2021. 176 healthy women aged 44 to 65 from the Central Slovenian region were included in the final analysis. Vitamin D status was determined by measuring 25(OH)D concentration. After 20 months an online follow-up questionnaire was sent out, to which 123 participants responded with complete data. Results Between March and May 2021, 61% of the participants were supplementing vitamin D. 55% of the supplementers and 88% of the non-supplementers had insufficient levels (total 25(OH)D <75 nmol/L). After 20 months in the follow-up, it was found that 62% of participants were taking vitamin D supplements, but only 70% of those who had initially reported taking supplements were still doing so. In the follow-up 61% of participants stated that they started or increased vitamin D intake due to COVID-19. Conclusions Vitamin D supplementation increased 7-fold compared to pre-pandemic levels and remained at a high level after 20 months. However, a significant number of participants discontinued supplementation, and only one-fifth were taking vitamin D throughout the entire year. Supplementation is effective for vitamin D deficiency prevention only at the individual level, however due to low compliance it should not be the only strategy for preventing vitamin D deficiency in the population.
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Affiliation(s)
- Vid VIČIČ
- University of Ljubljana, Faculty of Health Sciences, Chair of Biomedicine in Healthcare, Zdravstvena pot 5, 1000Ljubljana, Slovenia
| | - Ruža PANDEL MIKUŠ
- University of Ljubljana, Faculty of Health Sciences, Chair of Biomedicine in Healthcare, Zdravstvena pot 5, 1000Ljubljana, Slovenia
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Harkous D, Ghorayeb N, Gannagé-Yared MH. Prevalence and predictors of vitamin D deficiency in Lebanon: 2016-2022, before and during the COVID-19 outbreak. Endocrine 2023; 82:654-663. [PMID: 37597096 DOI: 10.1007/s12020-023-03483-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Vitamin D deficiency is very common worldwide, particularly in Middle-Eastern countries. Recent Lebanese studies demonstrated an improvement in vitamin D status over time. However, the comparison between the years before and during the COVID-19 outbreak has never been analyzed in the Middle-East area. This study aimed to determine the prevalence and the predictors of 25-hydroxyvitamin D (25(OH)D) levels during the last 7 years. METHODS Serum 25(OH)D levels from a large laboratory database were retrospectively collected from Hôtel-Dieu de France Hospital between January 2016 and June 2022 (N = 66,127). Data related to age, gender, season and year of sampling were also retrieved. RESULTS Mean age of the population was 50.6 ± 19 years, 62.7% were women, 5.3% were children and adolescents, 67.6% adults and 27% elderly. Mean serum 25(OH)D level was 25.7 ± 11.9 ng/mL. The overall population with vitamin D sufficiency (>30 ng/mL) was 31.9%. The increase in mean serum 25(OH)D observed between 2016 and 2022 was 6.36 ng/mL (p < 0.0001). The prevalence of 25(OH)D deficiency (<30 ng/mL) decreased from 76.2% in 2016 to 56.5% in 2022 (p < 0.0001) with a significant difference between the period before and during the COVID-19 outbreak (72.3% vs.42.5%, p < 0.0001). In a multivariate logistic regression, older age, female sex, summer season, years of the COVID-19 outbreak and outpatient samples were protective factors against the risk of hypovitaminosis D (p < 0.0001 for all variables). CONCLUSION Our study showed a continuous positive change in vitamin D status time, most notably after the COVID-19 outbreak. Further studies are needed to assess the clinical impact of the pandemic on vitamin D status in our population.
