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McLeod SL, Tarride JE, Mondoux S, Paterson JM, Plumptre L, Borgundvaag E, Dainty KN, McCarron J, Ovens H, Hall JN. Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care. CMAJ 2023; 195:E1463-E1474. [PMID: 37931947 PMCID: PMC10627570 DOI: 10.1503/cmaj.230492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Virtual urgent care (VUC) is intended to support diversion of patients with low-acuity complaints and reduce the need for in-person emergency department visits. We aimed to describe subsequent health care utilization and outcomes of patients who used VUC compared with similar patients who had an in-person emergency department visit. METHODS We used patient-level encounter data that were prospectively collected for patients using VUC services provided by 14 pilot programs in Ontario, Canada. We linked the data to provincial administrative databases to identify subsequent 30-day health care utilization and outcomes. We defined 2 subgroups of VUC users; those with a documented prompt referral to an emergency department by a VUC provider, and those without. We matched patients in each cohort to an equal number of patients presenting to an emergency department in person, based on encounter date, medical concern and the logit of a propensity score. For the subgroup of patients not promptly referred to an emergency department, we matched patients to those who were seen in an emergency department and then discharged home. RESULTS Of the 19 595 patient VUC visits linked to administrative data, we matched 2129 patients promptly referred to the emergency department by a VUC provider to patients presenting to the emergency department in person. Index visit hospital admissions (9.4% v. 8.7%), 30-day emergency department visits (17.0% v. 17.5%), and hospital admissions (12.9% v. 11.0%) were similar between the groups. We matched 14 179 patients who were seen by a VUC provider with no documented referral to the emergency department. Patients seen by VUC were more likely to have a subsequent in-person emergency department visit within 72 hours (13.7% v. 7.0%), 7 days (16.5% v. 10.3%) and 30 days (21.9% v. 17.9%), but hospital admissions were similar within 72 hours (1.1% v. 1.3%), and higher within 30 days for patients who were discharged home from the emergency department (2.6% v. 3.4%). INTERPRETATION The impact of the provincial VUC pilot program on subsequent health care utilization was limited. There is a need to better understand the inherent limitations of virtual care and ensure future virtual providers have timely access to in-person outpatient resources, to prevent subsequent emergency department visits.
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Affiliation(s)
- Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Jean-Eric Tarride
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Shawn Mondoux
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - J Michael Paterson
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Lesley Plumptre
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Emily Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Katie N Dainty
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Joy McCarron
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Howard Ovens
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Justin N Hall
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
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Moin JS, Vigod SN, Plumptre L, Troke N, Asaria M, Papanicolas I, Wodchis WP, Brail S, Anderson G. Sex differences among children, adolescents and young adults for mental health service use within inpatient and outpatient settings, before and during the COVID-19 pandemic: a population-based study in Ontario, Canada. BMJ Open 2023; 13:e073616. [PMID: 37914301 PMCID: PMC10626835 DOI: 10.1136/bmjopen-2023-073616] [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: 03/14/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The pandemic and public health response to contain the virus had impacts on many aspects of young people's lives including disruptions to daily routines, opportunities for social, academic, recreational engagement and early employment. Consequently, children, adolescents and young adults may have experienced mental health challenges that required use of mental health services. This study compared rates of use for inpatient and outpatient mental health services during the pandemic to pre-pandemic rates. DESIGN Population-based repeated cross-sectional study. SETTING Publicly delivered mental healthcare in primary and secondary settings within the province of Ontario, Canada. PARTICIPANTS All children 6-12 years of age (n=2 043 977), adolescents 13-17 years (n=1 708 754) and young adults 18-24 years (n=2 286 544), living in Ontario and eligible for provincial health insurance between March 2016 and November 2021. PRIMARY OUTCOME MEASURES Outpatient mental health visits to family physicians and psychiatrists for: mood and anxiety disorders, alcohol and substance abuse disorders, other non-psychotic mental health disorders and social problems. Inpatient mental health visits to emergency departments and hospitalisations for: substance-related and addictive disorders, anxiety disorders, assault-related injuries, deliberate self-harm and eating disorders. All outcomes were analysed by cohort and sex. RESULTS During the pandemic, observed outpatient visit rates were higher among young adults by 19.01% (95% CI: 15.56% to 22.37%; 209 vs 175 per 1000) and adolescent women 24.17% (95% CI: 18.93% to 29.15%; 131 vs 105 per 1000) for mood and anxiety disorders and remained higher than expected. Female adolescents had higher than expected usage of inpatient care for deliberate self-harm, eating disorders and assault-related injuries. CONCLUSIONS Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolescents and young women, and highlights the need to better monitor and identify mental health outcomes associated with COVID-19 containment measures and to develop policies to address these concerns.
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Affiliation(s)
- John S Moin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | - Miqdad Asaria
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Irene Papanicolas
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Shauna Brail
- Institute for Management & Innovation, University of Toronto Mississauga, Toronto, Ontario, Canada
| | - Geoff Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Moin JS, Vigod SN, Plumptre L, Troke N, Papanicolas I, Wodchis WP, Anderson G. Utilization of physician mental health services by birthing parents with young children during the COVID-19 pandemic: a population-based, repeated cross-sectional study. CMAJ Open 2023; 11:E1093-E1101. [PMID: 38016758 DOI: 10.9778/cmajo.20220239] [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: 11/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and nonpharmaceutical interventions that reduced the spread of infection had impacts on social interaction, schooling and employment. Concerns have been raised about the impact of these disruptions on the mental health of high-risk groups, including birthing parents of young children. METHODS This population-based, repeated cross-sectional study used health administrative databases in Ontario, Canada, to link children to birth parents and to measure subsequent mental health visits of birthing parents of younger (age 0-5 yr) and school-aged (6-12 yr) children. We used a repeated cross-sectional study design to estimate expected rates for visits to physicians for mental health diagnoses, based on prepandemic trends (March 2016-February 2020), and to compare those to observed visit rates during the March 2020-November 2021 period of the pandemic. RESULTS We identified 2 cohorts: 986 870 birthing parents of younger children and 1 012 997 birthing parents of school-aged children. In both cohorts, observed visit rates were higher than expected in the June 2020-August 2020 quarter (incidence rate ratio [IRR] 1.13, 95% confidence interval [CI] 1.10-1.16; and IRR 1.10, 95% CI 1.07-1.13, respectively), peaked in December 2020-February 2021 (IRR 1.24, 95% CI 1.20-1.27; and IRR 1.20, 95% CI 1.16-1.23) and remained higher than expected in September 2021-November 2021 (IRR 1.12, 95% CI 1.08-1.16; and IRR 1.09, 95% CI 1.06-1.13). The increases were driven mostly by visits for mood and anxiety disorders, and trends in increases were similar across physician type, birthing-parent age and deprivation quintile. INTERPRETATION The COVID-19 pandemic was associated with increased mental health visits for parents of young children. This raises concerns about mental health impacts and highlights the need to address these concerns.
