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Di Carlo C, Mighton C, Clausen M, Joshi E, Casalino S, Kim THM, Kowal C, Birken C, Maguire J, Bombard Y. Parents' attitudes towards research involving genome sequencing of their healthy children: a qualitative study. Eur J Hum Genet 2024; 32:171-175. [PMID: 37864046 PMCID: PMC10853502 DOI: 10.1038/s41431-023-01476-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/28/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
With widespread genomic sequencing research efforts, there is increasing impetus to return results to participants. Parents of healthy children are increasingly asked to participate in genomic research, yet there are limited studies of parental expectations for the return of results amongst healthy children. We explored parental attitudes towards their healthy children's participation in genomic research and expectations for return of results. Data collection involved semi-structured telephone interviews with parents of healthy children participating in a primary care research network. Transcripts were analyzed thematically using constant comparison. A total of 26 parents were interviewed: 22 were female, 19 self-reported as White/European, and 20 were aged 30-39. Three themes emerged: (1) Reciprocity; Parents preferred to receive medically actionable, childhood-onset results and expected recontact overtime in exchange for their research participation. (2) Downstream impacts of testing; Parents expected future clinical benefits but were concerned about the risk of genetic discrimination. (3) Power and empowerment; Some parents felt empowered to take preventative action for their child and relatives, while others did not want to limit their child's autonomy. Considering these tensions may help to inform participant-centered approaches to optimize parental decision-making and participation, as well as maximize the utility of results.
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Affiliation(s)
- Christina Di Carlo
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Chloe Mighton
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Marc Clausen
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Esha Joshi
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Selina Casalino
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Theresa H M Kim
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Catherine Birken
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Jonathon Maguire
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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Janus M, Ryan J, Pottruff M, Reid-Westoby C, Brownell M, Bennett T, Birken CS, Duku E, Ferro MA, Forer B, Georgiades S, Gorter JW, Guhn M, Maguire J, Manson H, Pei J, Santos R, Coplan RJ. Population-Based Teacher-Rated Assessment of Anxiety Among Canadian Kindergarten Children. Child Psychiatry Hum Dev 2023; 54:1309-1320. [PMID: 35244815 PMCID: PMC8894824 DOI: 10.1007/s10578-022-01332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/13/2022]
Abstract
Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.
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Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | - Julia Ryan
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Molly Pottruff
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Catherine S Birken
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stelios Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Maguire
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Rob Santos
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Robert J Coplan
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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Rasiah S, Jüni P, Sgro MD, Thorpe KE, Maguire J, Freeman SJ. School-based health care: improving academic outcomes for inner-city children-a prospective cohort quasi-experimental study. Pediatr Res 2023; 94:1488-1495. [PMID: 36755187 PMCID: PMC9907190 DOI: 10.1038/s41390-023-02473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/02/2022] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND We examined whether a school-based health center model improved academic achievement compared to usual care. METHODS This was a quasi-experimental prospective cohort study. The primary outcome was an academic achievement. In addition, we analyzed sociodemographic characteristics and their relationship to academic achievement, and the wait time for a developmental assessment. RESULTS The differences in change of grades over time (from 2016/2017 to 2018/2019) were small for reading (-0.83, 95% CI -3.48, 1.82, p = 0.51), writing (-1.11, 95% CI -3.25, 1.03, p = 0.28), and math (0.06, 95% CI -3.08, 2.94, p = 0.98). The experimental arm's average wait time for developmental assessment was 3.4 months. CONCLUSION In this small, quasi-experimental prospective cohort study, we did not find evidence that our SBHC model improved academic achievement; however, the wait time at the SBHCs was considerably less than the provincial wait time for a developmental assessment. TRIAL REGISTRATION NCT04540003. IMPACT This study describes a unique and innovative school-based health center model. Our findings support the benefits of school-based health centers in diagnosing and treating children with developmental and mental health disorders for disadvantaged communities. This study did not find an improvement in academic achievement for school-based health center users. This study found that the wait time to developmental assessment was shorter for school-based health center users compared to the wait time reported in the community. Pandemic-associated school disruptions have highlighted the importance of accessible school-based health services for children requiring mental health and developmental assessments and care.
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Affiliation(s)
- Saisujani Rasiah
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Michael D Sgro
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonathon Maguire
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Sloane J Freeman
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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Freeman SJ, Rasiah S, Cohen-Silver J, Xu K, Lebovic G, Maguire J. Mental Health Trajectories of Children and Caregivers Using School-Based Health Centers During the COVID-19 Pandemic. J Pediatr Health Care 2023; 37:511-518. [PMID: 37245129 PMCID: PMC10123352 DOI: 10.1016/j.pedhc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION This was a prospective study of children registered at school-based health centers (SBHCs) in Canada. The objectives were to compare mental health trajectories of children and parents/caregivers who accessed SBHCs during the pandemic relative to those who did not. METHOD Parents/caregivers of children who attended SBHCs completed the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) at three time points during the pandemic. The primary analysis used linear mixed models to examine the relationship between SBHC visits during the pandemic and children's SDQ score trajectories. The secondary analysis was the same for parents'/caregivers' GAD-7 scores. RESULTS There were 435 children included. SDQ and GAD-7 scores worsened over time for children and parents/caregivers who attended SBHCs during the pandemic compared to those who did not. DISCUSSION Children and parents/caregivers with worsening mental health symptoms may have sought care at SBHCs since they were accessible during the pandemic.
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Cost KT, Mudiyanselage P, Unternaehrer E, Korczak DJ, Crosbie J, Anagnastou E, Monga S, Kelley E, Schachar R, Maguire J, Arnold P, Burton CL, Georgiades S, Nicolson R, Birken CS, Charach A. The role of parenting practices in parent and child mental health over time. BJPsych Open 2023; 9:e147. [PMID: 37550865 PMCID: PMC10594096 DOI: 10.1192/bjo.2023.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Parent and child mental health has suffered during the pandemic and transition phase. Structured and shared parenting may be intervention targets beneficial to families who are struggling with parent or child mental health challenges. AIMS First, we investigated associations between structured and shared parenting and parent depression symptoms. Second, we investigated associations between structured and shared parenting and depression, hyperactivity/inattention and irritability symptoms in children. METHOD A total of 1027 parents in two-parent households (4797 observations total; 85.1% mothers) completed online surveys about themselves and their children (aged 2-18 years) from April 2020 to July 2022. Structured parenting and shared parenting responsibilities were assessed from April 2020 to November 2021. Symptoms of parent depression, child depression, child hyperactivity and inattention, child irritability, and child emotional and conduct problems were assessed repeatedly (one to 14 times; median of four times) from April 2020 to July 2022. RESULTS Parents who reported higher levels of shared parenting responsibilities had lower depression symptoms (β = -0.09 to -0.32, all P < 0.01) longitudinally. Parents who reported higher levels of shared parenting responsibilities had children with fewer emotional problems (ages 2-5 years; β = -0.07, P < 0.05), fewer conduct problems (ages 2-5 years; β = -0.09, P < 0.01) and less irritability (ages 13-18 years; β = -0.27, P < 0.001) longitudinally. Structured parenting was associated with fewer conduct problems (ages 2-5 years; β = -0.05, P < 0.05). CONCLUSIONS Shared parenting is beneficial for parent and child mental health, even under chaotic or inflexible life conditions. Structured parenting is beneficial for younger children.
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Affiliation(s)
- Katherine T. Cost
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Behavioural Neurosciences & Psychiatry, McMaster University, Canada
| | - Piyumi Mudiyanselage
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, Canada
| | - Eva Unternaehrer
- University Psychiatric Clinics Basel, University of Basel, Switzerland
| | - Daphne J. Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Evdokia Anagnastou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada; and Autism Research Centre, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Canada; and Department of Psychiatry, Queen's University, Canada
| | - Russell Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Jonathon Maguire
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada; and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Canada; and Department of Psychiatry and Medical Genetics, Cumming School of Medicine, University of Calgary, Canada
| | | | - Stelios Georgiades
- Department of Behavioural Neurosciences & Psychiatry, McMaster University, Canada
| | - Rob Nicolson
- Department of Psychiatry, University of Western Ontario, Canada
| | - Catherine S. Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Canada; and Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, Toronto, Canada; and Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada
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Gehring ND, Birken CS, Belanger S, Bridger T, Chanoine JP, Gibson WT, Hadjiyannakis S, Haines J, Hamilton J, Haqq AM, Henderson M, Ho J, Irvine B, Legault L, Luca P, Maguire J, McPherson AC, Morrison K, Wahi G, Weksberg R, Zwaigenbaum L, Ball GDC. Severe obesity and global developmental delay in preschool children: Findings from a Canadian Paediatric Surveillance Program study. Paediatr Child Health 2023; 28:107-112. [PMID: 37151929 PMCID: PMC10156927 DOI: 10.1093/pch/pxac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background The co-presentation of severe obesity (SO) and global developmental delay (GDD) in Canadian preschool children has not been examined. However, SO and GDD may require syndromic diagnoses and unique management considerations. Objectives To determine (1) minimum incidence; (2) age of onset and risk factors; and (3) health care utilization for co-presenting SO and GDD. Methods Through the Canadian Paediatric Surveillance Program (CPSP), a monthly form was distributed to participants from February 2018 to January 2020 asking for reports of new cases of SO and GDD among children ≤5 years of age. We performed descriptive statistics for quantitative questions and qualitative content analysis for open-ended questions. Results Forty-seven cases (64% male; 51% white; mean age: 3.5 ± 1.2 years) were included. Age of first weight concern was 2.5 ± 1.3 years and age of GDD diagnosis was 2.7 ± 1.4 years. Minimum incidence of SO and GDD was 3.3 cases per 100,000 for ≤5 years of age per year. Identified problems included school and/or behavioural problems (n = 17; 36%), snoring (n = 14; 30%), and asthma/recurrent wheeze (n = 10; 21%). Mothers of 32% of cases (n = 15) had obesity and 21% of cases (n = 10) received neonatal intensive care. Microarray was ordered for 57% (n = 27) of children. A variety of clinicians and services were accessed. As reported by CPSP participants, challenges faced by families and health service access were barriers to care. Conclusion Children with SO and GDD have multiple comorbidities, and require early identification and referral to appropriate services. These cases may also benefit from additional testing to rule out known genetic obesity syndromes.