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Affiliation(s)
- Diala Harkous
- Department of Endocrinology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nada Ghorayeb
- Department of Endocrinology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Cavarzere P, Pausilli R, Nicolussi Prinicpe L, Gaudino R, Guzzo A, Cantalupo G, Antoniazzi F. Decreased vitamin D levels in the pediatric population after COVID-19 lockdown. Ital J Pediatr 2023; 49:113. [PMID: 37670325 PMCID: PMC10478299 DOI: 10.1186/s13052-023-01515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUD SARS-Cov2 infection began to spread worldwide since December 2019; on March 2020, the World Health Organization characterized its related disease, named COVID-19, as a pandemic. In Italy, to contain the spread of infection a severe lockdown in the spring 2020 was instituted. Other less severe restrictions were imposed in the winter 2020-2021 and in the spring 2021. The containment measures caused a series of consequences for the population and, in particular, for children and adolescents that presented psychophysical problems. The aim of this manuscript is to investigate the serum levels of vitamin D in children and adolescents before, during and after the lockdown consequent to COVID-19 pandemic. METHODS This is a retrospective cross-sectional study, including all children and adolescents between 1 to 18 years referring to the Pediatric Endocrinology Service of the University Hospital of Verona, Italy, between January 2019 and December 2021. All patients affected by clinical conditions that involve vitamin D metabolism or assuming vitamin D supplementation were excluded. RESULTS In total, 491 children (36.7% males and 63.3% females) were enrolled in this study. The vitamin D levels decreased over time: 28.3 ± 10.2 ng/mL in 2019; 28.2 ± 11.4 ng/mL in 2020 and 24.9 ± 10.1 ng/mL in 2021 (p < 0.05). The vitamin D levels are significant higher in summer and in autumn in comparison with the levels of winter and spring, regardless of the examined years. CONCLUSIONS The measures adopted to contain the COVID-19 pandemic led to a reduction of serum levels of vitamin D in pediatric population, probably due to the reduced solar exposure. This may have severe consequences on the bone metabolism of those children who did not present optimal vitamin D levels even before the lockdown. Therefore, an adequate supplementation of vitamin D is necessary from the end of fall to the beginning of spring (November-April) in all children and adolescents living in Northern Italy.
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Affiliation(s)
- Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Romina Pausilli
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Lara Nicolussi Prinicpe
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Rossella Gaudino
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Alessandra Guzzo
- Laboratory Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Innovation Biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Child Neuropsychiatry Unit, University Hospital of Verona, Verona, Italy
| | - Franco Antoniazzi
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
- Regional Center for the Diagnosis and Treatment of Children and Adolescents With Rare Skeletal Disorders. Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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Dos Santos EA, Cavalheiro LAM, Rodrigues D, Machado-Rodrigues A, Silva MR, Nogueira H, Padez C. Is more prolonged sun exposure associated with healthier life habits and obesity indicators in Portuguese children? Am J Hum Biol 2023; 35:e23918. [PMID: 37228007 DOI: 10.1002/ajhb.23918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Sun exposure seems to have an indirect effect on the development of obesity through vitamin D synthesis in the skin, the primary source of this vitamin. The present study aimed to investigate associations among sun exposure time, obesity indicators, and lifestyle habits in children. METHODS A total of 4755 children (3-10 years; 49.86% boys) from the north, center and south-central Portugal were included in the present study. During 2016/2017 children's sun exposure time, screen time, time devoted to the practice of physical activity and active play were collected through standard questionnaires answered by parents. Statistical analyses were conducted to investigate differences among sun exposure time according to the sex, age, obesity indicators and lifestyle habits. RESULTS Linear regression analysis showed that sun exposure time presented a negative association with Body Mass Index (β = -0.09, 95% CI: -0.18; -0.003; p = .042), body fat % (β = -0.31, 95%; CI: -0.54; -0.07; p = .010), computer time (β = -0.08, 95% CI: -0.12; - 0.05; p < .0001) and a positive association with active play time (β = 0.22, 95% CI: 0.17; 0.27; p < .0001) and total time of physical activity practice (β = 10.01, 95% CI: 4.52; 15.20; p < .0001). CONCLUSIONS The results reinforce the need for future guidance on the ideal sun exposure time, especially in children, who are at risk for vitamin D deficiency. Standardization of criteria for classifying optimal sun exposure time in this age group, considering the parameters that affect vitamin D status, such as age and seasonality, should be considered when planning future guidelines.