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Affiliation(s)
- John S Moin
- Institute of Health Policy Management and Evaluation (Moin, Wodchis, Anderson), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital (Vigod); ICES Central (Plumptre, Troke), Toronto, Ont.; The London School of Economics and Political Science (Papanicolas), Health Policy London, London, UK; Brown School of Public Health (Papanicolas), Providence, RI; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.
| | - Simone N Vigod
- Institute of Health Policy Management and Evaluation (Moin, Wodchis, Anderson), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital (Vigod); ICES Central (Plumptre, Troke), Toronto, Ont.; The London School of Economics and Political Science (Papanicolas), Health Policy London, London, UK; Brown School of Public Health (Papanicolas), Providence, RI; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Lesley Plumptre
- Institute of Health Policy Management and Evaluation (Moin, Wodchis, Anderson), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital (Vigod); ICES Central (Plumptre, Troke), Toronto, Ont.; The London School of Economics and Political Science (Papanicolas), Health Policy London, London, UK; Brown School of Public Health (Papanicolas), Providence, RI; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Natalie Troke
- Institute of Health Policy Management and Evaluation (Moin, Wodchis, Anderson), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital (Vigod); ICES Central (Plumptre, Troke), Toronto, Ont.; The London School of Economics and Political Science (Papanicolas), Health Policy London, London, UK; Brown School of Public Health (Papanicolas), Providence, RI; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Irene Papanicolas
- Institute of Health Policy Management and Evaluation (Moin, Wodchis, Anderson), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital (Vigod); ICES Central (Plumptre, Troke), Toronto, Ont.; The London School of Economics and Political Science (Papanicolas), Health Policy London, London, UK; Brown School of Public Health (Papanicolas), Providence, RI; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Walter P Wodchis
- Institute of Health Policy Management and Evaluation (Moin, Wodchis, Anderson), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital (Vigod); ICES Central (Plumptre, Troke), Toronto, Ont.; The London School of Economics and Political Science (Papanicolas), Health Policy London, London, UK; Brown School of Public Health (Papanicolas), Providence, RI; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Geoff Anderson
- Institute of Health Policy Management and Evaluation (Moin, Wodchis, Anderson), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital (Vigod); ICES Central (Plumptre, Troke), Toronto, Ont.; The London School of Economics and Political Science (Papanicolas), Health Policy London, London, UK; Brown School of Public Health (Papanicolas), Providence, RI; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
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Felfeli T, Katsnelson G, Kiss A, Plumptre L, Paterson JM, Ballios BG, Mandelcorn ED, Glazier RH, Brent MH, Wong DT. Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade. Can J Ophthalmol 2023; 58:278-286. [PMID: 35577027 DOI: 10.1016/j.jcjo.2022.04.002] [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] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the population-level predictors for being unscreened for diabetic retinopathy (DR) among individuals with diabetes in a developed country. DESIGN A retrospective population-based repeated-cross-sectional study. PARTICIPANTS All individuals with diabetes (types 1 and 2) aged ≥20 years in the universal health care system in Ontario were identified in the 2011-2013 and 2017-2019 time periods. METHODS The Mantel-Haenszel test was used for the relative risk (RR) comparison of subcategories stratified by the 2 cross-sectional time periods. RESULTS A total of 1 145 645 and 1 346 578 individuals with diabetes were identified in 2011-2013 and 2017-2019, respectively. The proportion of patients unscreened for DR declined very slightly from 35% (n = 405 967) in 2011-2013 to 34% (n = 455 027) in 2017-2019 of the population with diabetes (RR = 0.967; 95% CI, 0.964-0.9693; p < 0.0001). Young adults aged 20-39 years of age had the highest proportion of unscreened patients (62% and 58% in 2011-2013 and 2017-2019, respectively). Additionally, those who had a lower income quintile (RR = 1.039; 95% CI, 1.036-1.044; p < 0.0001), were recent immigrants (RR = 1.286; 95% CI, 1.280-1.293; p < 0.0001), lived in urban areas (RR = 1.149; 95% CI, 1.145-1.154; p < 0.0001), had a mental health history (RR = 1.117; 95% CI, 1.112-1.122; p < 0.0001), or lacked a connection to a primary care provider (RR = 1.656; 95% CI, 1.644-1.668; p < 0.0001) had a higher risk of being unscreened. CONCLUSIONS This population-based study suggests that over 1 decade, 33% of individuals with diabetes are unscreened for DR, and young age, low income, immigration, residing in a large city, mental health illness, and no primary care access are the main predictors.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON.
| | | | - Alex Kiss
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON
| | | | - J Michael Paterson
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON
| | - Brian G Ballios
- Department of Ophthalmology, Toronto Western Hospital, Toronto, ON; Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, Toronto, ON
| | - Richard H Glazier
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, Toronto, ON
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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Fitzsimon JP, Belanger C, Glazier RH, Green M, Peixoto C, Mahdavi R, Plumptre L, Bjerre LM. Clinical and economic impact of a community-based, hybrid model of in-person and virtual care in a Canadian rural setting: a cross-sectional population-based comparative study. BMJ Open 2023; 13:e069699. [PMID: 37188465 DOI: 10.1136/bmjopen-2022-069699] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To determine the clinical and economic impact of a community-based, hybrid model of in-person and virtual care by comparing health-system performance of the rural jurisdiction where this model was implemented with neighbouring jurisdictions without such a model and the broader regional health system. DESIGN A cross-sectional comparative study. SETTING Ontario, Canada, with a focus on three largely rural public health units from 1 April 2018 until 31 March 2021. PARTICIPANTS All residents of Ontario, Canada under the age of 105 eligible for the Ontario Health Insurance Plan during the study period. INTERVENTIONS An innovative, community-based, hybrid model of in-person and virtual care, the Virtual Triage and Assessment Centre (VTAC), was implemented in Renfrew County, Ontario on 27 March 2020. MAIN OUTCOME MEASURES Primary outcome was a change in emergency department (ED) visits anywhere in Ontario, secondary outcomes included changes in hospitalisations and health-system costs, using per cent changes in mean monthly values of linked health-system administrative data for 2 years preimplementation and 1 year postimplementation. RESULTS Renfrew County saw larger declines in ED visits (-34.4%, 95% CI -41.9% to -26.0%) and hospitalisations (-11.1%, 95% CI -19.7% to -1.5%) and slower growth in health-system costs than other rural regions studied. VTAC patients' low-acuity ED visits decreased by -32.9%, high-acuity visits increased by 8.2%, and hospitalisations increased by 30.0%. CONCLUSION After implementing VTAC, Renfrew County saw reduced ED visits and hospitalisations and slower health-system cost growth compared with neighbouring rural jurisdictions. VTAC patients experienced reduced unnecessary ED visits and increased appropriate care. Community-based, hybrid models of in-person and virtual care may reduce the burden on emergency and hospital services in rural, remote and underserved regions. Further study is required to evaluate potential for scale and spread.
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Affiliation(s)
- Jonathan P Fitzsimon
- Arnprior and District Memorial Hospital, Arnprior Regional Health, Arnprior, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | | | | | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Roshanak Mahdavi
- Ottawa Hospital, Civic Campus, ICES Ottawa, Ottawa, Ontario, Canada
| | | | - Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
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Troke N, An D, Kim E, Balogh R, Plumptre L. COVID-19 testing, infection rates, and related outcomes in adults with intellectual and developmental disabilities (IDD): An application of linked administrative health data to support Ontario’s COVID-19 response. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.2025] [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: 10/15/2022] Open
Abstract
ObjectivesPeople with intellectual and developmental disabilities (IDD) have been disproportionately impacted by COVID-19, a population more likely to experience poor health outcomes. An Applied Health Research Question (AHRQ) request through ICES led to an investigation that monitored COVID-19 related infections and outcomes in adults with and without IDD.
ApproachThe ICES-AHRQ team approved a request from the Ministry of Children, Community and Social Services (MCCSS), to determine the proportion of adults with IDD tested and confirmed positive for COVID-19. The scientists also explored if positive IDD cases experienced similar health outcomes to the general population. The open cohort was derived by linking those with a COVID-19 test in Ontario Laboratories Information System, from January 2020 to December 2021, to supplemented positive case data and administrative health databases. An algorithm was used to define IDD by a series of inpatient hospitalizations, emergency department and/or physician visits, with IDD diagnostic codes.
ResultsSimilar rates of testing and positivity were observed for those with (46%; 6%) and without IDD (43%; 5%). However, adults with IDD confirmed positive for COVID-19 were mostly male (62% vs 49%), aged 18-29 (40% vs 27%), had medical conditions associated with frailty (15% vs 4%), and from the lowest neighborhood income quintile (27% vs 23%), compared to the non-IDD population, respectively. Cumulatively, deaths and hospitalizations following a COVID-19 diagnosis were two-times more likely in the IDD population, while comparable rates of intensive care unit (ICU) admissions were reported. Particularly, adults with IDD aged 18-54 experienced higher rates of hospitalizations (48% vs 30%), ICU admissions (56% vs 36%), and deaths (26% vs 6%), compared to the same age group in those without IDD.