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Affiliation(s)
- Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine S Birken
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stacey Belanger
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Tracey Bridger
- Discipline of Pediatrics, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Jean-Pierre Chanoine
- Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - William T Gibson
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jess Haines
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Jill Hamilton
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Mélanie Henderson
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Josephine Ho
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Laurent Legault
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Paola Luca
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jonathon Maguire
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Morrison
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rosanna Weksberg
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Ontario, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Pullenayegum EM, Birken C, Maguire J. Causal inference with longitudinal data subject to irregular assessment times. Stat Med 2023. [PMID: 37054723 DOI: 10.1002/sim.9727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 02/10/2023] [Accepted: 03/18/2023] [Indexed: 04/15/2023]
Abstract
Data collected in the context of usual care present a rich source of longitudinal data for research, but often require analyses that simultaneously enable causal inferences from observational data while handling irregular and informative assessment times. An inverse-weighting approach to this was recently proposed, and handles the case where the assessment times are at random (ie, conditionally independent of the outcome process given the observed history). In this paper, we extend the inverse-weighting approach to handle a special case of assessment not at random, where assessment and outcome processes are conditionally independent given past observed covariates and random effects. We use multiple outputation to accomplish the same purpose as inverse-weighting, and apply it to the Liang semi-parametric joint model. Moreover, we develop an alternative joint model that does not require covariates for the outcome model to be known at times where there is no assessment of the outcome. We examine the performance of these methods through simulation and illustrate them through a study of the causal effect of wheezing on time spent playing outdoors among children aged 2-9 years and enrolled in the TargetKids! study.
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Affiliation(s)
- Eleanor M Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Catherine Birken
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Jonathon Maguire
- Department of Paediatrics, St Michael's Hospital, Toronto, Canada
- Departments of Paediatrics & Nutritional Sciences, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
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Rae S, Ong F, Dennis CL, Hamilton J, Pullenayegum E, Maguire J, Birken C. Parent involvement in child anthropometric measurement. BMC Prim Care 2023; 24:89. [PMID: 37016320 PMCID: PMC10073622 DOI: 10.1186/s12875-023-02028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/03/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Young children are often accompanied by their parent/caregiver when attending primary healthcare visits, where clinical procedures such as anthropometric measurements are conducted. Parents are not typically involved in their child's anthropometric measurement collection, and there are no recommendations for parental involvement during visits. The objective of this study was to describe parents' experiences with being involved in their child's anthropometric measurements. METHODS A 10-question survey comprised of scaled and open-ended questions was self-administered to participants after child anthropometric measurement collection including length/height, weight, head, arm, and waist circumference. Survey data were analyzed using a general inductive approach and thematic analysis. Surveys were collected in participating TARGet Kids! primary care practice sites in Toronto, Canada. Survey respondents included 30 parents of children < 2 years of age, and 30 parents of children 2-5 years of age. RESULTS 76% of parents with children aged < 2 years and 93% of those with children aged 2-5 years rated their overall experience in being involved in their child's anthropometric measurement as enjoyable or thoroughly enjoyable. Analysis of open-ended survey questions revealed five themes: [1] parent interest in child growth; [2] ease of anthropometric measurement; [3] extended clinic visit; [4] child discomfort; and [5] interest in participating in research. CONCLUSION Parents reported a high degree of enjoyment in being involved in their child's anthropometric measurements. Parent participation in anthropometric measurement may improve parental satisfaction with children's primary healthcare. Future research may include assessing the reliability of measurements taken with the support of a parent/caregiver.
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Affiliation(s)
- Sarah Rae
- Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
| | - Frank Ong
- Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Jill Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Jonathon Maguire
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Division of Paediatrics, St Michael's Hospital, Toronto, ON, Canada
| | - Catherine Birken
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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Rae S, Maguire J, Aglipay M, Barwick M, Danavan K, Haines J, Jenkins J, Klaassen M, Moretti ME, Ong F, Persaud N, Porepa M, Straus S, Tavares E, Willan A, Birken C. Randomized controlled trial evaluating a virtual parenting intervention for young children at risk of obesity: study protocol for Parenting Addressing Early Years Intervention with Coaching Visits in Toronto (PARENT) trial. Trials 2023; 24:8. [PMID: 36600302 PMCID: PMC9811050 DOI: 10.1186/s13063-022-06947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The prevalence of overweight (15%) and obesity (6%) in children under 5 years of age in Canada are high, and young children with overweight and obesity are at increased risk of the development of chronic disease(s) in adulthood. Prior research has demonstrated very few published trials on effective obesity prevention interventions in young children at risk of obesity, within primary healthcare settings. The aim of this study is to determine if 18-48-month-old children at risk for obesity, who are randomized to receive the Parents Together program (i.e., intervention group), have reduced body mass index z-score (zBMI), compared to those not receiving the intervention, at a 12-month follow-up. Secondary clinical outcomes between the intervention and control groups will be compared at 12 months. METHODS A pragmatic, parallel group, 1:1, superiority, randomized control trial (RCT) through the TARGetKids! Practice Based Research Network will be conducted. Young children (ages 18-48 months) who are at increased risk for childhood obesity will be invited to participate. Parents who are enrolled in the intervention group will participate in eight weekly group sessions and 4-5 coaching visits, facilitated by a trained public health nurse. Children and parents who are enrolled in the control group will receive the usual health care. The primary outcome will be compared between intervention arms using an analysis of covariance (ANCOVA). Feasibility and acceptability will be assessed by parent focus groups and interviews, and fidelity to the intervention will be measured using nurse-completed checklists. A cost-effectiveness analysis (CEA) will be conducted. DISCUSSION This study will aim to reflect the social, cultural, and geographic diversity of children in primary care in Toronto, Ontario, represented by an innovative collaboration among applied child health researchers, community health researchers, and primary care providers (i.e., pediatricians and family physicians in three different models of primary care). Clinical and implementation outcomes will be used to inform future research to test this intervention in a larger number, and diverse practices across diverse geographic settings in Ontario. TRIAL REGISTRATION ClinicalTrials.gov NCT03219697. Registered on June 27, 2017.
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Affiliation(s)
- Sarah Rae
- grid.17063.330000 0001 2157 2938Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON Canada
| | - Jonathon Maguire
- grid.415502.7Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON Canada ,grid.34429.380000 0004 1936 8198Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON Canada
| | - Mary Aglipay
- grid.415502.7Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON Canada
| | - Melanie Barwick
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Karoon Danavan
- grid.17063.330000 0001 2157 2938Department of Pediatrics, Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Jess Haines
- grid.34429.380000 0004 1936 8198Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON Canada
| | - Jennifer Jenkins
- grid.17063.330000 0001 2157 2938Applied Psychology and Human Development, University of Toronto, Toronto, ON Canada
| | - Marie Klaassen
- grid.417191.b0000 0001 0420 3866Toronto Public Health, Toronto, ON Canada
| | - Myla E. Moretti
- grid.17063.330000 0001 2157 2938Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON Canada
| | - Frank Ong
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON Canada
| | - Nav Persaud
- grid.415502.7Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON Canada ,grid.415502.7Department of Family and Community Medicine, Centre for Urban Health Solutions and Department of Family and Community Medicine, University of Toronto, St. Michael’s Hospital, Toronto, ON Canada
| | - Michelle Porepa
- grid.17063.330000 0001 2157 2938Department of Pediatrics, Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Sharon Straus
- grid.415502.7Department of Pediatrics, St Michael’s Hospital, Pediatric Research, Toronto, ON Canada
| | - Erika Tavares
- grid.42327.300000 0004 0473 9646Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON Canada
| | - Andrew Willan
- grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Catherine Birken
- grid.17063.330000 0001 2157 2938Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pediatrics, Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON Canada
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Samtani B, Gray N, Omand J, Keown-Stoneman C, Aglipay M, Birken C, Maguire J. Early Life Antibiotic Prescription for Upper Respiratory Tract Infection Is Associated With Higher Antibiotic Use in Childhood. J Pediatric Infect Dis Soc 2022; 11:559-564. [PMID: 36067011 PMCID: PMC9795472 DOI: 10.1093/jpids/piac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Antibiotic prescription for uncomplicated upper respiratory tract infection (URTI) in children is not recommended but remains common. The primary objective was to evaluate the relationship between antibiotic prescription for URTI prior to age 2 and antibiotic prescription for URTI after age 2. It was hypothesized that antibiotic prescription for URTI in early childhood may increase the risk of antibiotic use for subsequent URTIs. The secondary objective was to investigate whether this relationship was different for acute otitis media (AOM), for which antibiotics may be indicated. METHODS A prospective cohort study was conducted between December 2008 and March 2016 at 9 primary care practices in Toronto, Canada. Healthy children aged 0-5 years that met TARGet Kids! cohort eligibility criteria were included if they had at least one sick visit prior to age 2 and least one sick visit after age 2. Generalized Estimating Equation (GEE) models were used to evaluate this relationship while considering within-subject correlation. RESULTS Of 2380 participants followed for a mean duration of 4.6 years, children who received an antibiotic prescription for URTI prior to age 2 had higher odds of receiving an antibiotic prescription for URTI in later childhood (adjusted odds ratio: 1.39; 95% confidence interval: 1.19 to 1.63; P < .001). This relationship did not appear to be different for AOM compared to non-AOM URTI. CONCLUSION Antibiotic prescription for URTI before age 2 was associated with antibiotic prescription for URTI in later childhood. Reducing early life antibiotic prescription for URTI may be associated with reduction in antibiotic prescription for subsequent URTIs.