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Affiliation(s)
- Elizabete A Dos Santos
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Daniela Rodrigues
- Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Maria-Raquel Silva
- Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
- Comprehensive Health Research Centre-Group of Sleep, Chronobiology and Sleep Disorders-Nova Medical School, University of Lisbon, Lisbon, Portugal
| | - Helena Nogueira
- Research Centre for Anthropology and Health, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
| | - Cristina Padez
- Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
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Benameur T, Kaliyadan F, Saidi N, Porro C. A Retrospective Chart Review Evaluating Changes in 25-Hydroxyvitamin D Levels among Patients Attending the University Healthcare Centre during the COVID-19 Pandemic. Nutrients 2023; 15:nu15102345. [PMID: 37242228 DOI: 10.3390/nu15102345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
COVID-19-pandemic-related home confinement aids in limiting the spread of the virus but restricts exposure to sunlight, thereby possibly affecting 25(OH)D concentrations. This study aimed to investigate the effect of lockdown measures on 25(OH)D levels in outpatients visiting the healthcare centre over a period of two years. In this retrospective chart review, outpatients who visited a university healthcare centre for a health check-up over a period of two years were included. The patients' 25(OH)D serum levels and status were compared before, during, and after the lockdown periods. A total of 7234 patients were included in this study, with a mean age of 34.66 ± 16.78. The overall prevalence of 25(OH)D insufficiency, deficiency and sufficiency was 33.8%, 30.7% and 35.4%, respectively. The proportion of individuals with 25-(OH) D deficiency prior to lockdown was 29% and this proportion increased in the lockdown and post-lockdown periods to 31.1% and 32%, respectively. Although gender was less likely to have an impact on the 25 (OH) D level during the lockdown period (p = 0.630), we found an association between gender and 25 (OH) D status in the pre-lockdown and post-lockdown periods (p < 0.001 and p < 0.001, respectively). Another association between nationality and 25 (OH)D levels was found before, during and after the lockdown periods (p < 0.001). In addition, the youngest population, aged between 1 and 14, was strongly affected by the home confinement. Age had a positive and significant (p < 0.05) effect on 25 (OH) D status regardless of the different periods. Moreover, in the pre-lockdown period, male outpatients had 1.56 chance of having a sufficient level of 25 (OH)D. However, during the lockdown period, this chance decreased to 0.85 and then increased to 0.99 after the lockdown period. We found no statistically significant difference in the mean serum concentrations or in the prevalence of vitamin D insufficiency when we compared values from before, during and immediately after the COVID-19 lockdown period. However, there was a generally increased prevalence of vitamin D insufficiency in our study population. Another association between gender, nationality and age groups with 25(OH) D was found. Regular exposure to UVR is recommended for maintaining adequate vitamin D levels and to prevent vitamin D deficiency. Further research is needed to determine the best indications for vitamin D supplementation if confinement periods are extended and to consider the potential health consequences of prolonged confinement periods not only on vitamin D status but also on overall public health. The findings of this study may be considered by stakeholders for a targeted supplementation approach for risk groups.
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Affiliation(s)
- Tarek Benameur
- Department of Biomedical Sciences, College of Medicine, King Faisal University, Al Ahsa 31982, Saudi Arabia
| | - Feroze Kaliyadan
- Sree Narayana Institute of Medical Sciences, Kerala University of Health Sciences, Thrissur 683594, India
| | - Neji Saidi
- Department of Mathematics and Statistics, College of Sciences, King Faisal University, Al Ahsa 31982, Saudi Arabia
| | - Chiara Porro
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy
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Agüero-Domenech N, Bernabeu E, García-Valentín A, Sarrión A, Jover S, Baranda J, Cortés-Castell E, Gil-Guillén V, García-Teruel MJ. Influence of Strict Lockdown on Vitamin D Deficiency in Pregnant Women: A Word of Caution. Nutrients 2023; 15:nu15081972. [PMID: 37111192 PMCID: PMC10143695 DOI: 10.3390/nu15081972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The main source of vitamin D results from skin sunlight exposure. Vitamin D deficiency (VDD) is linked to several adverse events during pregnancy. While performing a cross-sectional study with 886 pregnant women in Elda (Spain) from September 2019 to July 2020 to determine the association of VDD with gestational diabetes mellitus in relation to body mass index, a strict lockdown (SL) due to the COVID-19 pandemic was declared from 15 March 2020 to 15 May 2020. To determine if VDD prevalence in the local population of pregnant women was influenced by SL, a retrospective cross-sectional study was conducted to estimate the prevalence odds ratio (POR) for the association of VDD and SL. A crude logistic regression model was calculated, and then further adjusted by the biweekly measured vitamin D-specific UVB dose in our geographical area. The POR during SL was 4.0 (95%CI = 2.7-5.7), with a VDD prevalence of 77.8% in the quarantine period. Our results revealed that VDD prevalence in pregnant women was influenced by SL. This valuable information could guide us in future if public officials order the population to stay indoors for any given reason.