Conclusion/ImplicationsReal-time administrative health data and analytics were used to support Ontario’s COVID-19 response in those with IDD. To inform decision making and policy actions related to immediate testing strategies, MCCSS used such findings to increase the availability of testing for adults with IDD, who may face multiple barriers.
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Borgundvaag E, Plumptre L, Paterson M, An D, McLeod S, Tarride JE, Atzema C, Schull M, Verma A, Hall J. Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1926] [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: 10/14/2022] Open
Abstract
ObjectiveIn response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person.
ApproachEvaluation of the VED program was supported by the ICES Applied Health Research Question Program, which is funded by the Ontario Ministry of Health to answer questions directly related to Ontario healthcare policy, planning, or practice. VED visit records from December 2020 to May 2021 were linked with Ontario administrative data. VED patients with low acuity complaints were matched 1:1 with in-person ED comparators according to visit date, presenting complaint, and a propensity score that incorporated age, sex, comorbidities, and other important potential confounders. The primary outcomes were healthcare utilization within 7 days and all-cause mortality within 30 days.
ResultsOf the 609 eligible patients discharged from the VED, 600 (98.5%) were successfully matched to a comparator. Mean (SD) age was 43.0 (21.1) and 64.1% were female. In-person ED revisits and hospitalizations were similar for VED and comparator patients at 72 hours (ED: 12.1% vs. 11.3%; Δ 0.8%, 95%: -2.8, 4.5%; hospitalization: 1.2% vs. 1.5%; Δ 0.3%, 95%: -0.7, 1.4%,) and 7 days (ED: 16.1% vs. 14.4%; Δ 1.7, 95%: -2.4, 5.7%; hospitalization: 1.7% vs. 1.8%; Δ 0.2%, 95%: -0.1, 1.4%) following the index visit. The number of patients visiting a primary care provider within 7 days was also similar between groups (36.7% vs. 32.4%; Δ 4.3, 95%: -1.1, 9.8%). No patients died within 30 days.
Conclusion/ImplicationsVED patients and their matched comparators had similar healthcare utilization in the 7 days following their index ED visit. Methodology from this study will inform a province-wide evaluation of VED programs across Ontario.
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Golding H, Churchill K, Levy C, An D, Hall R, Plumptre L. Evidence from an Applied Health Research Question (AHRQ): Health care utilization of publicly funded rehab services for patients post COVID-19 diagnosis. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.2083] [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: 10/15/2022] Open
Abstract
ObjectivesThe Rehabilitative Care Alliance issued an Applied Health Research Question request to collect information regarding healthcare and rehabilitation use among COVID-19 positive individuals. The objective of this project is to determine the association between length of stay (LOS) in acute care and the number of rehabilitation services used post COVID-19 diagnosis.
ApproachHospital and rehabilitation service use was identified among individuals diagnosed with COVID-19, using administrative health data. Admission into acute care within 30 days post COVID-19 diagnosis was recorded. Use of inpatient, physiatry and home-care rehabilitative services were collected until March 31st 2021. Outpatient rehabilitation reporting is not mandatory and was not included. Marginalization was evaluated using the Ontario Marginalization Index factor scores. The association between LOS in acute care and number of rehabilitation categories used was assessed using a negative binomial model, stratified by with or without a stay in the ICU and controlling for age, sex, comorbidities and long-term care residence.
ResultsOf 181,139 individuals diagnosed with COVID-19 prior to December 31st 2020, 5% were hospitalized. Of those hospitalized 2.3% then entered rehabilitation compared to 0.06% who were not hospitalized post COVID-19 infection. Rehabilitation users had higher residential instability (mean=0.45 vs -0.01 in the overall cohort), dependency (mean=-0.02 vs -0.27) and material deprivation (mean=0.37 vs 0.19) but similar ethnic diversity (mean=0.87 vs 0.90) compared to the full cohort. LOS in acute care was associated with a 3.3% increased risk of using additional rehabilitation services for individuals without a stay in the ICU (RR 1.033, 95% CI: 1.011 to 1.055; p=0.0036), and a 3.7% increased risk for individuals with a stay in the ICU (RR 1.037, 95% CI: 1.025 to 1.048; p<.0001).
ConclusionsPost COVID-19 diagnosis, a larger proportion of rehabilitation service users were hospitalized compared to all COVID-19+ individuals. Additionally, LOS in acute care was associated with the use of more rehabilitation care categories following a COVID-19 diagnosis, and the association was stronger for more severe cases requiring an ICU stay.
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Troke N, An D, Kim E, Lunsky Y, Balogh R, Plumptre L. COVID-19 vaccination rates and related outcomes in adults with intellectual and developmental disabilities (IDD): An application of linked administrative health data to support Ontario’s COVID-19 response . Int J Popul Data Sci 2022. [PMCID: PMC9644964 DOI: 10.23889/ijpds.v7i3.2065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Moin JS, Troke N, Plumptre L, Anderson GM. Impact of the COVID-19 Pandemic on Diabetes Care for Adults With Type 2 Diabetes in Ontario, Canada. Can J Diabetes 2022; 46:S1499-2671(22)00094-6. [PMID: 35953411 PMCID: PMC9059339 DOI: 10.1016/j.jcjd.2022.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The COVID-19 pandemic and related public health prevention measures have led to a disruption of the delivery of routine care and may have had an impact on the quality of diabetes care. Our aim in this study was to evaluate the extent to which structure, process and outcome quality measures in diabetes care changed in the first 6 months of the pandemic compared with previous periods. METHODS A before-and-after observational study of all community-living Ontario residents >20 years of age and living with diabetes. The patients were divided into 3 cohorts: a pandemic cohort, alive March to September 2020 (n=1,393,404); reference cohort 1, alive March to September 2019 (n=1,415,490); and reference cohort 2, alive September 2019 to February 2020 (n=1,444,000). Outcome measures were in-person/virtual visits to general practitioners and specialists, eye examinations, glycated hemoglobin (A1C) and low-density lipoprotein (LDL) testing, filled prescriptions, and admissions to emergency departments (EDs) and hospitals for acute and chronic diabetes complications. RESULTS The probability of an in-person visit to a GP decreasing by 47% (95% confidence interval [CI], 47% to 47%) in the pandemic period compared with both previous periods. The probability of having an eye exam was lower by 43% (95% CI, 44% to 43%), an A1C test by 28% (95% CI, 29% to 28%) and an LDL test by 31% (95% CI, 31% to 31%) in the pandemic period compared with the same 6-month period the year before. There were very small decreases in drug prescriptions and decreases of 18% and 16% in ED and hospital visits for complications. CONCLUSIONS We observed disruptions to both structure and processes measures of diabetes care in Ontario during the first wave of the pandemic.
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Affiliation(s)
- John S Moin
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | | | - Geoffrey M Anderson
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
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Durbin A, Balogh R, Lin E, Palma L, Plumptre L, Lunsky Y. Changes in community and hospital-based health care use during the COVID-19 pandemic for adults with and without intellectual and developmental disabilities. J Intellect Disabil Res 2022; 66:399-412. [PMID: 35353400 PMCID: PMC9115061 DOI: 10.1111/jir.12929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Due to the functional, cognitive and communication impairments associated with intellectual and/or developmental disabilities (IDD), adaptations to service delivery during the COVID-19 pandemic may impact people with IDD differently than others. For community and hospital-based services, this study describes the proportion of adults with and without IDD who used health care in the year pre-COVID-19 and the first year of the pandemic. METHODS This retrospective cohort study used linked health administrative databases to identify adults aged 18-105 years with and without IDD using unique encoded identifiers. Counts and proportions of adults who used health care services were reported for the pre-COVID-19 year (16 March 2019 to 14 March 2020) and the first COVID-19 year (15 March 2020 to 15 March 2021). RESULTS Across services, the proportion of adults who used services was lower during the first COVID-19 year compared with the year prior, except for virtual physician visits that increased markedly for people with and without IDD. While the proportion of adults who used services was higher for those with IDD compared with those without IDD for both years, differences were greatest for mental health emergency visits and hospitalisations; adults with IDD were 6.3 to 10.9 times more likely to use these services than others with no IDD during the pandemic. CONCLUSIONS During the first COVID-19 year in Ontario, Canada, service use decreased for all service types, except for virtual physician visits. In both years, adults with IDD remained more likely to use services than other adults, with the largest differences in use of mental health hospitalisations and mental health emergency department visits.