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Affiliation(s)
- Bhavna Samtani
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Gray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Omand
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charles Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mary Aglipay
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Catherine Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathon Maguire
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
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11
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Aglipay M, Semalhago J, Keown-Stoneman C, Tuite A, Birken C, Maguire J. 90 An analysis of COVID-19 public health measure adherence among parents and children and the corresponding effects of lockdowns and school closures. Paediatr Child Health 2022. [PMCID: PMC9586049 DOI: 10.1093/pch/pxac100.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Public health preventive measures have been a necessary intervention in preventing COVID-19 transmission. Objectives The objectives of this study were 1) To investigate how the adherence to COVID-19 public health measures among parents and children in Ontario changed over time; 2) To determine if provincial lockdowns were associated with higher adherence to public health measures among parents; 3) To determine if school closures were associated with higher adherence to public health measures among children. Design/Methods A longitudinal study was conducted in children aged 0-10 years and their parents through the TARGet Kids! COVID-19 Study of Children and Families in the Greater Toronto Area, Canada (April 2020 -May 2021). Parents completed weekly questionnaires on sociodemographics and public health practices. The primary exposure was calendar date. Secondary exposures were provincial lockdowns and school closures. The primary outcome was adherence to public health preventive measures (staying home, limiting visitors in the home, avoiding contact with others, socially distancing, and handwashing, measured as number of days practicing per week) measured separately for parents and children. Linear mixed effects regression and piecewise linear splines mixed effects models were conducted. Results 819 children and their parents contributed 13,220 observations to the study over 13 months. Mean age was 5.6 years (SD=2.7) and 373 were female (45.5%). 273 children (35.1%) had a parent who worked as an essential worker and 254 (35.4%) of families lived in a COVID-19 ‘hotspot’. The number of days per week that parents adhered to all 5 public health measures decreased by 0.029 days (p<0.001), and by 0.146 days for children (p<0.001) over the study duration. For parents, adherence to the five public health measures decreased over time during the first lockdown (β=-0.06, p<0.001) and first reopening (β=-0.01, p<0.001), but increased again during the second lockdown (β=0.01, p<0.001). For children, adherence to the five public health measures decreased over time during the first school closure, increased during the second closure, and decreased during second reopening (β=-0.04, p<0.01). See Figure 1. Conclusion Parents and children both decreased in their adherence to social distancing, staying at home, and avoiding contact with others over time. Lockdown after a period of reopening increased parent adherence to public health measures and school closures increased adherence in children. Supports may be necessary to help children and parents maintain adherence to public measures over prolonged periods of lockdown and school closure. ![]()
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Nurse K, Janus M, Birken C, Keown-Stoneman C, Omand J, Maguire J, Reid-Westoby C, Duku E, Lebovic G, Mamdani M, Simpson JR, Tremblay M, Parkin P, Borkhoff C. 38 Developmental Screening Using the Infant Toddler Checklist at 18 Months and School Readiness at 4 to 6 Years. Paediatr Child Health 2022. [PMCID: PMC9586087 DOI: 10.1093/pch/pxac100.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The American Academy of Pediatrics recommends developmental screening at multiple visits using both a general developmental tool and an autism spectrum disorder (ASD)-specific tool. The Canadian Paediatric Society recommends screening at a single visit at 18 months. There is no consensus on which tool is best suited for one-time screening. The Infant Toddler Checklist (ITC) identifies children who are at risk for communication impairment, may detect ASD, and may be a useful screening tool at the 18-month visit. Objectives To examine the screening test accuracy of the ITC at the 18-month visit to predict school readiness at kindergarten age. Design/Methods This prospective cohort study included children who attended primary care health supervision visits in Toronto, Canada. Parents completed the ITC at the 18-month visit and teachers completed the Early Development Instrument (EDI - a population-level measure of school readiness in kindergarten) at 4-6 years. An ITC screen is positive if there is concern for expressive speech delay (speech composite below the 10th percentile) and/or other communication delay (social composite, symbolic composite or the total score below the 10th percentile). Children were considered overall vulnerable on the EDI if at least one of five domains was below the 10th percentile of the Ontario population: language and cognitive development; physical health and well-being; social competence; emotional maturity; communication skills and general knowledge. We calculated screening test properties with 95% confidence intervals (CIs), using EDI vulnerability as the criterion measure. We used multivariable regression models to examine the association between the ITC and EDI domains. Results Of 293 children, 30 (10%) had a positive ITC. At follow-up, 54 (18%) children had a teacher-reported EDI vulnerability. The specificity (range, 87%-96%) and negative predictive value (range, 83%-95%) for the ITC were high; false positive rate was low (range, 4%-13%); sensitivity was low (range, 11%-37%). A positive ITC was associated with a lower score in EDI language and cognitive development (b= -0.62, 95% CI: -1.25, -0.18; P=0.046) and EDI communication skills and general knowledge (b= -1.08, 95% CI: -2.10, -0.17; P=0.036). We found no evidence of an association between ITC and EDI vulnerability. Conclusion The ITC at 18 months had high specificity (87%-96%) suggesting that most children with a negative ITC will demonstrate school readiness at 4-6 years. False positive rates were low, minimizing over-diagnosis. The ITC, with its focus on speech and language, communication disorders and ASD, may be a candidate for screening at the 18-month visit.
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Rae S, Ong F, Pullenayegum E, Carsley S, Hamilton J, Maguire J, Dennis CL, Birken C. 12 Reliability of Two-Person Anthropometric Measurement of Young Children with Parent Facilitator. Paediatr Child Health 2022. [PMCID: PMC9586101 DOI: 10.1093/pch/pxac100.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Body Mass Index is recommended by the World Health Organization for the measurement of growth and the diagnosis of overweight and obesity in children. The reliability of anthropometric measurements is important for assessment of child growth due to the challenges faced when measuring younger children, including the difficulty of having the child remain still during measurement collection. The current gold-standard for anthropometric measurement collection in children in a clinical research setting, set by the World Health Organization, requires the use of two trained anthropometrists. Objectives The purpose of this study was to determine the reliability of anthropometric measurements between two trained anthropometrists working in a pair and one trained anthropometrist working with a child’s parent/caregiver in a primary healthcare setting. Design/Methods An observational study to determine measurement reliability was conducted in a primary care child research network in Canada. 76 children 0 – 5 years old had their length/height, weight, head, arm, and waist circumference measured a total of four consecutive times: twice by two trained anthropometrists working in a pair (researcher-researcher team) and twice by one trained anthropometrist working with a child’s parent/caregiver (researcher-parent team). Inter- and intra- observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM) and the coefficient of reliability (R). Results The %TEM values across both age groups, children 0 - < 2 and 2 – 5 years of age, for length/height and weight were < 2% and the R coefficient values were >0.99, indicating a high degree of inter- and intra- observer reliability. The TEM values were greater for inter- and intra- observer reliability across all age groups for length/height in comparison to other anthropometric measurement parameters, with greater variation seen in the length for children 0 - < 2 years of age. The TEM values across both age groups for inter- and intra- observer reliability of arm circumference was outside of the acceptable range of < 2%, indicating greater measurement error. There was greater variation seen in waist circumference across both age groups. Conclusion This study suggests that anthropometric measurement, including length/height and weight, taken by one trained anthropometrist with the assistance of a parent/caregiver is reliable. These findings can be used to encourage the utilization of a child’s parent/caregiver to assist with anthropometric measurement collection in clinical setting(s) to enhance feasibility and efficiency and reduce the research costs of including a second trained anthropometrist.
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Kucab M, Keown-Stoneman C, Birken C, Perlman M, Maguire J. 89 Centre-based child care attendance in early childhood and adiposity in later childhood: a prospective cohort study. Paediatr Child Health 2022. [PMCID: PMC9586046 DOI: 10.1093/pch/pxac100.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background One in three children are living with overweight or obesity in North America. The burden of childhood obesity is disproportionately experienced by children from low-income families, who are more likely to have obesity. Centre-based child care attendance may influence important adiposity risk factors such as dietary intake, eating behaviour, and physical activity, but its impact on childhood obesity is unclear. Objectives The primary objective was to evaluate the relationship between the intensity of centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny’s). The secondary objective was to explore if family income modified the relationship. Design/Methods A prospective cohort study of children 1 to 10 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was intensity of centre-based child care attendance (hours/week). The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Interaction terms for child age and family income were explored. A linear mixed effects model and logistic generalized estimating equations were used to determine the association between centre-based child care attendance and child zBMI. Results 3,503 children were included (mean age: 2.7 years). Children who attended centre-based child care full time (40 hours/week) had a 0.11 lower zBMI at 4 years (95% CI -0.19, -0.03; p=0.005) and lower odds of obesity (zBMI > 2) at 4 (OR 0.58; 95% CI 0.34, 0.99; p=0.04) and 10 years of age (OR 0.52; 95% CI 0.29, 0.90; p=0.02) relative to children who attended non-centre-based child care. The relationship was modified by family income such that, children from families with an income of <$50,000CDN who attended centre-based child care full time had a 0.35 (95% CI -0.56, -0.15; p=0.001), 0.34 (95% CI -0.54, -0.13, p=0.001) and 0.29 (95% CI -0.50, -0.07, p=0.009) lower zBMI at 4, 7 and 10 years of age, respectively, relative to children who attended non-centre-based child care. Conclusion Centre-based child care attendance in early childhood was associated with lower adiposity and odds of obesity in later childhood. This relationship was stronger for children who were from lower income families. Centre-based child care may be an effective early intervention to prevent childhood obesity.