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Affiliation(s)
- Nuria Agüero-Domenech
- Department of Gynaecology and Obstetrics, Hospital General Universitario Elda, 03600 Elda, Spain
- Department of Public Health, History of Science and Gynaecology, Miguel Hernández University, 03550 San Juan, Spain
| | - Eduardo Bernabeu
- Department of Cardiac Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain
- ISABIAL ("Instituto de Investigación Sanitaria y Biomédica de Alicante"), 03010 Alicante, Spain
| | - Antonio García-Valentín
- Department of Cardiac Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain
| | - Ana Sarrión
- Department of Gynaecology and Obstetrics, Hospital General Universitario Elda, 03600 Elda, Spain
| | - Silvia Jover
- Department of Gynaecology and Obstetrics, Hospital General Universitario Elda, 03600 Elda, Spain
| | - Javier Baranda
- Department of Gynaecology and Obstetrics, Hospital General Universitario Elda, 03600 Elda, Spain
| | - Ernesto Cortés-Castell
- Department of Pharmacology, Pediatrics and Organic Chemistry, Miguel Hernández University, 03550 San Juan, Spain
| | - Vicente Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, 03550 San Juan, Spain
| | - María J García-Teruel
- Department of Gynaecology and Obstetrics, Hospital General Universitario Elda, 03600 Elda, Spain
- Department of Public Health, History of Science and Gynaecology, Miguel Hernández University, 03550 San Juan, Spain
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Vitamin D Deficiency Prevalence in Hospitalized Patients with COVID-19 Significantly Decreased during the Pandemic in Slovakia from 2020 to 2022 Which Was Associated with Decreasing Mortality. Nutrients 2023; 15:nu15051132. [PMID: 36904131 PMCID: PMC10005285 DOI: 10.3390/nu15051132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to changes in lifestyle, which could influence vitamin D status on a population level. The purpose of our study was to compare 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalized because of severe COVID-19 during two waves of the pandemic (2020/21 vs. 2021/22). A total of 101 patients from the 2021/22 wave were compared with 101 sex- and age-matched subjects from the 2020/21 wave. Patients from both groups were hospitalized during the winter season from 1 December to 28 February. Men and women were analyzed together and separately. The mean 25(OH)D concentration increased from 17.8 ± 9.7 ng/mL to 25.2 ± 12.6 ng/mL between waves. The prevalence of vitamin D deficiency (<20 ng/mL) decreased from 82% to 54%. The prevalence of adequate serum 25(OH)D concentration (>30 ng/mL) increased from 10% to 34% (p < 0.0001). The proportion of patients with a history of vitamin D supplementation increased from 18% to 44% (p < 0.0001). Low serum 25(OH)D concentration was independently associated with mortality after adjusting for age and sex for the whole cohort of patients (p < 0.0001). The prevalence of inadequate vitamin D status in hospitalized patients with COVID-19 in Slovakia decreased significantly, probably due to a higher rate of vitamin D supplementation during the COVID-19 pandemic.