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Affiliation(s)
- A. Durbin
- Unity Health Toronto, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- ICESTorontoOntarioCanada
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - R. Balogh
- ICESTorontoOntarioCanada
- Faculty of Health SciencesOntario Tech University Unity HealthOshawaOntarioCanada
| | - E. Lin
- ICESTorontoOntarioCanada
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - L. Palma
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - L. Plumptre
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Y. Lunsky
- Unity Health Toronto, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- ICESTorontoOntarioCanada
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Azrieli Adult Neurodevelopmental CentreCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
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Ishiguro L, An D, Plumptre L, Paul J, Mecredy G, Li K, Ho M, Bronskill S, Victor C, Schull M, Paterson M. Supporting policy and practice in Ontario through ICES’ Applied Health Research Question (AHRQ) Program. Int J Popul Data Sci 2021. [DOI: 10.23889/ijpds.v6i3.1683] [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: 10/20/2022] Open
Abstract
ICES upholds a strong reputation for generating high-quality evidence to inform policy and practice through its collaborations with a broad range of health system stakeholders including government policymakers and healthcare providers including clinicians. Supported by the Ontario Ministry of Health and Ministry of Long-Term Care, the ICES Applied Health Research Question (AHRQ) Program leverages the data holdings and, scientific and clinical expertise to generate evidence tailored to the information needs of requestors. This paper outlines the approach, process, strengths, challenges and the resulting influence and impact to the healthcare landscape in Ontario.
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Ishiguro L, An DA, Plumptre L, Paul J, Mecredy G, Li K, Ho MM, Bronskil SE, Victor JC, Schull MJ, Paterson JM. Supporting policy and practice in Ontario through ICES' Applied Health Research Question (AHRQ) program. Int J Popul Data Sci 2021; 6:1683. [PMID: 34778572 PMCID: PMC8559893 DOI: 10.23889/ijpds.v6i1.1683] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
ICES upholds a strong reputation for generating high-quality evidence to inform policy and practice through its collaborations with a broad range of health system stakeholders including government policymakers and healthcare providers including clinicians. Supported by the Ontario Ministry of Health and Ministry of Long-Term Care, the ICES Applied Health Research Question (AHRQ) Program leverages the data holdings and, scientific and clinical expertise to generate evidence tailored to the information needs of requestors. This paper outlines the approach, process, strengths, challenges and the resulting influence and impact to the healthcare landscape in Ontario.
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Affiliation(s)
| | | | | | | | | | | | | | - Susan E. Bronskil
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - J. Charles Victor
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael J. Schull
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Evaluation Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - J. Michael Paterson
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Saunders N, Plumptre L, Diong C, Gandhi S, Schull M, Guttmann A, Paterson JM. Acute Care Visits for Assault and Maltreatment Before vs During the COVID-19 Pandemic in Ontario, Canada. JAMA Health Forum 2021; 2:e211983. [PMID: 35977194 PMCID: PMC8796993 DOI: 10.1001/jamahealthforum.2021.1983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Natasha Saunders
- ICES, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Michael Schull
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - J. Michael Paterson
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Stewart A, Antoniou T, Graves E, Plumptre L, Carusone SC. Health care utilization in medically complex people living with HIV before and after admission to an HIV-specific community facility: a pre-post comparison study. CMAJ Open 2021; 9:E460-E465. [PMID: 33958381 PMCID: PMC8157977 DOI: 10.9778/cmajo.20200024] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People living with HIV and multiple comorbidities have high rates of health service use. This study evaluates system usage before and after admission to a community facility focused on HIV care. METHODS We used Ontario administrative health databases to conduct a pre-post comparison of rates and costs of hospital admissions, emergency department visits, and family physician and home care visits among medically complex people with HIV in the year before and after admission to Casey House, an HIV-specific hospital in Toronto, for all individuals admitted between April 2009 and March 2015. Negative binomial regression was used to compare rates of health care utilization. We used Wilcoxon rank sum tests to compare associated health care costs, standardized to 2015 Canadian dollars. To contextualize our findings, we present rates and costs of health service use among Ontario residents living with HIV. RESULTS During the study period, 268 people living with HIV were admitted to Casey House. Emergency department use declined from 4.6 to 2.5 visits per person-year (p = 0.02) after discharge from Casey House, and hospitalization rates declined from 1.4 to 1.1 admissions per person-year (p = 0.05). Conversely, home care visits increased from 24.3 to 35.6 visits per person-year (p = 0.01) and family physician visits increased from 18.3 to 22.6 visits per person-year (p < 0.001) in the year after discharge. These changes were associated with reduced overall costs to the health care system. The reduction in overall costs was not significant (p = 0.2); however, costs of emergency department visits (p < 0.001) and physician visits (p < 0.001) were significantly less. INTERPRETATION Health care utilization by people with HIV was significantly different before and after admission to a community hospital focused on HIV care. This has implications for health care in other complex patient populations.
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Affiliation(s)
- Ann Stewart
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont.
| | - Tony Antoniou
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
| | - Erin Graves
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
| | - Lesley Plumptre
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
| | - Soo Chan Carusone
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
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Garbens A, Wallis CJD, Klaassen Z, Saskin R, Plumptre L, Kodama R, Herschorn S, Nam RK. Comprehensive assessment of the morbidity of renal mass biopsy: A population-based assessment of biopsy-related complications. Can Urol Assoc J 2020; 15:42-47. [PMID: 32744997 DOI: 10.5489/cuaj.6477] [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: 11/19/2022]
Abstract
INTRODUCTION We sought to assess seven-day and 30-day complications following renal mass biopsy (RMB), including mortality, hospitalizations, emergency department (ED) visits, and operative and non-operative complications and compare these to rates in population-matched controls. METHODS We performed a population-based, matched, retrospective cohort study of patients undergoing RMB following consultation with a urologist and axial imaging from 2003-2015 in Ontario, Canada. Data on seven-day and 30-day rates of mortality, as well as operative and non operative complications after RMB were reported. The seven-day and 30-day rates of mortality, operative and non-operative interventions, hospitalizations, and ED visits were compared to matched controls using multivariable logistic regression. RESULTS Among 6840 patients who underwent RMB in the study period, 24 (0.4%) and 159 (2.3%) died within seven and 30 days of their biopsy, respectively. Seven- and 30-day operative intervention rates were 79 (1.2%) and 236 (3.4%), respectively. Seven- and 30-day non-operative intervention rates were 227 (3.3%) and 529 (7.7%), respectively. Thirty-day mortality (odds ratio [OR] 8.1, 95% confidence interval [CI] 5.1-13.0), hospitalizations (OR 12.6, 95% CI 10.6-15.2), and ED visits (OR 3.8, 95% CI 3.4-4.3) were more common among patients who underwent RMB than the matched controls (p<0.001 for each). CONCLUSIONS Patients undergoing RMB may have a small but non-negligible increased risk of mortality, hospital readmission, and ED visits compared to matched controls. However, limitations in the granularity of the dataset limits the strength of these conclusions. Further studies are needed to confirm our results. These risks should be discussed with patients for shared decision-making and considered in the risk/benefit tradeoff for the management of small renal masses.