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15
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Deveci A, Keown-Stoneman C, Maguire J, O'Connor D, Birken C. 53 The association between maternal preconception BMI and child zBMI growth rates. Paediatr Child Health 2022. [PMCID: PMC9586055 DOI: 10.1093/pch/pxac100.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Elevated body mass index (BMI) and rapid growth in early childhood are important predictors of obesity risk. While studies have identified an association between maternal preconception BMI and child BMI z-scores (zBMI), the association with zBMI growth rates during distinct growth periods is unclear. Objectives To assess the association between maternal preconception BMI and child zBMI growth rates and BMI z-scores, in children aged 0 to 10 years old. Additionally, to examine whether child sex and gestational weight gain (GWG) modify these associations. Design/Methods This longitudinal study consisted of healthy children (0 to 10 years) enrolled in a primary care practice-based research cohort. The exposure was maternal BMI measured during the preconception period, defined as the 2 years prior to pregnancy. The primary outcome was child zBMI growth, modeled with piecewise linear splines for age. The secondary outcome was repeated measures of child BMI z-scores. Piecewise linear mixed models were used to determine the association with growth, while linear mixed models were used for zBMI. Effect modification by child sex and GWG was explored. Results 499 children were included. Maternal preconception BMI had a small, but statistically significant association with child zBMI growth rates during some growth periods, with the strongest association from 0 to 4 months (0.007; p=0.004). Maternal preconception BMI was also associated with child zBMI; 1kg/m2 increase was associated with 0.03 zBMI increase (p=0.001). Child sex and maternal GWG did not modify these associations. Conclusion There is evidence to suggest an association between maternal preconception BMI and child zBMI growth and scores. In addition to maternal and pregnancy benefits, preconception interventions may have longer-term benefits for child growth. ![]()
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Tom K, De Silva N, Polack A, Singh K, Keown-Stoneman C, Maguire J, Birken C, Wong P. 11 Clinician Management of Childhood Dyslipidemia in the Community Setting. Paediatr Child Health 2022. [PMCID: PMC9586116 DOI: 10.1093/pch/pxac100.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Childhood dyslipidemia is a known risk factor for the development of cardiovascular disease (CVD) in adulthood. Although adverse health outcomes of dyslipidemias are rare in childhood, the atherosclerotic process begins in early life. An overlooked lifelong progression of disease may result in myocardial infarction and stroke in later life. There are currently no Canadian paediatric guidelines for lipid screening. Despite dyslipidemia identification, early treatment or management may not be initiated. Primary care providers (PCP) are well positioned to advise and reinforce cardiovascular health behaviours to minimize the risk of CVD and promote lifelong cardiovascular health. Objectives To describe clinician practice patterns associated with childhood dyslipidemia management in the community setting. Design/Methods A retrospective chart review was conducted for children 2 to 10 years of age with abnormal lipid profiles. Participants were recruited from a practice-based research network. Non-fasting blood samples were obtained. The primary study outcome was the proportion of physicians engaging in each step of management practice. R version 3.6.2 (R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analysis. Results Among 462 children identified with dyslipidemia, all were seen by PCP at their next follow-up visit. PCP rarely informed families about abnormal lipid profiles. PCP frequently counselled on diet and eating habits (n=424, 95.1%), but less often on physical activity (n=154, 34.5%), screen time (n=24, 5.4%), and sleep (n=1, 0.2%). Family history of CVD, diabetes, high cholesterol, or hypertension was infrequently discussed (n=5, 1.1%). PCP repeated fasting lipid profiles uncommonly (n=20, 4.5%). Management plans for abnormal lipid profiles were not documented. Only one participant had a follow-up visit (n=1, 0.2%). Referrals were rarely made to dieticians (n=2, 0.4%) and were not in response to abnormal lipid levels. Conclusion Dyslipidemia in childhood is a risk factor for the development of adult cardiovascular disease. Among children with abnormal lipid profiles, our study showed PCP rarely identified and initiated early management for abnormal lipid levels. Our results may inform the need for paediatric lipid screening and management guidelines to develop best clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter Wong
- Hospital for Sick Children, University of Toronto
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17
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Rothwell SA, Forber KJ, Dawson CJ, Salter JL, Dils RM, Webber H, Maguire J, Doody DG, Withers PJA. A new direction for tackling phosphorus inefficiency in the UK food system. J Environ Manage 2022; 314:115021. [PMID: 35483277 DOI: 10.1016/j.jenvman.2022.115021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 06/14/2023]
Abstract
The UK food system is reliant on imported phosphorus (P) to meet food production demand, though inefficient use and poor stewardship means P is currently accumulating in agricultural soils, wasted or lost with detrimental impacts on aquatic environments. This study presents the results of a detailed P Substance Flow Analysis for the UK food system in 2018, developed in collaboration with industry and government, with the key objective of highlighting priority areas for system interventions to improve the sustainability and resilience of P use in the UK food system. In 2018 the UK food system imported 174.6 Gg P, producing food and exportable commodities containing 74.3 Gg P, a P efficiency of only 43%. Three key system hotspots for P inefficiency were identified: Agricultural soil surplus and accumulation (89.2 Gg P), loss to aquatic environments (26.2 Gg P), and waste disposal to landfill and construction (21.8 Gg P). Greatest soil P accumulation occurred in grassland agriculture (85% of total accumulation), driven by loadings of livestock manures. Waste water treatment (12.5 Gg P) and agriculture (8.38 Gg P) account for most P lost to water, and incineration ashes from food system waste (20.3 Gg P) accounted for nearly all P lost to landfill and construction. New strategies and policy to improve the handling and recovery of P from manures, biosolids and food system waste are therefore necessary to improve system P efficiency and reduce P accumulation and losses, though critically, only if they effectively replace imported mineral P fertilisers.
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Affiliation(s)
- S A Rothwell
- Lancaster Environment Centre, Lancaster University, Lancaster, UK.
| | - K J Forber
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | | | - J L Salter
- Agricultural Industries Confederation, Peterborough, UK
| | - R M Dils
- Environment Agency, Wallingford, UK
| | - H Webber
- Department for Environment, Food & Rural Affairs, London, UK
| | - J Maguire
- Department for Environment, Food & Rural Affairs, London, UK
| | - D G Doody
- Agri Food and Biosciences Institute, Belfast, Northern Ireland, UK
| | - P J A Withers
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
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Massara P, Keown-Stoneman C, Maguire J, Bandsma R, Comelli E, Birken C. The Association between Longitudinal BMI Patterns in Children and their Parents. Curr Dev Nutr 2022. [PMCID: PMC9194168 DOI: 10.1093/cdn/nzac070.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives Parental (maternal and paternal) weight before and after pregnancy has been associated with an increased risk of obesity in the offspring. However, less is known on the longitudinal association between parental and child growth trajectories across early childhood. This work aims to describe parental and child body mass index (BMI) trajectory patterns from birth until adolescence and assess their association. Methods We analyzed 1537 single-child families participating in the Applied Research Group for Kids (TARGet Kids! ) cohort (ON, Canada). Children and their parents had repeated measurements of weight and length or height from child's birth to 13 years during scheduled visits with their primary care physician. These measurements were used to calculate BMI for parents and age and sex adjusted BMI z-scores (zBMI) for children based on the World Health Organization. Latent class mixed modeling was used to identify children and parental growth patterns. A loglinear analysis was conducted to study the tri-party interaction between child, maternal, paternal longitudinal patterns. Jaccard distance was used to assess cluster similarity. Results We identified two distinct patterns in children (normal, increasing obesity), mothers (normal, increasing obesity), and fathers (overweight, obesity). The three-way loglinear analysis indicated that the tri-party interaction between children, maternal and paternal growth patterns interaction was significant (χ2 (1) = 15.1, p < .001). 92.1% of children in the normal pattern had mothers in the normal pattern and fathers in the overweight pattern. Cluster similarity was 63% for mothers and children, but 12.5% between fathers and children, with most children from the increasing obesity group with a father in the overweight group. Conclusions There is a significant tri-party association between children, maternal and paternal BMI patterns from birth to adolescence. Future studies should aim in studying eating and other health behaviors associated with these relationships at the family level. Funding Sources Joannah and Brian Lawson Center for Child Nutrition, Ontario Graduate Scholarship, Canadian Institutes of Health Research.
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Kucab M, Keown-Stoneman C, Birken C, Perlman M, Maguire J. Centre-Based Child Care Attendance in Early Childhood and Growth in Later Childhood: A Prospective Cohort Study. Curr Dev Nutr 2022. [PMCID: PMC9193996 DOI: 10.1093/cdn/nzac070.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives Attending centre-based child care in early childhood may influence important health behaviours including nutrition, physical activity and routines related to child growth and weight status. The primary objective was to evaluate the relationship between centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny's). The secondary objective was to explore if family income and child age modified the relationship. Methods A prospective cohort study of children aged 1 to 10 years was conducted through the TARGet Kids! primary care research network. The exposure was centre-based child care attendance (hours/week). Outcomes were zBMI and odds of overweight and obesity (zBMI > 1). Interaction terms for child age and family income were explored. Linear mixed effect models and logistic generalized estimating equations were used. Results 3,503 children who attended child care were included (mean age: 2.7 years at baseline). Children who attended centre-based care full-time (40 hours/week) had a 0.11 (95% CI: −0.19, −0.03; p = 0.01) lower zBMI at 4 and 7 years of age and lower odds of overweight/obesity at 4 years of age (OR 0.78; 95% CI 0.62, 0.97; p = 0.03) relative to children who attended non-centre-based care. Children from families with income < $50,000CDN who attended centre-based care full time had a 0.32 (95% CI: −0.50, −0.14; p = 0.001) lower zBMI and lower odds of overweight/obesity (OR 0.52; 95% CI: 0.28, 0.99; p = 0.05) at 10 years of age relative to children who attended non-centre-based care. Conclusions Attending centre-based child care in early childhood was associated with a lower zBMI and lower odds of overweight/obesity in later childhood, and associations were stronger for children from lower income families. Centre-based child care may be an effective early intervention for the prevention of childhood obesity. Funding Sources Canadian Institutes of Health Research (CIHR).
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Giannoumis M, Mok E, Borkhoff CM, Birken CS, Maguire J, Parkin PC, Li P, Constantin E. Association of accelerometry-derived social jetlag and sleep with temperament in children less than 6 years of age. J Clin Sleep Med 2022; 18:1993-1999. [PMID: 35532114 PMCID: PMC9340604 DOI: 10.5664/jcsm.10056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Social jetlag (SJL) measures the discrepancy between circadian and social clocks. Using accelerometry-derived data, our objective was to assess the prevalence of SJL in young healthy children and determine the association of SJL and sleep with temperament. METHODS Of 117 children participating in TARGet Kids!, a Canadian cohort of healthy preschool-aged children, 78 children (39 girls (50%)); mean age [SD]: 35.1[20.5] months) were included. Sleep was measured objectively using accelerometry. Temperament dimensions (surgency, negative affectivity, and effortful control) were assessed with the very short forms of Rothbart's child and infant behavior questionnaires. We examined associations of SJL and sleep with temperament using multivariable linear regression models adjusted for sex, age, ethnicity, and preschool/daycare attendance. RESULTS 20 out of 78 (25.6%) experienced SJL of greater than 30 minutes. SJL was greater in children who attended preschool/daycare compared with children who did not (26.3[18.8]min vs. 17.6[14.8]min; p<0.05). There was no evidence of an association between SJL and any temperament dimension. We found evidence of an association between increased sleep duration and increased negative affectivity scores (longer 24h sleep (ß:0.347, 95% CI:0.182,0.512, p<0.0001); longer nighttime sleep duration (ß:0.413, 95% CI:0.163,0.663, p=0.002)). CONCLUSIONS In our cohort, 1 in 4 preschool-aged children experienced SJL. Increased sleep duration was associated with increased negative affect, which could have implications for children developing internalizing behavior such as depression or low-self-esteem. We found that sleep duration, but not SJL, was associated with temperament and may impact daytime behavior of young children.