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Mohd Saffian S, Jamil NA, Mohd Tahir NA, Hatah E. Vitamin D insufficiency is high in Malaysia: A systematic review and meta-analysis of studies on vitamin D status in Malaysia. Front Nutr 2022; 9:1050745. [PMID: 36466384 PMCID: PMC9715981 DOI: 10.3389/fnut.2022.1050745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/03/2022] [Indexed: 10/29/2023] Open
Abstract
PURPOSE To estimate the vitamin D status of participants residing in Malaysia. METHODS PubMed, Scopus, Web of Science, and MyJurnal were searched up to June 2022 without language restrictions. Studies that reported the 25-hydroxyvitamin D [25(OH)D] concentrations and defined their cut-off for deficiency or insufficiency from healthy participants residing in Malaysia were included. The random effects model was used to pool vitamin D status using established cut-offs of <30, <50, and <75 nmol/L according to age group. RESULTS From 299 studies screened, 32 studies were included in the meta-analysis. The pooled proportion for <30 nmol/L was 21% (95% CI 9-36, n = 2,438 from 10 studies), while the pooled proportion <50 nmol/L was 64% (95% CI 56-72, n = 13,977 from 30 studies), and <75 nmol/L was 85% (95% CI 61-100, n = 1,376 from five studies). Heterogeneity was high (I2 ranged from 98-99%). Higher proportions of vitamin D insufficiency (defined as <50 nmol/L) were found in participants living in the urban areas (compared to rural areas), in females (compared to males), and in Malays and Malaysian Indians (compared to Malaysian Chinese) ethnicities. CONCLUSION More than half of Malaysians have insufficient vitamin D levels, despite being a country that is close to the equator. We strongly urge prompt public health measures to improve the vitamin D status in Malaysia. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021260259].
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Affiliation(s)
- Shamin Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Aini Jamil
- Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Asyikin Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ernieda Hatah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Beyazgül G, Bağ Ö, Yurtseven İ, Coşkunol F, Başer S, Çiçek D, Kanberoğlu Gİ, Çelik F, Nalbantoğlu Ö, Özkan B. How Vitamin D Levels of Children Changed During COVID-19 Pandemic: A Comparison of Pre-pandemic and Pandemic Periods. J Clin Res Pediatr Endocrinol 2022; 14:188-195. [PMID: 35135185 PMCID: PMC9176086 DOI: 10.4274/jcrpe.galenos.2022.2021-10-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The synthesis of vitamin D is related to sun exposure, thus the restrictions during the Coronavirus disease-2019 (COVID-19) pandemic may have affected the levels of vitamin D in all age groups. The aim of this study was to evaluate vitamin D levels of healthy children and adolescents during the first year of the pandemic. METHODS The study group included healthy children and adolescents who were admitted for general check-ups and evaluated with 25(OH)D levels. Then, it was divided into two groups: Group 1 “pre-pandemic”, and Group 2 “pandemic”. Vitamin D levels were recorded from the hospital database and were compared according to age groups, gender, and the season, retrospectively. RESULTS The study group [mean age=90.29±59.45 median age=79 interquartile range (IQR): 102 months, male/female: 1409/1624] included 3033 children and adolescents (Group 1/Group 2 n=1864/1169). Although the mean 25(OH)D levels among preschool children did not differ between groups, the vitamin D levels of school-aged children and adolescents were significantly lower in the pandemic period than in the pre-pandemic period [Group 1 median=16.50 (IQR: 10.5) vs Group 2 median=15.9 (IQR: 11.3) in 6-12 age group (p=0.026); Group 1 median=13.30 (IQR: 10.2) vs Group 2 median=11.20 (IQR: 9.7) in 12-18 age group (p=0.003)]. Moreover, the 25(OH)D levels of adolescents showed seasonal variance with lower levels in winter, and unexpectedly, in summer. CONCLUSION Pandemic-related restrictions have caused significant decreases in vitamin D levels of school-aged children and adolescents. We suggest that children and adolescents should be given vitamin D supplementation in order to maintain sufficient levels of vitamin D during the pandemic.