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Affiliation(s)
- Alaina Garbens
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Zachary Klaassen
- Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, United States
| | - Refik Saskin
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Ronald Kodama
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Plumptre L, Tammen SA, Sohn KJ, Masih SP, Visentin CE, Aufreiter S, Malysheva O, Schroder TH, Ly A, Berger H, Croxford R, Lamers Y, Caudill MA, Choi SW, O'Connor DL, Kim YI. Maternal and Cord Blood Folate Concentrations Are Inversely Associated with Fetal DNA Hydroxymethylation, but Not DNA Methylation, in a Cohort of Pregnant Canadian Women. J Nutr 2020; 150:202-211. [PMID: 31562504 DOI: 10.1093/jn/nxz232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/28/2019] [Accepted: 09/03/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Aberrancies in fetal DNA methylation programming may modify disease susceptibility of the offspring. Maternal folate status has potential to alter fetal DNA methylation. OBJECTIVES We examined the association of maternal and cord blood concentrations of folate and unmetabolized folic acid (UMFA), vitamin B-12, vitamin B-6, and choline with fetal DNA methylation and hydroxymethylation and assessed potential modifying effects of 38 fetal genetic variants in 22 genes. METHODS Nutrient blood concentrations were measured in 368 pregnant women in early pregnancy (12-16 wk of gestation) and at delivery (37-42 wk of gestation) and in cord blood. DNA methylation and hydroxymethylation in cord blood mononuclear cells were quantified by LC-MS/MS. Pearson partial correlations were used to determine the association between individual nutrients and DNA methylation and hydroxymethylation. RESULTS Serum and RBC folate and plasma UMFA concentrations (primary outcomes) in early pregnancy, at delivery, and in cord blood were not significantly associated with fetal DNA methylation. In contrast, maternal RBC folate in early pregnancy (r = -0.16, P = 0.04) and cord plasma UMFA (r = -0.23, P = 0.004) were inversely correlated with fetal DNA hydroxymethylation. Neither maternal and cord blood concentrations of other nutrients nor fetal genotypes (secondary outcomes) were significantly associated with fetal DNA methylation or hydroxymethylation. Infants born to mothers with RBC folate concentrations in the highest quartile and serum vitamin B-12 concentrations in the lowest quartile in early pregnancy had significantly lower fetal DNA methylation and higher birth weight compared with those born to mothers with lower RBC folate and higher serum vitamin B-12 concentrations (P = 0.01). CONCLUSIONS Maternal and cord blood folate concentrations are associated with fetal DNA hydroxymethylation, but not DNA methylation, in a cohort of pregnant Canadian women. The observation that high folate and low vitamin B-12 maternal status in early pregnancy may be associated with decreased fetal DNA methylation and higher birth weight warrants further investigation. This trial was registered at clinicaltrials.gov as NCT02244684.
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Affiliation(s)
- Lesley Plumptre
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
| | - Stephanie A Tammen
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Kyoung-Jin Sohn
- Keenan Research Center for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shannon P Masih
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
| | - Carly E Visentin
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
| | - Susanne Aufreiter
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Olga Malysheva
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Theresa H Schroder
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, Vancouver Campus, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Ly
- Keenan Research Center for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ruth Croxford
- Freelance Statistics Consultant, Toronto, Ontario, Canada
| | - Yvonne Lamers
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, Vancouver Campus, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie A Caudill
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Sang-Woon Choi
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.,Chaum Life Center, CHA School of Medicine, Seoul, Korea
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Young-In Kim
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Brosnan JT, Plumptre L, Brosnan ME, Pongnopparat T, Masih SP, Visentin CE, Berger H, Lamers Y, Caudill MA, Malysheva OV, O'Connor DL, Kim YI. Formate concentrations in maternal plasma during pregnancy and in cord blood in a cohort of pregnant Canadian women: relations to genetic polymorphisms and plasma metabolites. Am J Clin Nutr 2019; 110:1131-1137. [PMID: 31350902 PMCID: PMC6821548 DOI: 10.1093/ajcn/nqz152] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND One-carbon metabolism, responsible for purine and thymidylate synthesis and transmethylation reactions, plays a critical role in embryonic and fetal development. Formate is a key player in one-carbon metabolism. In contrast to other one-carbon metabolites, it is not linked to tetrahydrofolate, is present in plasma at appreciable concentrations, and may therefore be distributed to different tissues. OBJECTIVE The study was designed to determine the concentration of formate in cord blood in comparison with maternal blood taken earlier in pregnancy and at delivery and to relate formate concentrations to potential precursors and key fetal genotypes. METHODS Formate and amino acids were measured in plasma during early pregnancy (12-16 wk), at delivery (37-42 wk), and in cord blood samples from 215 mothers, of a prospective cohort study. Three fetal genetic variants in one-carbon metabolism were assessed for their association with cord plasma concentrations of formate. RESULTS The formate concentration was ∼60% higher in the cord blood samples than in mothers' plasma. The maternal formate concentrations did not differ between the early pregnancy samples and those taken at delivery. Plasma concentrations of 4 formate precursors (serine, glycine, tryptophan, and methionine) were increased in cord blood compared with the maternal samples. Cord blood formate was influenced by fetal genotype, being ∼12% higher in infants harboring the MTHFR A1298C (rs1801131) AC or CC genotypes and 10% lower in infants harboring the MTHFD1 G1958A (rs2236225) GA or AA genotypes. CONCLUSIONS The increased formate concentrations in cord blood may support the increased activity of one-carbon metabolism in infants. As such, it would support increased rates of purine and thymidylate synthesis and the provision of methionine for methylation reactions.
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Affiliation(s)
- John T Brosnan
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada,Address correspondence to JTB (e-mail: )
| | - Lesley Plumptre
- Department of Nutritional Science, University of Toronto, Toronto, Ontario, Canada,Keenan Research Centre for Biomedical Sciences of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Margaret E Brosnan
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Theerawat Pongnopparat
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Shannon P Masih
- Department of Nutritional Science, University of Toronto, Toronto, Ontario, Canada,Keenan Research Centre for Biomedical Sciences of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Carly E Visentin
- Department of Nutritional Science, University of Toronto, Toronto, Ontario, Canada,Keenan Research Centre for Biomedical Sciences of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Lamers
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie A Caudill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Olga V Malysheva
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Deborah L O'Connor
- Department of Nutritional Science, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Young-In Kim
- Department of Nutritional Science, University of Toronto, Toronto, Ontario, Canada,Keenan Research Centre for Biomedical Sciences of St. Michael's Hospital, Toronto, Ontario, Canada,Division of Gastroenterology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Antoniou T, Graves E, Plumptre L, Stewart A, Chan Carusone S. Antiretroviral Prescription Pick-up and Physician Follow-up After Hospital Discharge Among Medically Complex People With HIV. Open Forum Infect Dis 2019; 6:ofz009. [PMID: 30740471 PMCID: PMC6359909 DOI: 10.1093/ofid/ofz009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/14/2019] [Indexed: 11/23/2022] Open
Abstract
In this study, only 22 of 206 (10.7%) socially marginalized individuals living with HIV and multiple comorbid conditions filled a prescription for antiretroviral therapy within 7 days of discharge from an HIV specialty hospital, despite comprehensive discharge planning. Additional interventions facilitating postdischarge continuity of care are required for this population.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Toronto, Ontario, Canada
| | | | | | - Ann Stewart
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Plumptre L, Graves E, Ishiguro L, Antoniou T, Stewart A, Carusone SC. Evidence from an Applied Research Health Question (AHRQ): Healthcare utilization of HIV patients before and after admission to Casey House, a specialized HIV hospital. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.917] [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
IntroductionThe Applied Health Research Question (AHRQ) portfolio is an initiative funded by the Ontario Ministry of Health and Long-Term Care, leveraging the linked data and the scientific expertise at ICES to answer questions from Knowledge Users that have a direct impact on healthcare policy, planning or practice.
Objectives and ApproachA request from Casey House, a specialty HIV hospital located in Toronto, ON, was reviewed and approved by the ICES AHRQ Team to evaluate patient healthcare utilization and costs. The purpose was to support the design of programs and services, improve transitions from healthcare settings to community services, and inform continuous quality improvement initiatives. Using inpatient records, hospital admissions to Casey House were identified in fiscal years 2009-2014. Inpatient, emergency, outpatient and home care visits were characterized before and after admission. Using the Ontario Drug Benefit Claims, antiretroviral (ARV) prescription fills were examined 7 days post discharge.