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Affiliation(s)
| | - Elise Mok
- Research Institute, McGill University Health Centre, Montreal, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jonathon Maguire
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Canada
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Patricia Li
- Research Institute, McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Evelyn Constantin
- Research Institute, McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
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21
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Younis M, Barnhill SW, Maguire J, Pretell-Mazzini J. Management of humeral impending or pathological fractures with intramedullary nailing: reaming versus non reaming technique-a retrospective comparative study. Musculoskelet Surg 2022; 106:35-41. [PMID: 32451845 DOI: 10.1007/s12306-020-00668-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To compare reamed intramedullary nailing (RIM) versus un-reamed intramedullary nailing (URIM) for the treatment of impending and pathological fractures of the humeral shaft in terms of 24-h postoperative pain, blood transfusion requirements, surgical time, surgical complications, medical complications, length of stay and consolidation rates. METHODS A retrospective comparative study between January 2013 and December 2018 was conducted. Student's t test, Mann-Whitney U and Chi-square tests were used to detect differences within the two study groups. Multiple linear regression was done to adjust for possible confounders. RESULTS A total of 53 patients (33 RIM vs. 20 URIM) underwent humeral nailing. Fifteen (28%) were impending fractures (7 RIM vs. 8 URIM). Multiple myeloma (49%) and metastatic carcinoma (39.6%) were the most common etiologies. Pain score (5.13 ± 0.68 RIM vs. 6.78 ± 0.62 URIM; p = 0.082) and total dose of opioids (33.125 ± 27.6 RIM vs. 33.3 ± 22.28 URIM; p = 0.462) showed similar results. Blood transfusion was more prevalent within RIM group (34.48% RIM vs. 20% URIM; p = 0.044) with a clinical tendency of higher blood loss (207.86 ± 150.83RIM vs. 127.00 ± 179.98 URIM; p = 0.092). There was a consolidation rate of 71.05% (27/38) with no statistical difference (73.08% (19/26) RIM vs. 66.67% (8/12) URIM; p = 0.685). CONCLUSION Our study suggests possible benefit of URIM in terms of less blood transfusions with no difference in consolidation rates. Even though without significance, a tendency to less blood loss, less events of systemic complication and lower length of stay was observed with URIM. Despite its limitations, this study can be used to design future prospective ventures that quantify patient-reported outcomes and provide more clear evidence.
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Affiliation(s)
- M Younis
- Department of Orthopaedic Surgery, University of Miami Hospital, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - S W Barnhill
- Department of Orthopaedic Surgery, University of Miami Hospital, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - J Maguire
- Department of Education, University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - J Pretell-Mazzini
- Department of Orthopaedic Surgery, University of Miami Hospital, 1400 NW 12th Ave, Miami, FL, 33136, USA.
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22
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Persaud N, Woods H, Workentin A, Adekoya I, Dunn JR, Hwang SW, Maguire J, Pinto AD, O'Campo P, Rourke SB, Werb D. Recommandations pour une reprise équitable après la pandémie de COVID-19 au Canada. CMAJ 2022; 194:E60-E72. [PMID: 35039395 PMCID: PMC8900790 DOI: 10.1503/cmaj.210904-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont.
| | - Hannah Woods
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Aine Workentin
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Itunu Adekoya
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - James R Dunn
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Stephen W Hwang
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Jonathon Maguire
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Andrew D Pinto
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Patricia O'Campo
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Sean B Rourke
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Daniel Werb
- Centre MAP pour des solutions en santé urbaine (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), Hôpital St. Michael du Réseau hospitalier Unity Health Toronto; Faculté de médecine (Persaud, Hwang, Maguire, Pinto) et Département de psychiatrie (Rourke), Faculté de médecine, Université de Toronto, Toronto, Ont
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23
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Persaud N, Woods H, Workentin A, Adekoya I, Dunn JR, Hwang SW, Maguire J, Pinto AD, O'Campo P, Rourke SB, Werb D. Recommendations for equitable COVID-19 pandemic recovery in Canada. CMAJ 2021; 193:E1878-E1888. [PMID: 37578741 PMCID: PMC8677581 DOI: 10.1503/cmaj.210904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Aine Workentin
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Itunu Adekoya
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - James R Dunn
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Jonathon Maguire
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Andrew D Pinto
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Daniel Werb
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
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24
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Li X, Vanderloo L, Maguire J, Keown-Stoneman C, Aglipay M, Anderson L, Cost K, Charach A, Vanderhout S, Birken C. 39 Physical and social distancing measures and child health behaviours during COVID-19: A cohort study. Paediatr Child Health 2021. [PMCID: PMC8689857 DOI: 10.1093/pch/pxab061.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Primary Subject area
Public Health and Preventive Medicine
Background
Various studies have examined the general impact of the COVID-19 outbreak on children’s health behaviours. The impact of public health measures practised by children during COVID-19 is relatively unknown.
Objectives
The primary objective was to determine the association between physical and social distancing measures and children’s outdoor time, sleep duration, and screen time during COVID-19.
Design/Methods
A longitudinal study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) between April 14 and July 15, 2020. Parents were asked to complete questionnaires about isolation, physical distancing practices, and children’s health behaviours. The primary exposure was the average number of days that children practised physical and social distancing measures per week. The three outcomes were children’s outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed effects models were fitted using repeated measures of primary exposure and outcomes.
Results
This study included 554 observations from 265 children. Physical and social distancing measures were associated with shorter outdoor time (-17.2; 95% CI -22.07, -12.40; p < 0.001) and longer total screen time (11.3; 95% CI 3.88, 18.79; p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (< 5 years), and the associations with total screen time were stronger in females and in older children (≥ 5 years).
Conclusion
Physical and social distancing measures during COVID-19 have resulted in negative impacts on the health behaviours of Canadian children living in a large metropolitan area.
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Abraham GR, Nyimanu D, Kuc R, Maguire J, Davenport AP, Hoole SP. Transmyocardial extraction of endothelin-1 correlates with increased microvascular resistance following percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Coronary microvascular dysfunction (CMD) can persist following successful percutaneous coronary intervention (PCI). Endothelin-1 (ET-1) is a potent vasoconstrictor and may be an important mediator of CMD. We sought to assess the trans-myocardial gradient (TMG – coronary sinus minus coronary root levels) of ET-1 and its precursor - Big ET-1 and assess the correlation with pressure-wire indices of CMD: coronary flow reserve (CFR) and index of microvascular resistance (IMR).
Methods
Paired blood samples from the aortic root and coronary sinus were collected before and after pressure wire guided PCI from patients with stable angina. Plasma was then analysed using specific enzyme linked immunosorbent assay (ELISA) for quantification of ET-1 and Big ET-1 and correlated with pressure-wire data.
Results
Samples were analysed from 66 patients. Both mean ET-1 and Big ET-1 concentrations increased post-PCI in both the aorta (ET-1: 1.0±0.4 pg/ml to 1.4±0.4 pg/ml, p<0.0001 and Big ET-1: 2.8±1.3 pg/ml to 3.4±1.6 pg/ml, p<0.0001) and coronary sinus (ET-1: 1.0±0.3 pg/ml to 1.2±0.3 pg/ml, p=0.03 and Big ET-1: 3.2±1.7 pg/ml to 3.8±1.5 pg/ml, p=0.01). TMG extraction of ET-1 increased following PCI: 0.05±0.25 pg/ml vs.-0.20±0.41 pg/ml, p=0.01. In contrast, there was TMG release of Big ET-1 before and after PCI: 0.46±1.26 pg/ml vs. 0.38±1.03 pg/ml, p=0.52. ET-1 extraction correlated with IMR post-PCI (Pearson's r=0.293, p=0.02). Patients with CFR<2 post-PCI demonstrated a numerical trend towards higher mean ET-1 extraction than those with preserved CFR post-PCI (0.30±0.51 pg/ml vs. 0.16±0.42 pg/ml, p=0.31) as did those with criteria for Type 4a Myocardial Infarction compared with those without (0.39±0.57 vs. 0.15±0.41, p=0.11).
Conclusions
ET-1 and Big ET-1 significantly increase post-PCI. Trans-myocardial extraction of ET-1 increases post-PCI and correlates with post-PCI CMD.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jon Moulton Charity Trust.NIHR Cambridge Biomedical Research Centre Biomedical Resources Grant. TMG of ET-1 and Big ET-1ET-1 extraction and post-PCI IMR
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Affiliation(s)
- G R Abraham
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - D Nyimanu
- University of Cambridge, Cambridge, United Kingdom
| | - R Kuc
- University of Cambridge, Cambridge, United Kingdom
| | - J Maguire
- University of Cambridge, Cambridge, United Kingdom
| | | | - S P Hoole
- Royal Papworth Hospital, Cambridge, United Kingdom
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Vanderloo LM, Vanderhout SM, Tavares E, Maguire J, Straus S, Birken CS. Parent engagement in co-design of clinical trials: the PARENT trial. Trials 2021; 22:347. [PMID: 34001229 PMCID: PMC8130403 DOI: 10.1186/s13063-021-05305-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 04/30/2021] [Indexed: 12/04/2022] Open
Abstract
Evidence generated from partnering with parents to design and conduct research together may be used to refine, adjust, and modify future research approaches. This study aimed to describe the initial approaches to parent engagement in the design of the PARENT trial as well as understand parent perspectives on the acceptability and relevance of the PARENT trial and potential barriers and facilitators to participation.Parents participating in the TARGet Kids! cohort were invited to participate in a focus group, called the PARENT panel, to co-design the PARENT trial. This focus group was conducted to capture diverse individual and collective parents' experiences. Overall methodological approaches for the PARENT panel were informed by the CIHR Strategy for Patient Oriented Research (SPOR) guiding principles (mutual respect, co-building, inclusiveness, and support) for patient engagement in research, and facilitated through the Knowledge Translation Program in the Li Ka Shing Knowledge Institute at Unity Health Toronto. Using a Nominal Group Technique, the PARENT panel provided feedback on the feasibility, relevance, and acceptability of the proposed intervention. Findings from this work will be used to further refine, adjust, and modify the next iteration of the PARENT trial, which will also serve as an opportunity to discuss the efforts made by researchers to incorporate parent suggestions and what additional steps are required for improved patient engagement.