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Affiliation(s)
- Güler Beyazgül
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey Phone: +90 232 464 61 67 E-mail:
| | - Özlem Bağ
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - İlkay Yurtseven
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Fulya Coşkunol
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Saynur Başer
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Duygu Çiçek
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Gül İrem Kanberoğlu
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Filiz Çelik
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Özlem Nalbantoğlu
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Behzat Özkan
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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11
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Miranda I, Sangüesa-Nebot MJ, González A, Doménech J. Impact of strict population confinement on fracture incidence during the COVID-19 pandemic. Experience from a public Health Care Department in Spain. J Orthop Sci 2022; 27:677-680. [PMID: 33933326 PMCID: PMC8081314 DOI: 10.1016/j.jos.2021.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND the COVID-19 pandemic has led to drastic "stay-at-home" measures for the population. The aim of this study was to know the influence of the population strict confinement on the presentation of the different types of fracture as well as on the needs of hospital admission by the Orthopedic Surgery and Traumatology Service. METHODS a retrospective observational analytical descriptive study was carried out on the population attended in the Emergency Services of two general hospitals in a public Health Care Department in Spain. Data were studied from the two-months confinement period in 2020 and compared with the same period in 2018 and 2019. RESULTS A total of 56,332 emergency cases were included. There was a decrease in the total number of patients attended along the confinement period compared to the same period in the two previous years. Fracture cases decreased by 58,8% in the confinement period (330 in 2020; 715 in 2018 and 884 in 2019). Also there was a 37,6% reduction in fractures needing admission or surgery. The percentage distribution of the types of fractures that required admission resulted in a decrease in upper and lower limb fractures, whereas the number of vertebral and hip fractures remained unchanged. CONCLUSIONS both the reduction of fractures attended in the emergency department and the maintenance of the number of hip fractures must be taken into account when establishing contingency plans in the event of a pandemic situation in order to properly plan human resources and materials.
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Affiliation(s)
- Ignacio Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova y Hospital de Liria, Valencia, Spain,Health Care Department Arnau-Lliria, Valencia, Spain,Corresponding author. Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, C/ Sant Climent 12, 46015 Valencia, Spain
| | - María José Sangüesa-Nebot
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova y Hospital de Liria, Valencia, Spain,Health Care Department Arnau-Lliria, Valencia, Spain
| | - Antonio González
- Health Care Department Arnau-Lliria, Valencia, Spain,Clinical Documentation Department, Hospital Arnau de Vilanova. Valencia, Spain
| | - Julio Doménech
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova y Hospital de Liria, Valencia, Spain,Health Care Department Arnau-Lliria, Valencia, Spain
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12
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Karimian P, Tahami MS, Sayyahfar S, Aghajani Delavar M. Association of vitamin D and severity of COVID-19 in children. Eur J Transl Myol 2022; 32. [PMID: 35441835 PMCID: PMC9295166 DOI: 10.4081/ejtm.2022.10453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 12/15/2022] Open
Abstract
Vitamin has a major role in the functions of the immune system, and the efficacy of this vitamin in reducing inflammation has been identified. Considering the effects of vitamin D, this study research was performed for investigating the relationship between vitamin D and the severity of COVID-19 in children. This cross-sectional study was performed on 101 children infected with the new coronavirus from September 2020 to October 2021. Information on vitamin D levels, demographic factors, and clinical and laboratory findings were documented in information forms and prepared for statistical analyses. The average of children was 2.85 ± 0.85 years. Low oxygen saturation was observed in 35.3% of infected children. The level of involvement was higher in subjects with vitamin D levels higher than 30 and less than 10 ng/ml (p = 0.04). Clinical signs in cases with deficient and sufficient vitamin D levels were more severe in terms of tachypnea and tachycardia (p = 0.01). Children with vitamin D lower than 10 ng/ml showed more frequency (p = 0.02). Cases with moderate vitamin D had fewer gastrointestinal complications (p = 0.03). Also, oxygen levels were lower in children who had low levels of vitamin D (p = 0.02). Vitamin D levels were associated with levels of involvement, tachycardia, tachypnea, clinical signs, gastrointestinal problems, and O2 levels. Moderate vitamin D levels in children are a critical issue that should be considered.
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Affiliation(s)
- Pegah Karimian
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Ali Asghar Children's Hospital, Tehran.
| | - Motahareh Sadat Tahami
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Ali Asghar Children's Hospital, Tehran.
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, School of Medicine, Tehran.
| | - Motahare Aghajani Delavar
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Ali Asghar Children's Hospital, Tehran.