ResultsBetween April 1, 2009 and March 31, 2015, 268 HIV patients had one or more hospital admissions to Casey House. The majority of Casey House patients had an Aggregated Diagnosis Group (ADG) ≥ 10 (79%) or Resource Utilization Band (RUB) = 5 (78%), indicating a high co-morbidity burden. Rate of emergency department usage declined from 4.61 to 2.46 per person-year, before and after Casey House admission (p < 0.0001). Conversely, home care visits increased from 24.29 to 35.63 per person-year and family physician visits increased from 18.33 to 22.59 per person-year before and after Casey House admission (both p < 0.0001). Interestingly, 89% did not fill an ARV prescription within 7 days of Casey House discharge, however 76% followed up with an outpatient HIV visit within 30 days.
Conclusion/ImplicationsHealthcare utilization differed before and after admission to Casey House. Follow-up post-discharge warrants further examination to increase ARV prescription fills. Data from this AHRQ has facilitated future policy and programming changes. Results have been disseminated throughout the Toronto HIV research community to generate discussion on quality improvement in this population.
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Sharp JR, Maguire JL, Carsley S, Abdullah K, Chen Y, Perrin EM, Parkin PC, Birken CS, Maguire JL, Lau E, Laupacis A, Parkin PC, Salter M, Szatmari P, Weir S, Abdullah K, Aglipay M, Ali Y, Anderson LN, Bayoumi I, Birken CS, Borkhoff CM, Carsley S, Chen S, Chen Y, Dai DW, Darmawikarta D, Dennis CL, Eny K, Erdle S, Furlong K, Kavikondala K, Koroshegyi C, Kowal C, Lee GJ, Maguire JL, Mason D, Omand J, Parkin PC, Persaud N, Plumptre L, van den Heuvel M, Vanderhout S, Wong P, Zabih W, Abdurrahman M, Anderson B, Anderson K, Arbess G, Baker J, Barozzino T, Bergeron S, Bhagat D, Blanchette N, Bloch G, Bonifacio J, Bowry A, Brown A, Bugera J, Calpin C, Campbell D, Cheema S, Cheng E, Chisamore B, Constantin E, Culbert E, Danayan K, Das P, Derocher MB, Do A, Dorey M, Doukas K, Egger A, Farber A, Freedman A, Freeman S, Fung K, Gazeley S, Goldenberg D, Guiang C, Ha D, Hafiz S, Handford C, Hanson L, Harrington L, Hatch H, Hughes T, Jacobson S, Jagiello L, Jansz G, Kadar P, Kiran T, Kitney L, Knowles H, Kwok B, Lakhoo S, Lam-Antoniades M, Lau E, Leung FH, Li A, Li P, Loo J, Louis J, Mahmoud S, Male R, Mascoll V, Moodie R, Morinis J, Nader M, Naymark S, Neelands P, Owen J, Parry J, Peer M, Pena K, Perlmutar M, Persaud N, Pinto A, Pitt T, Porepa M, Qi V, Ramji N, Ramji N, Rana J, Rosenthal A, Rouleau K, Saunderson J, Saxena R, Schiralli V, Sgro M, Shepherd S, Smiltnieks B, Srikanthan C, Taylor C, Turner S, Uddin F, Vaughan J, Weisdorf T, Wijayasinghe S, Wong P, Wormsbecker A, Ying E, Young E, Zajdman M, Bustos M, Camacho C, Dalwadi D, Jegathesan T, Malhi T, Thadani S, Thompson J, Thompson L, Allen C, Boodhoo B, Hall J, Juni P, Lebovic G, Pope K, Shim J, Thorpe K, Azad A. Temperament Is Associated With Outdoor Free Play in Young Children: A TARGet Kids! Study. Acad Pediatr 2018; 18:445-451. [PMID: 28842293 DOI: 10.1016/j.acap.2017.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 03/09/2017] [Revised: 08/04/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Outdoor free play is important for preschoolers' physical activity, health, and development. Certain temperamental characteristics are associated with obesity, nutrition, and sedentary behaviors in preschoolers, but the relationship between temperament and outdoor play has not been examined. This study examined whether there is an association between temperament and outdoor play in young children. METHODS Healthy children aged 1 to 5 years recruited to The Applied Research Group for Kids (TARGet Kids!), a community-based primary care research network, from July 2008 to September 2013 were included. Parent-reported child temperament was assessed using the Childhood Behavior Questionnaire. Outdoor free play and other potential confounding variables were assessed through validated questionnaires. Multivariable linear regression was used to determine the association between temperament and outdoor play, adjusted for potential confounders. RESULTS There were 3393 children with data on outdoor play. The association between negative affectivity and outdoor play was moderated by sex; in boys, for every 1-point increase in negative affectivity score, mean outdoor play decreased by 4.7 minutes per day. There was no significant association in girls. Surgency was associated with outdoor play; for every 1-point increase in surgency/extraversion, outdoor play increased by 4.6 minutes per day. CONCLUSIONS Young children's temperamental characteristics were associated with their participation in outdoor free play. Consideration of temperament could enhance interventions and strategies to increase outdoor play in young children. Longitudinal studies are needed to elucidate the relationship between children's early temperament and physical activity.
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Affiliation(s)
- Julia R Sharp
- Department of Post-Graduate Medical Education, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Jonathon L Maguire
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Department of Paediatrics, St Michael's Hospital, Toronto, Canada
| | - Sarah Carsley
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Kawsari Abdullah
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Yang Chen
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Eliana M Perrin
- Department of Pediatrics, Division of Primary Care, Duke University, Durham, NC
| | - Patricia C Parkin
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada
| | - Catherine S Birken
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Canada; Child Health Evaluative Studies, SickKids Research Institute, Toronto, Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
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Barzilay E, Moon A, Plumptre L, Masih SP, Sohn KJ, Visentin CE, Ly A, Malysheva O, Croxford R, Caudill MA, O'Connor DL, Kim YI, Berger H. Fetal one-carbon nutrient concentrations may be affected by gestational diabetes. Nutr Res 2018; 55:57-64. [PMID: 29914628 DOI: 10.1016/j.nutres.2018.04.010] [Citation(s) in RCA: 9] [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] [Received: 07/24/2017] [Revised: 01/19/2018] [Accepted: 04/15/2018] [Indexed: 01/21/2023]
Abstract
Both insufficiency and excess of one-carbon nutrients (folate, choline, vitamins B6 and B12) during pregnancy have been associated with gestational diabetes mellitus (GDM). However, the precise nature of this association has not been clearly established. We hypothesized that GDM may affect one-carbon nutrients concentrations in the fetus, thus possibly participating in epigenetic programing of the offspring. Maternal blood was collected at recruitment (12-16 weeks). At delivery (28-42 weeks), both maternal and cord blood were collected. Blood concentrations of one-carbon nutrients and their metabolites were compared between the two groups. A total of 368 women were included in the study, of whom 19 (5.6%) were later diagnosed with GDM. No significant differences were found in maternal blood concentrations of one-carbon nutrients and their metabolites between the GDM and control groups at recruitment or at delivery. In cord blood, however, serum folate (87.7 [IQR 70.4-103.9] vs 66.6 [IQR 45.5-80.3] nmol/L, P = .025) and plasma TMAO (2.82 [IQR 1.3-3.2] vs 1.35 [IQR 1.0-2.0] μmol/L, P = .017) concentrations were higher, while plasma betaine concentrations were lower (17.5 [IQR 16.3-19.4] vs 21.1 [IQR 18.0-24.1] μmol/L, P = .019) in infants born to mothers with GDM compared with control. Our data suggest that while maternal blood concentrations of one-carbon nutrients and their metabolites may not affect the risk of GDM, GDM may alter concentrations of serum folate, plasma betaine and TMAO in cord blood. These alterations in one-carbon nutrient concentrations in fetal circulation may impact epigenetic programing, thereby contributing to physiologic changes and disease susceptibility in adulthood associated with GDM offspring.