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Affiliation(s)
- Leigh M Vanderloo
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
- School of Occupational Therapy, Health & Rehabilitation Sciences, Western University, London, Canada.
| | - Shelley M Vanderhout
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Erika Tavares
- Genetics and Genome Biology, The Hospital for Sick Children Research Institute [Parent representative], Toronto, Canada
| | - Jonathon Maguire
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Straus
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Abstract
Data collected longitudinally as part of usual health care is becoming increasingly available for research, and is often available across several centres. Because the frequency of follow-up is typically determined by the patient's health, the timing of measurements may be related to the outcome of interest. Failure to account for the informative nature of the observation process can result in biased inferences. While methods for accounting for the association between observation frequency and outcome are available, they do not currently account for clustering within centres. We formulate a semi-parametric joint model to include random effects for centres as well as subjects. We also show how inverse-intensity weighted GEEs can be adapted to account for clustering, comparing stratification, frailty models, and covariate adjustment to account for clustering in the observation process. The finite-sample performance of the proposed methods is evaluated through simulation and the methods illustrated using a study of the relationship between outdoor play and air quality in children aged 2-9 living in the Greater Toronto Area.
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Affiliation(s)
- Eleanor M Pullenayegum
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine Birken
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, St Michael's Hospital, Toronto, ON, Canada
| | - Jonathon Maguire
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, St Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
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28
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Murad A, Maguire J, Bergfeld W. Drug-induced alopecia areata? Clin Exp Dermatol 2020; 46:363-366. [PMID: 32681530 DOI: 10.1111/ced.14381] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/14/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A Murad
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.,Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - J Maguire
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - W Bergfeld
- Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, OH, USA
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29
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Peng W, Maguire J, Hayen A, Adams J, Sibbritt D. How to increase the value of self-reported health service data by using data linkage: a case study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
This is a case study for recurrent stroke prevention. Lifestyle factors account for about 80% of the risk of recurrent stroke. Most health services studies examining stroke prevention rely on stroke survivors' self-reported lifestyle behaviour data. How can researchers increase the value of collected self-reported data to provide additional information for more comprehensive assessments?
Methods
45 and Up Study is the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. This case study linked self-reported longitudinal lifestyle data in the 45 and Up Study, with corresponding mortality data (i.e. NSW Registry of Births, Deaths and Marriages & NSW Cause of Death Unit Record File) and hospital data (i.e. NSW Admitted Patient Data Collection) via the Centre for Health Record Linkage (CHeReL). The main outcome measures are health services, clinical outcomes, and mortality rates for stroke care. The analyses will include descriptive analysis, multivariate regression analysis, and survival analysis.
Results
A total of 8410 stroke survivors who participated in the 45 and Up Study were included in this data linkage study. From January 2006 to December 2015, 99249 hospital claims (mean: 13 times admission to hospital per person) and 2656 death registration records have been linked to these participants. The mean age of the stroke survivors was 72 (SD = 11) years, with 56% being males. These results are preliminary and more analyses will be conducted by using quality of life status, clinical diagnosis, comorbidities, and procedures.
Conclusions
Data linkage enables researchers to generate comprehensive findings on health services studies and gain a more holistic understanding of the determinants and outcomes of stroke prevention with lower data collection costs and less burden on participants.
Key messages
Data linkage brings about a new opportunity for self-reported data on health services utilisation. It is a cost-effective way to enhance existing self-reported data via the data linkage approach to increase its usefulness for informing health service planning.
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Affiliation(s)
- W Peng
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - J Maguire
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - A Hayen
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - D Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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30
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Fuller A, Siddiqi A, Shahidi F, Anderson L, Keown-Stoneman C, Maguire J, Birken C. 114 Distributional Decomposition: A Novel Method for Understanding Inequities in Child Growth, Behavior and Development. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Income related inequities in child health are well-established, with children from lower income households showing increased risk of obesity, behavior problems, and delayed development. To facilitate clinical diagnosis, outcomes are conventionally measured in dichotomous terms. However, inequities may exist along the entire range of distribution, with implications for population health.
Objectives
Our primary objective was to examine differences in the distribution of three measures of child health by income: body mass index (BMI), behavior difficulties and development.
Design/Methods
This was a cross sectional study of children enrolled in a primary care practice-based research cohort. Our study included generally healthy children recruited from age 0-5 years. Dependent variables were 1) BMI z-score (zBMI) at 5 years; 2) behavior: total score on the Strengths and Difficulties Questionnaire (SDQ), measured at 3-5 years; 3) development: total score on the Infant Toddler Checklist (ITC), measured at 18-24 months. Independent variable was parent-reported annual household income (< $100,000 vs ≥ $100000). We then used distributional decomposition, which uses mathematical re-weighting to construct a counterfactual distribution that describes the distribution of the lower income group based on the predictor profile (child age, sex, birthweight, prematurity, breastfeeding duration; maternal age, education, immigration status, ethnicity) of the higher income group.
Results
Our study samples consisted of 1649 (zBMI), 764 (SDQ) and 761 (ITC) children. Mean BMI z-score was 0.16, median total difficulties score was 7, median ITC score was 48. Comparing distributions graphically (Figure 1), children with low income have a higher risk distribution for all outcomes; for example, children with low income were more likely to have BMI z-scores in the underweight and obese ranges. For each outcome, the counterfactual curve lower income children with the predictor profile of their higher income counterparts reduced inequities somewhat, particularly in the normal or low risk range, but not in the high-risk range. However, there were notable unexplained portions of inequity remaining.
Conclusion
In a cohort of generally healthy children, we found evidence of meaningful income-related inequities in the distribution of child zBMI, behavior difficulties, and development. Population health interventions aiming to mitigate these inequities by addressing common predictors may improve outcomes in the normal range; however targeted clinical interventions are likely required for those in the high-risk range.
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Affiliation(s)
- Anne Fuller
- Division of Paediatric Medicine, The Hospital for Sick Children, Department of Paediatrics, University of Toronto
| | | | | | - Laura Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University
| | - Charles Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute, Unity Health Toronto (St. Michael’s Hospital)
| | - Jonathon Maguire
- Li Ka Shing Knowledge Institute
- Department of Paediatrics, University of Toronto
| | - Catherine Birken
- Department of Paediatrics, University of Toronto
- Child Health Evaluative Sciences, SickKids Research Institute
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Vanderhout S, Keown-Stoneman C, Birken C, Thorpe K, O’Connor D, Maguire J. 61 Cow’s milk fat and child adiposity: a prospective cohort study. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
International guidelines recommend that children older than 2 years of age consume reduced fat (0.1-2%) instead of whole cow’s milk (3.25% fat) to prevent childhood obesity, but these guidelines are consensus-based and have a low GRADE level of evidence.
Objectives
The primary objective of this study was to evaluate the longitudinal relationship between cow’s milk fat (0.1-3.25%) intake and Body Mass Index z-score (zBMI) in children aged 9 months to 8 years. The secondary objective was to determine the relationship between cow’s milk fat intake and odds of overweight (zBMI >1) and obesity (zBMI > 2).
Design/Methods
A prospective cohort study of children 9 months to 8 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was cow’s milk fat consumption (skim (0.1%), 1%, 2%, or whole [3.25%]), measured by parental report. The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Height and weight were measured by trained research assistants and zBMI was determined according to the WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow’s milk fat intake and child zBMI.
Results
Among children aged 9 months to 8 years of age (N= 7467), each 1% increase in cow’s milk fat consumed was associated with a 0.05 lower zBMI score (95% CI -0.07 to -0.03, p< 0.0001). Compared to children who consumed reduced fat (0.1-2%) cow’s milk, there was evidence that children who consumed whole cow’s milk had 16% lower odds of overweight (OR=0.84, 95% CI 0.77 to 0.91), p< 0.0001) and 18% lower odds of obesity (OR= 0.82, 95% CI 0.68 to 1.00, p= 0.047).
Conclusion
Guidelines for reduced fat instead of whole cow’s milk during childhood may not be effective in preventing overweight or obesity. Randomized controlled trial data is needed to understand which cow’s milk fat optimizes child growth, development and nutrition.
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Wu L, Charach A, Keown-Stoneman C, Birken C, Constantin E, Maguire J, Stremler R. 73 Sleep Duration and Internalizing Symptoms in Children. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Emotional problems such as anxiety and low mood have been associated with sleep problems in children.
Objectives
This study’s objective was to assess the association between sleep duration and internalizing symptoms in children age 5-12 years (y). Next, we evaluated whether meeting the National Sleep Foundation’s guidelines for sufficient sleep (≥10 hours, age 3-5; ≥9, age 6-12) is associated with internalizing symptoms.
Design/Methods
A cross-sectional study in N = 800 healthy children ages 5-12y, recruited from primary care physicians’ offices in Toronto, Canada was conducted through TARGet Kids! research network. Using linear regression, we investigated the association between parent reported sleep duration (hours) and parent reported internalizing symptoms using the Strengths and Difficulties Questionnaire (SDQ), controlling for child age, sex, zBMI, family composition, and maternal education.