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13
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Tomaszewska A, Rustecka A, Lipińska-Opałka A, Piprek RP, Kloc M, Kalicki B, Kubiak JZ. The Role of Vitamin D in COVID-19 and the Impact of Pandemic Restrictions on Vitamin D Blood Content. Front Pharmacol 2022; 13:836738. [PMID: 35264968 PMCID: PMC8899722 DOI: 10.3389/fphar.2022.836738] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022] Open
Abstract
Vitamin D is a hormone regulating the immune system and playing a pivotal role in responses to microbial infections. It regulates inflammatory processes by influencing the transcription of immune-response genes in macrophages, T cells, and dendritic cells. The proven role of vitamin D in many infectious diseases of the respiratory tract indicated that vitamin D should also play a role in SARS-CoV-2 infection. Vitamin D inhibits cytokine storm by switching the pro-inflammatory Th1 and Th17 to the anti-inflammatory Th2 and Treg response. Vitamin D is therefore expected to play a role in preventing, relieving symptoms, or treating SARS-CoV-2 infection symptoms, including severe pneumonia. There are several possible mechanisms by which vitamin D may reduce the risk of COVID-19 infection, such as induction of the transcription of cathelicidin and defensin. Also a nongenomic antiviral action of vitamin D and lumisterol, the molecule closely related to vitamin D, was reported. Despite this enormous progress, currently, there is still insufficient scientific evidence to support the claim that vitamin D supplementation may help treat COVID-19 infection. The pandemic restrictions were also shown to impact vitamin D uptake by limiting exposure to sunlight.
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Affiliation(s)
- Agata Tomaszewska
- Pediatric, Nephrology, and Allergology Clinic, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Rustecka
- Pediatric, Nephrology, and Allergology Clinic, Military Institute of Medicine, Warsaw, Poland
| | | | - Rafal P Piprek
- Department of Comparative Anatomy, Institute of Zoology and Biomedical Research, Jagiellonian University, Krakow, Poland
| | - Małgorzata Kloc
- The Houston Methodist Research Institute, Houston, TX, United States.,Department of Surgery, The Houston Methodist Hospital, Houston, TX, United States.,Department of Genetics, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Bolesław Kalicki
- Pediatric, Nephrology, and Allergology Clinic, Military Institute of Medicine, Warsaw, Poland
| | - Jacek Z Kubiak
- Faculty of Medicine, CNRS, UMR 6290, Institute of Genetics and Development of Rennes, University Rennes, Rennes, France.,Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Warsaw, Poland
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14
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Domenici R, Vierucci F. Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052973. [PMID: 35270666 PMCID: PMC8910000 DOI: 10.3390/ijerph19052973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 02/01/2023]
Abstract
Human milk is the best food for infants. Breastfeeding has been associated with a reduced risk of viral and bacterial infections. Breast milk contains the perfect amount of nutrients needed to promote infant growth, except for vitamin D. Vitamin D is crucial for calcium metabolism and bone health, and it also has extra-skeletal actions, involving innate and adaptive immunity. As exclusive breastfeeding is a risk factor for vitamin D deficiency, infants should be supplemented with vitamin D at least during the first year. The promotion of breastfeeding and vitamin D supplementation represents an important objective of public health.