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Affiliation(s)
- Eran Barzilay
- Department of Obstetrics & Gynecology, St. Michael's Hospital & University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ashley Moon
- The Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lesley Plumptre
- The Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Shannon P Masih
- The Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Kyoung-Jin Sohn
- The Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carly E Visentin
- The Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Anna Ly
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Olga Malysheva
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY
| | - Ruth Croxford
- Freelance statistics consultant, Toronto, Ontario, Canada
| | - Marie A Caudill
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Research Institute, the Hospital for Sick Children
| | - Young-In Kim
- The Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics & Gynecology, St. Michael's Hospital & University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND The prevalence of obesity in children has been shown to be plateauing or decreasing in some countries. However, the burden of severe obesity is often not assessed. Children with severe obesity may be at an increased risk for cardiovascular disease and diabetes. The objective is to determine the prevalence of severe obesity in young children and to examine the association with cardiometabolic risk factors. METHODS A longitudinal study was conducted through The Applied Research Group for Kids! (TARGet Kids!), a practice-based research network in Toronto, Canada. Healthy children from birth to 6 years of age were recruited and followed through middle childhood. The main outcomes of the study were as follows: total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and non-HDL cholesterol, triglycerides, glucose, systolic blood pressure (SBP), and diastolic blood pressure (DBP). BMI was age and sex standardized based on the WHO growth standards. A BMI z-score >3 was used to define obesity for children <5 years of age, and severe obesity for children ≥5 years of age. RESULTS Among 5738 children <5 years, 0.8% had a zBMI >3. In 626 children who were 5 and 6 years old, 2.1% had a zBMI >3. In the multivariable analysis adjusted for age, sex, maternal ethnicity, and family history, using repeated measures, children with a zBMI >3 had significantly higher odds of having abnormal SBP [odds ratio (OR) 6.4, 95% confidence interval (CI) 1.5-27.9; p = 0.01] and DBP (OR, 3.6 95% CI 1.2-10.6; p = 0.02), respectively, as compared with healthy-weight children. Trends demonstrating an association between a zBMI >3 and abnormal lipid levels were also identified. CONCLUSION Young children with a zBMI >3 have significantly higher blood pressure measures and trends toward worse lipid profiles than children at lower zBMIs.
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Affiliation(s)
- Sarah E Carsley
- 1 Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children , Toronto, Ontario, Canada .,2 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada
| | - Laura N Anderson
- 3 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada
| | - Lesley Plumptre
- 1 Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Patricia C Parkin
- 1 Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children , Toronto, Ontario, Canada .,2 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,4 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Jonathon L Maguire
- 2 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,4 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,5 The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto , Toronto, Ontario, Canada
| | - Catherine S Birken
- 1 Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children , Toronto, Ontario, Canada .,2 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,4 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
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Plumptre L, Anderson LN, Chen Y, Carsley S, Narang I, Hamilton J, McCrindle B, Parkin PC, Maguire JL, Birken CS, on behalf of the TARGet Kids! Colla. Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children. Child Obes 2017; 13:291-299. [PMID: 30433827 DOI: 10.1089/chi.2016.0279] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 12/26/2022]
Abstract
BACKGROUND The aim of this study is to determine if sleep duration in early childhood is associated with cardiometabolic risk (CMR) in later childhood as assessed by a CMR cluster score [sum of age- and sex-standardized z-scores of waist circumference (WC), systolic blood pressure, triglycerides, glucose, and (inverse) high-density lipoprotein (HDL)]. Secondary objectives included examining sleep duration and the individual CMR factors and BMI z-score. PATIENTS AND METHODS A prospective cohort study was conducted using data from the TARGet Kids! practice-based research network in Toronto, Canada. Children (n = 597) with parent-reported 24-hour sleep duration in early childhood (12-36 months) and a follow-up visit (36-96 months) with all five CMR factors were included in the analysis. Multivariable linear regression was used to assess the relationship between early childhood sleep duration and later childhood CMR, adjusting for relevant covariates. RESULTS Average 24-hour sleep duration in early childhood [mean age: 28.1 (6.6) months] was 11.8 (1.4) hours, with 87% meeting or exceeding total sleep recommendations for their age. Sleep duration in early childhood was not associated with the CMR cluster score in later childhood. Shorter sleep duration was associated with higher HDL concentrations [adjusted β = -0.028 (95% confidence interval: -0.049 to -0.007), p = 0.009]. CONCLUSIONS Further research is needed to determine if early childhood sleep duration is associated with HDL in later childhood. Future studies, which investigate sleep quality in addition to sleep duration, may be helpful.
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Affiliation(s)
- Lesley Plumptre
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Laura N Anderson
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,2 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada
| | - Yang Chen
- 3 The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto, Ontario, Canada
| | - Sarah Carsley
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada
| | - Indra Narang
- 5 Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Jill Hamilton
- 6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,7 Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children , Toronto, Ontario, Canada
| | - Brian McCrindle
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,8 Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto , Toronto, Ontario, Canada
| | - Patricia C Parkin
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,9 Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Jonathon L Maguire
- 3 The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,10 Department of Pediatrics, St. Michael's Hospital , Toronto, Ontario, Canada
| | - Catherine S Birken
- 1 Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada .,4 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada .,6 Department of Pediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,9 Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children , Toronto, Ontario, Canada
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25
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Plumptre L, Masih SP, Sohn KJ, Kim D, Visentin CE, Ly A, Berger H, Croxford R, O'Connor DL, Kim YI. Suboptimal maternal and cord plasma pyridoxal 5' phosphate concentrations are uncommon in a cohort of Canadian pregnant women and newborn infants. Matern Child Nutr 2017; 14. [PMID: 28544455 DOI: 10.1111/mcn.12467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 12/31/2022]
Abstract
Vitamin B6 is important in fetal development, but little is known of the vitamin B6 status of pregnant women and newborns in North America and potential modifying factors. This prospective study determined maternal and cord plasma concentrations of pyridoxal 5' phosphate (PLP; an indicator of vitamin B6 status) in a convenience sample of 368 Canadian pregnant women and their newborns. The association of maternal intake of vitamin B6 and fetal genetic variants with cord plasma PLP and homocysteine concentrations was also examined. Dietary and supplemental intakes of vitamin B6 were assessed in early and mid to late pregnancy. PLP concentrations were measured in maternal plasma in early pregnancy and at delivery, and in cord plasma. Six fetal variants of the MTHFR and CβS genes were assessed for their association with cord plasma PLP and homocysteine concentrations. Geometric mean (95% CI) PLP concentrations were 107 (98, 116) nmol/L in early pregnancy and 58 (53, 62) nmol/L at delivery, respectively, and 296 (275, 319) nmol/L in cord blood (p < .0001). During early pregnancy and at delivery, 3.6% and 5.5% of women had plasma PLP concentrations <20 nmol/L, respectively. Ninety eight percent of the women with supplemental B6 intake of at least the recommended dietary allowance had PLP concentrations >20 nmol/L. Fetal genetic variants were not associated with cord PLP and homocysteine concentrations. Vitamin B6 deficiency is uncommon in a cohort of Canadian pregnant women due largely to prevalent vitamin B6 supplement use.