Results
The adjusted model showed an inverse association between sleep duration and internalizing symptoms (β estimate = -0.33 (95%CI -0.57, -0.07), p=0.011). Of children aged 6-12y, 36 (6%), and of those aged 5y, 28 (14%) did not meet guidelines for sufficient sleep. Insufficient sleep was inversely associated with internalizing symptoms (β estimate = -0.70 (-1.38, -0,02), p=0.044). However, the association attenuated slightly once adjusted for child age, sex, zBMI, family composition, and maternal education (β estimate = -0.64 (-1.38, 0.10), p=0.088).
Conclusion
There is evidence that a parent reported decrease in sleep of 3 hours is associated with a small (1 point) increase on the internalizing scale in children between 5 and 12 years. The primary limitation is that sleep duration and internalizing symptoms were reported by parents.
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Elliott L, Maguire J, Birken C, Keown-Stoneman C, Jenkins D. 88 Vegetarian diet, growth and micronutrient stores in childhood: A prospective cohort study. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vegetarian diets are becoming increasingly popular among Canadians, yet few studies have evaluated the relationship between a vegetarian diet and childhood growth and nutritional status. Since vegetarian diets can be less energy dense and may have lower micronutrient content, we hypothesized that a vegetarian diet may affect childhood growth including lower adiposity and height, as well as lower micronutrient stores.
Objectives
The primary objective of this study was to evaluate the relationship between vegetarian diet and growth, including adiposity and height among healthy children 6 months to 10 years of age. Secondary objectives included the examination of the relationship between vegetarian diet and iron and vitamin D stores. We also explored whether cow’s milk intake or age modified the associations between vegetarian diet and growth, and micronutrient stores.
Design/Methods
This was a prospective cohort study of healthy children age 6 months to 10 years. The primary exposure was vegetarian diet measured by parent report. The primary outcome was BMI z-score. Secondary outcomes included height-for-age z-score, serum ferritin, and serum 25-hydroxyvitamin D. Anthropometric measures and venous blood samples were collected at health supervision visits by trained research assistants. Linear mixed effect modelling was used to determine the association between vegetarian diet, growth, and micronutrient stores.
Results
A total of 8912 children (n = 248 vegetarian) participated. In the adjusted models there was no evidence of an association between vegetarian diet and BMI z-score (p = 0.605, 95% CI: -0.06, 0.10), height-for-age z-score (p 0.057, 95% CI: -0.16, 0.002), serum ferritin (p = 0.768, 95% CI: -3.84, 2.84), or 25-hydroxyvitamin D (p = 0.204, 95% CI: -2.14, 0.46). The relationship between vegetarian diet and serum 25-hydroxyvitamin D was modified by child age. Volume of cow’s milk intake did not modify the relationships between vegetarian diet and BMI z-score, height-for-age z-score, serum ferritin, or 25-hydroxyvitamin D. In a secondary analysis, we examined adiposity through weight status categories and found children with a vegetarian diet had higher odds of being underweight (BMI z-score <-2) (OR 1.9, p = 0.006, 95% CI 1.21-3.00).
Conclusion
In this prospective cohort study, evidence of an association between vegetarian diet and lower BMI z-score, height-for-age z-score, and micronutrient stores was not found. Our results suggest children with vegetarian diets had higher odds of being underweight. Future research is needed to evaluate dietary factors and patterns of children following vegetarian diets, especially those with an underweight weight status.
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Affiliation(s)
- Laura Elliott
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Jonathon Maguire
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Paediatrics, St. Michael’s Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Canada
| | - Catherine Birken
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charles Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Clinical Nutrition and Risk Factor Modification Centre St. Michael’s Hospital, Toronto, Canada
- Division of Endocrinology and Metabolism St. Michael’s Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
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Massara P, Bandsma R, Bourdon C, Maguire J, Comelli E, Birken C, Keown-Stoneman CDG. Outlier Detection in Growth Data: Beyond Biologically Implausible Values. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa056_021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Eliminating anthropometry measurement error and employing outlier and biological implausible values (BIV) detection methods adapted to longitudinal measurements is important for the study of growth. This work aimed to review and assess the accuracy of the available BIV and outlier detection methods and propose a growth trajectory outlier detection method.
Methods
We included 2354 infants from the Applied Research Group for Kids (TARGet Kids! ) cohort-based in Toronto (ON, Canada) that recruits healthy children from birth to 5 years of age. We considered infants with at least 8 length and weight measurements available between the 1st and the 24th month of age. Weight-for-length z-scores (wflz) were calculated using the WHO growth standards. Outlier measurements were randomly introduced in 5% of the wflz measurements using a normal distribution (μ = 0, σ = 1). We employed 4 outlier detection methods; an empirical detection method for BIV using the cut-offs derived from the WHO Child Growth Standards, a clustering method, a method based on cluster prototypes for individual outlier measurements and a method based on cluster prototypes for entire growth trajectories. Each method was applied individually and evaluated using the sensitivity and specificity indexes based on the manually introduced outliers. We also calculated the Kappa statistic to evaluate the agreement of each method against the manual outliers.
Results
After excluding premature (<37 weeks), low birth weight (<1500 g) neonates and children with missing length and weight measurements, we analyzed 393 children with a total of 3144 measurements. Sensitivity and specificity for the four methods ranged between 4.4%–55.0% and 83.7% −99.7%, respectively, with kappa being non-significant (P > 0.05) only for the empirical. The clustering detection method reported a higher finding rate, while the empirical method found most of the BIV, but few of the rest of the outliers.
Conclusions
BIV account for a small portion of the possible outliers in growth datasets. We show that additional statistical or model-based methods are required for a more comprehensive outlier detection process, which has implications for growth analysis and nutritional assessment.
Funding Sources
Joannah and Brian Lawson Center for Child Nutrition, Connaught Fund, Onassis Foundation.
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Affiliation(s)
| | - Robert Bandsma
- Translational Medicine Program, The Hospital for Sick Children, Canada
| | - Celine Bourdon
- Translational Medicine Program, The Hospital for Sick Children, Canada
| | - Jonathon Maguire
- University of Toronto & Li Ka Shing Knowledge Institute -St. Michael's Hospital
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35
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Joachim KC, Farid-Kapadia M, Butcher NJ, Chee-A-Tow A, Monsour A, Cohen E, Mahant S, Guttmann A, Offringa M, Maguire J, Hogan A, Major‐Cook N, Oppedisano S, Patel H, Soscia J, Stack N, Van Biervliet S. Core outcome set for children with neurological impairment and tube feeding. Dev Med Child Neurol 2020; 62:201-206. [PMID: 31372989 DOI: 10.1111/dmcn.14326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/25/2022]
Abstract
AIM To develop a core outcome set (COS) for evaluating gastrostomy/gastrojejunostomy tube impact in children with neurological impairment. METHOD Healthcare providers/researchers and caregivers rated the importance of candidate outcomes on a 5-point Likert scale. Outcomes rated 'somewhat important' or 'very important' by most (≥85%) respondents were voted on during a consensus meeting. Outcomes that reached consensus for inclusion were ratified and assigned to Outcome Measures in Rheumatology filter core areas. The COS was validated in a separate group of caregivers. RESULTS Twelve outcomes were selected from 120 candidate outcomes to form the COS. These included five 'Life Impact' outcomes, three 'Pathophysiological Manifestations' outcomes, two 'Resource Use' outcomes, one 'Growth and Development' outcome, and one 'Death' outcome. INTERPRETATION We developed an evidence-informed and consensus-based COS for use in studies of gastrostomy/gastrojejunostomy tube feeding in children with neurological impairment. Implementation of this COS will help reduce heterogeneity between studies and facilitate evidence-based decision-making. WHAT THE PAPER ADDS Caregivers, healthcare providers, and researchers ranked the importance of 120 outcomes. Twelve core outcomes were identified as essential to measure in future clinical research studies.
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Affiliation(s)
- Kariym C Joachim
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Mufiza Farid-Kapadia
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada.,Paediatrics Outcomes Research Team, Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, Toronto, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada.,Paediatrics Outcomes Research Team, Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Paediatrics Outcomes Research Team, Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, Toronto, Ontario, Canada
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, Faculty of Medicine and Dentistry and .,Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathon Maguire
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; and.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics and
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37
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Weldon P, Cove J, Maguire J. WS14-6 Psychological resilience in adults with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Gibson E, Aglipay M, Keown-Stoneman C, Birken C, Thorpe K, O’Connor D, Parkin P, Maguire J. 58 Effect of high vs. standard dose wintertime vitamin D supplementation on adiposity in young healthy children: A secondary analysis of a pragmatic RCT. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Aglipay M, Birken C, Dai D, Parkin P, Maguire J. 70 High Dose Vitamin D for the Prevention of Wheezing in Preschoolers: A Secondary Analysis of a Randomized Clinical Trial. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Omand J, Janus M, Maguire J, Parkin P, Birken C. 62 Nutritional risk in early childhood and later school concern outcomes. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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Soczynska I, Maguire J, Birken C, O’Connor D, Dai D, Aglipay M, Keown-Stoneman C. 59 Age of introduction to cow milk and childhood growth. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Izabela Soczynska
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon Maguire
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael’s Hospital, Toronto, Ontario, Canada
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine Birken
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Deborah O’Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David Dai
- Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mary Aglipay
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Charles Keown-Stoneman
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Biostatistics at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Vanderhout S, Aglipay M, Maguire J, Juando-Prats C. 60 CoMFORT: Cow Milk Fat Obesity pRevention Trial Feasibility Study. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Samtani B, Gray N, Omand J, Keown-Stoneman C, Aglipay M, Birken C, Maguire J. 21 The association between early life exposure to antibiotics and antibiotics for upper respiratory tract infections in later childhood. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bhavna Samtani
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Natasha Gray
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Jessica Omand
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Charles Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
| | - Mary Aglipay
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
| | - Catherine Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Jonathon Maguire
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
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Vanderhout S, Aglipay M, Maguire J, Birken C, Thorpe K, O’Connor D, Torabi N. 61 Cow’s milk fat & child adiposity: a systematic review and meta-analysis. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Loeb M, Dang AD, Thiem VD, Thanabalan V, Wang B, Nguyen NB, Tran HTM, Luong TM, Singh P, Smieja M, Maguire J, Pullenayegum E. Effect of Vitamin D supplementation to reduce respiratory infections in children and adolescents in Vietnam: A randomized controlled trial. Influenza Other Respir Viruses 2019; 13:176-183. [PMID: 30328294 PMCID: PMC6379634 DOI: 10.1111/irv.12615] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/11/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022] Open
Abstract
Background It is uncertain whether vitamin D can reduce respiratory infection. Objective To determine whether vitamin D supplementation reduces influenza and other upper viral respiratory tract infections. Methods A total of 1300 healthy children and adolescents between the ages of 3 and 17 years were randomized to vitamin D (14 000 U weekly) or placebo for 8 months in Vietnam. The primary outcome was reverse transcriptase (RT)‐PCR–confirmed influenza infection, and the coprimary outcome was multiplex PCR–confirmed non‐influenza respiratory viruses. Participants, caregivers, and those assessing outcomes were blinded to group assignment. Results A total of 650 children and adolescents were randomly assigned to vitamin D and 650 to placebo. The mean baseline serum 25‐hydroxyvitamin D levels were 65.7 nmol/L and 65.2 nmol/L in the intervention and placebo groups, respectively, with an increase to 91.8 nmol/L in the vitamin D group and no increase, 64.5 nmol/L, in the placebo group. All 1300 participants randomized contributed to the analysis. We observed RT‐PCR–confirmed influenza A or B occurred in 50 children (7.7%) in the vitamin D group and in 43 (6.6%) in the placebo group (hazard ratio [HR]: 1.18, 95% CI: 0.79‐1.78). RT‐PCR–confirmed non‐influenza respiratory virus infection occurred in 146 (22.5%) in the vitamin D group and in 185 (28.5%) in the placebo group (hazard ratio [HR]: 0.76, 95% CI: 0.61‐0.94). When considering all respiratory viruses, including influenza, the effect of vitamin D in reducing infection was significant, HR: 0.81, 95% CI: 0.66‐0.99. Conclusion Vitamin D supplementation did not reduce the incidence of influenza but moderately reduced non‐influenza respiratory viral infection.