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15
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Sodri NI, Mohamed-Yassin MS, Mohd Nor NS, Ismail IA. Rickets Due to Severe Vitamin D and Calcium Deficiency During the COVID-19 Pandemic in Malaysia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934216. [PMID: 34723934 PMCID: PMC8570386 DOI: 10.12659/ajcr.934216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Female, 22-month-old
Final Diagnosis: Nutritional rickets
Symptoms: Bowing of legs
Medication:—
Clinical Procedure:—
Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Nurul Izzah Sodri
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Batu Caves, Selangor, Malaysia
| | | | - Noor Shafina Mohd Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.,Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Ilham Ameera Ismail
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Batu Caves, Selangor, Malaysia
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16
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Rustecka A, Maret J, Drab A, Leszczyńska M, Tomaszewska A, Lipińska-Opałka A, Będzichowska A, Kalicki B, Kubiak JZ. The Impact of COVID-19 Pandemic during 2020-2021 on the Vitamin D Serum Levels in the Paediatric Population in Warsaw, Poland. Nutrients 2021; 13:nu13061990. [PMID: 34207901 PMCID: PMC8227523 DOI: 10.3390/nu13061990] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The main source of vitamin D is skin synthesis, which depends on sunlight exposure. During the pandemic, COVID-19 children were obliged to home confinement, which potentially limiting sunlight exposure. The aim of this study was to evaluate whether home confinement led to decreased vitamin D serum levels in children in Warsaw, Poland. METHODS The study included 1472 children who were divided into two groups, based on the date of 25(OH)D level blood sampling: before and during the pandemic. Children under 1 year of age (infants) were analysed separately. RESULTS A statistically significant decrease in the average level of vitamin D was observed between groups of children over 1 year of age (35 ng/mL ± 18 vs. 31 ng/mL ± 14). In infants from both groups, the mean vitamin D levels were within the normal range (Group 1 inf 54 ng/mL ± 21 vs. Group 2 inf 47 ng/mL ± 15). The characteristic seasonal variability was observed before the pandemic, with maximal vitamin D levels in summer (40 ng/mL ± 17) and minimal levels in winter (30 ng/mL ± 14). During the pandemic, no seasonal variability was observed (summer 30 ng/mL ± 11 vs. winter 30 ng/mL ± 19). CONCLUSIONS The COVID-19 pandemic restrictions led to a significant decrease in vitamin D serum levels in children.
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Affiliation(s)
- Agnieszka Rustecka
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Justyna Maret
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Ada Drab
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Michalina Leszczyńska
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Agata Tomaszewska
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Agnieszka Lipińska-Opałka
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
- Correspondence:
| | - Agata Będzichowska
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Bolesław Kalicki
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Jacek Z. Kubiak
- Cell Cycle Group, Faculty of Medicine, Institute of Genetics and Development of Rennes, University of Rennes 1, 35000 Rennes, France;
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17
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Wong RS, Tung KTS, So HK, Wong WHS, Wong SY, Tsang HW, Tung JYL, Chua GT, Ho MHK, Wong ICK, Ip P. Impact of COVID-19 Pandemic on Serum Vitamin D Level among Infants and Toddlers: An Interrupted Time Series Analysis and before-and-after Comparison. Nutrients 2021; 13:nu13041270. [PMID: 33924387 PMCID: PMC8069706 DOI: 10.3390/nu13041270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/16/2022] Open
Abstract
Background: During the coronavirus disease 2019 (COVID-19) pandemic, the implementation of social distancing and home confinement measures may elevate the risk of vitamin D deficiency particularly for infants. This study aimed to quantify changes in vitamin D level among infants and toddlers in Hong Kong after the COVID-19 outbreak. Methods: We recruited 303 infants and toddlers aged 2–24 months by stratified random sampling from 1 June 2019 to November 30, 2020. Regression models were used to estimate the effect of time on infants’ serum 25-hydroxyvitamin D (25(OH)D) level overall and by age groups before and after the outbreak. Interrupted time series (ITS) analysis was performed to examine the sustained effect of COVID-19 on their serum 25(OH)D level. Results: The ITS results showed no immediate reduction in serum 25(OH)D level among infants, but a decreasing trend was observed in the subsequent months post-outbreak at a monthly decline rate of −6.32 nmol/L. When analyzed by age group, the magnitude of post-outbreak reduction in 25(OH)D was stronger among younger infants (aged 2–6 months). Conclusion: Guidelines and recommendations should be given to pregnant women and mothers to ensure sufficient vitamin D level in their infants during the COVID-19 period.
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Affiliation(s)
- Rosa S. Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Keith T. S. Tung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Hung-Kwan So
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Wilfred H. S. Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Siew Yan Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Hing Wai Tsang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Joanna Y. L. Tung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
- Department of Paediatrics, Hong Kong Children’s Hospital, Hong Kong, China
| | - Gilbert T. Chua
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Marco H. K. Ho
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China;
- Research Department of Practice and Policy, UCL School of Pharmacy, London WC1E 6BT, UK
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China; (R.S.W.); (K.T.S.T.); (H.-K.S.); (W.H.S.W.); (S.Y.W.); (H.W.T.); (J.Y.L.T.); (G.T.C.); (M.H.K.H.)
- Correspondence: ; Tel.: +852-2255-4090; Fax: +852-2855-1523
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