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Affiliation(s)
- Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Vu Dinh Thiem
- Department of Epidemiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Vitheya Thanabalan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Biao Wang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nguyen Binh Nguyen
- Department of Epidemiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Hung Thi Mai Tran
- Department of International Cooperation, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tan Minh Luong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Pardeep Singh
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathon Maguire
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Allan K, Fallon B, Maguire J, Tran D. 2473. How Does Acquiring a Vaccine-Preventable Disease Impact Parental and Physician Responses to Vaccine Hesitancy? Open Forum Infect Dis 2018. [PMCID: PMC6254935 DOI: 10.1093/ofid/ofy210.2126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kate Allan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Barbara Fallon
- St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathon Maguire
- St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Dat Tran
- Public Health Division, Oregon Health Authority, Portland, Oregon
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Lara-Corrales I, Huang CM, Parkin PC, Rubio-Gomez GA, Posso-De Los Rios CJ, Maguire J, Pope E. Vitamin D Level and Supplementation in Pediatric Atopic Dermatitis: A Randomized Controlled Trial. J Cutan Med Surg 2018; 23:44-49. [PMID: 30336685 DOI: 10.1177/1203475418805744] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by a pruritic eczematous rash. Evidence surrounding the role of serum vitamin D (VD) in modifying disease severity is inconsistent. OBJECTIVES: To determine whether VD levels are correlated with AD severity and the effects of VD supplementation on disease modification. METHODS: This was a 2-phase study, using a cross-sectional design to evaluate the relationship between VD level and severity, as well as a double-blinded, randomized control trial to elucidate the effects of VD supplementation. Patients aged 0 to 18 years with AD were included in phase 1, and disease severity and serum VD levels were determined. Those with renal, liver, or other dermatologic conditions were excluded. Patients with abnormal (<72.7 nmol/L) VD levels were eligible for phase 2 and to be randomized to either VD supplementation of 2000 IU/d or placebo. VD level and severity were assessed at baseline and 3 months. RESULTS: The 77 patients included in phase 1 had a mean (SD) age of 7.4 (4.5) years, and 45.5% (33/77) were female. Increased severity was significantly correlated with lower VD levels ( P = .015). Of the 45 patients included in phase 2, 21 and 24 were assigned to the supplementation and placebo arm, respectively. The mean (SD) change in severity did not differ significantly between the supplementation (15.35 [9.71]) and placebo (15.13 [8.97]) groups after 3 months of intervention ( P = .7). CONCLUSION: Although VD levels correlated with AD severity, VD supplementation did not significantly improve disease severity.
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Affiliation(s)
- Irene Lara-Corrales
- 1 Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Patricia C Parkin
- 3 Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | - Jonathon Maguire
- 3 Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elena Pope
- 1 Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Omand J, Maguire J, O'Connor D, Parkin P, Birken C, Thorpe K, Zhu J, To T. Comparing two asthma diagnoses using a prospective cohort of young children. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionAsthma is the most common chronic illness of childhood and places a large burden on the health care system. Asthma prevalence is commonly measured in national surveys by questionnaire. In Ontario, the Ontario Asthma Surveillance Information System (OASIS) developed a validated health claims diagnosis algorithm using health administrative data.
Objectives and ApproachThe primary objective of this study was to measure the agreement between the health claims diagnosis algorithm (OASIS diagnosis algorithm) and questionnaire diagnosis (TARGet Kids! diagnosis) of asthma in children younger than 6 years of age. Secondary objectives were to identify concordant and discordant pairs, and to identify factors associated with disagreement.
A comparison study including 3368 children participating in the TARGet Kids! practice based research network between 2008 and 2013 in Toronto, Canada. OASIS diagnosis algorithm and TARGet Kids! diagnosis asthma cases were compared using kappa statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
ResultsPrevalence of asthma was estimated to be 15% by the OASIS diagnosis algorithm and 7% by TARGet Kids! diagnosis. The Kappa statistic was 0.47 (95% CI: 0.42 – 0.51), sensitivity 82\%, specificity 90%, PPV 38% and NPV 98% for OASIS diagnosis algorithm using TARGet Kids! diagnosis as the criterion standard. There were 3011 concordant pairs (2820 true negatives and 191 true positives) and 357 discordant pairs (315 false positives and 42 false negatives). Statistically significant factors associated with false positives included: male sex, higher zBMI and history of allergy. No statistically significant factors associated with false negatives were identified.
Conclusion/ImplicationsOASIS diagnosis algorithm had high sensitivity, specificity, and NPV but low PPV relative to TARGet Kids! diagnosis of asthma. Although, the OASIS diagnosis may identify more asthma cases in young children, its diagnostic properties are similar in older children and it may be a useful tool for longitudinal asthma surveillance.
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Omand J, To T, O'Connor D, Parkin P, Birken C, Thorpe K, Maguire J. 25-hydroxyvitamin D and health service utilization for asthma in early childhood. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionAsthma is the most common chronic illness of childhood and a common reason for hospital admission. Studies suggest that low vitamin D levels may be associated with health service utilization (HSU) for childhood asthma.
Objectives and ApproachThe primary objective was to determine if vitamin D serum levels in early childhood were associated with HSU for asthma including: a) total HSU, b) hospital admissions, c) emergency department visits and d) outpatient sick visits. Secondary objectives were to determine whether vitamin D supplementation in pregnancy or childhood were associated with HSU for asthma. Prospective cohort study of children participating in the TARGet Kids! practice based research network. HSU was determined by linking each child's provincial health insurance number to health administrative databases. Multivariable quasi Poisson and logistic regression were used to evaluate the associations.
Results2926 healthy children ages 0-6 years had 25-hydroxyvitamin D data available and were included in the primary analysis. Mean (IQR) 25-hydroxyvitmain D level was 84 nmol/L (65-98 nmol/L), 218 and 1267 children had 25-hydroxyvitamin D levels <50 nmol/L and <75 nmol/L, respectively. In the adjusted models, there were no associations between 25-hydroxyvitamin D (continuously or dichotomized at 50 and 75 nmol/L), vitamin D supplementation in pregnancy or childhood and HSU for asthma.
Conclusion/ImplicationsHigher vitamin D blood values do not appear to be associated with HSU for asthma in this population of healthy urban children.
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Jean-St-Michel E, Meza JM, Maguire J, Coles J, McCrindle BW. Survival to Stage II with Ventricular Dysfunction: Secondary Analysis of the Single Ventricle Reconstruction Trial. Pediatr Cardiol 2018. [PMID: 29520465 DOI: 10.1007/s00246-018-1845-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ventricular dysfunction affects survival in patients with single right ventricle (RV), and remains one of the primary indications for heart transplantation. Since it is challenging to predict the capacity of patients with ventricular dysfunction to proceed to the stage II procedure, we sought to identify factors that would be associated with death or heart transplantation without achieving stage II for single RV patients with ventricular dysfunction after Norwood procedure. The Single Ventricle Reconstruction (SVR) trial public-use database was used. Patients with a RV ejection fraction less than 44% or a RV fractional area of change less than 35% on the post-Norwood echocardiogram were included. Parametric risk hazard analysis was used to identify risk factors for death or transplantation without achieving stage II. Of 365 patients with ventricular function measurements on the post-Norwood echocardiogram, 123 (34%) patients had RV dysfunction. The transplantation-free survival was significantly lower for those with ventricular dysfunction compared to those with normal function (log rank Chi-square = 4.23, p = 0.04). Furthermore, having a Blalock-Taussig (BT) shunt, a large RV, a post-Norwood infectious complication, and a surgeon who performs five or less Norwood per year were independent risk factors for death or transplantation without achieving stage II. The predicted 6-month transplantation-free survival for patients with all four identified risk factors was 1% (70% CI 0-13%). Early heart transplantation referral might be considered for post-Norwood patients with BT shunt and RV dysfunction, especially if other high-risk features are present.
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Affiliation(s)
- Emilie Jean-St-Michel
- Division of Cardiology, The Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - James M Meza
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, Department of Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Jonathon Maguire
- Li Ka Shing Knowledge Institute of St. Michael's hospital, Department of Pediatrics, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, M5B1W8, Canada
| | - John Coles
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, Department of Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Brian W McCrindle
- Division of Cardiology, The Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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