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Affiliation(s)
- Lesley Plumptre
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shannon P Masih
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kyoung-Jin Sohn
- Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Denise Kim
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Carly E Visentin
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anna Ly
- Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics and Gynaecology, St. Michael's Hospital & University of Toronto, Toronto, Ontario, Canada
| | - Ruth Croxford
- Freelance Statistics Consultant, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Young-In Kim
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Visentin CE, Masih SP, Plumptre L, Schroder TH, Sohn KJ, Ly A, Lausman AY, Berger H, Croxford R, Lamers Y, Kim YI, O'Connor DL. Low Serum Vitamin B-12 Concentrations Are Prevalent in a Cohort of Pregnant Canadian Women. J Nutr 2016; 146:1035-42. [PMID: 27075906 DOI: 10.3945/jn.115.226845] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/26/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Among Canadian women of reproductive age, 5% and 20% have serum vitamin B-12 concentrations indicative of deficiency (<148 pmol/L) and marginal status (148-220 pmol/L), respectively. Given the association between suboptimal vitamin B-12 and adverse pregnancy outcomes, an understanding of vitamin B-12 status during pregnancy, and factors that influence it, is required. OBJECTIVE This prospective analysis from the PREFORM (PREnatal FOlic acid exposuRe on DNA Methylation in the newborn infant) study investigated 1) vitamin B-12 status in a cohort of Canadian pregnant women and their newborns, 2) the association of maternal dietary vitamin B-12 intake with maternal and cord blood concentrations of vitamin B-12 and its biomarkers, and 3) the association of fetal genetic polymorphisms with cord blood concentrations of vitamin B-12 and its biomarkers. METHODS In pregnant Canadian women (n = 368; mean ± SD age: 32 ± 5 y), vitamin B-12 intakes were assessed in early (0-16 wk) and mid- to late (23-37 wk) pregnancy. Serum vitamin B-12 and plasma total homocysteine (tHcy) and methylmalonic acid (MMA) in maternal blood at 12-16 wk of pregnancy and at delivery (28-42 wk) and in cord blood were measured and compared by using regression analyses. The associations of 28 fetal genetic variants in vitamin B-12 metabolism and cord blood vitamin B-12, tHcy, and MMA concentrations were assessed by using regression analysis, with adjustment for multiple testing. RESULTS A total of 17% and 38% of women had deficient and 35% and 43% had marginal serum vitamin B-12 concentrations at 12-16 wk of pregnancy and at delivery, respectively. Only 1.9-5.3% had elevated MMA (>271 nmol/L), and no women had elevated tHcy (>13 μmol/L). Maternal dietary vitamin B-12 intake during pregnancy was either weakly associated or not associated with maternal and cord blood vitamin B-12 (r(2) = 0.17-0.24, P < 0.0008), tHcy (P = NS) and MMA (r(2) = 0.05-0.11, P < 0.001). Fetal genetic polymorphisms were not associated with cord blood concentrations of vitamin B-12 and its biomarkers. CONCLUSIONS Deficient and marginal serum vitamin B-12 concentrations are prevalent in Canadian pregnant women with the use of traditional cutoffs, despite supplement use. Given the growing interest among women to adhere to a vegetarian diet that may be lower in vitamin B-12, and vitamin B-12's importance in pregnancy, the functional ramifications of these observations need to be elucidated. This trial was registered at clinicaltrials.gov as NCT02244684.
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Affiliation(s)
- Carly E Visentin
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shannon P Masih
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lesley Plumptre
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Theresa H Schroder
- Food, Nutrition, and Health Program, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Kyoung-Jin Sohn
- Departments of Medicine and Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anna Ly
- Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrea Y Lausman
- Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Howard Berger
- Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Yvonne Lamers
- Food, Nutrition, and Health Program, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Young-In Kim
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Departments of Medicine and Keenan Research Center for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada;
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Plumptre L, Masih SP, Ly A, Aufreiter S, Sohn KJ, Croxford R, Lausman AY, Berger H, O'Connor DL, Kim YI. High concentrations of folate and unmetabolized folic acid in a cohort of pregnant Canadian women and umbilical cord blood. Am J Clin Nutr 2015; 102:848-57. [PMID: 26269367 DOI: 10.3945/ajcn.115.110783] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/14/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mandatory fortification, prevalent supplement use, and public health guidelines recommending periconceptional supplementation have increased folic acid intakes in North American pregnant women. However, the effects of increased folic acid intakes during pregnancy on maternal and cord blood folate concentrations have not been well established. OBJECTIVES In this prospective study, we determined maternal and cord blood concentrations of folate and unmetabolized folic acid (UMFA) in a cohort of pregnant Canadian women and their newborns and examined the effect of maternal intakes of folate and folic acid and fetal genetic variants in folate metabolism on folate status. DESIGN Folate and folic acid intakes of 368 Canadian pregnant women were assessed in early (0-16 wk) and late (23-37 wk) pregnancy. Blood concentrations of folate and UMFA were measured with the use of immunoassays and liquid chromatography-mass spectrometry, respectively, in maternal samples in early pregnancy (12-16 wk), at delivery (28-42 wk), and in cord blood. Four fetal genetic variants of the 5,10-methylenetetrahydrofolate reductase (MTHFR) and dihydrofolate reductase (DHFR) genes were assessed for their association with cord blood concentrations of folate and UMFA. RESULTS Geometric mean (95% CI) maternal red blood cell (RBC) folate concentrations were 2417 nmol/L (2362, 2472 nmol/L ) and 2793 nmol/L (2721, 2867 nmol/L ) in early pregnancy and at delivery, respectively. The mean (95% CI) cord RBC folate concentration was 2689 nmol/L (2614, 2765 nmol/L). UMFA was detectable in >90% of maternal and cord plasma samples. Although 3 fetal MTHFR and DHFR genetic variants had no effect, the fetal MTHFR 677TT genotype was associated with significantly lower cord serum (P = 0.03) and higher cord RBC (P = 0.02) folate concentrations than those of the wild type. CONCLUSIONS Notwithstanding differences in assays, maternal and cord RBC folate and plasma UMFA concentrations were higher than previously reported values. Functional ramifications of high folate and UMFA concentrations in maternal and fetal circulation warrant additional investigation because an excess folate status may affect long-term health outcomes of the offspring. This study was registered at www.clinicaltrials.gov as NCT02244684.
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Affiliation(s)
- Lesley Plumptre
- Departments of Nutritional Sciences and Keenan Research Center for Biomedical Science and
| | - Shannon P Masih
- Departments of Nutritional Sciences and Keenan Research Center for Biomedical Science and
| | - Anna Ly
- Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susanne Aufreiter
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyoung-Jin Sohn
- Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center for Biomedical Science and
| | - Ruth Croxford
- Freelance statistics consultant, Toronto, Ontario, Canada; and
| | - Andrea Y Lausman
- Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Howard Berger
- Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Deborah L O'Connor
- Departments of Nutritional Sciences and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Young-In Kim
- Departments of Nutritional Sciences and Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Center for Biomedical Science and Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Canada;
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Masih SP, Plumptre L, Ly A, Berger H, Lausman AY, Croxford R, Kim YI, O'Connor DL. Pregnant Canadian Women Achieve Recommended Intakes of One-Carbon Nutrients through Prenatal Supplementation but the Supplement Composition, Including Choline, Requires Reconsideration. J Nutr 2015; 145:1824-34. [PMID: 26063067 DOI: 10.3945/jn.115.211300] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Folate, vitamin B-6, vitamin B-12, and choline are involved in one-carbon metabolism and play critical roles in pregnancy including prevention of birth defects and promotion of neurodevelopment. However, excessive intakes may adversely affect disease susceptibility in offspring. Intakes of these nutrients during pregnancy are not well characterized. OBJECTIVE Our aim was to determine dietary and supplemental intakes and major dietary sources of one-carbon nutrients during pregnancy. METHODS In pregnant women (n = 368) at ≤16 wk postconception, supplement use >30 d before pregnancy was assessed by maternal recall and supplement and dietary intakes in early (0-16 wk) and late pregnancy (23-37 wk) were assessed by food-frequency questionnaire. RESULTS Preconception, 60.1% (95% CI: 55.8, 64.3) of women used B vitamin-containing supplements. This increased to 92.8% (95% CI: 89.6, 95.2) in early and 89.0% (95% CI: 85.0, 92.3) in late pregnancy. Median supplemental folic acid, vitamin B-12, and vitamin B-6 were 1000 μg/d, 2.6 μg/d, and 1.9 mg/d, respectively. Forty-one percent and 50% of women had dietary intakes of folate and vitamin B-6 less than the estimated average requirement (520 mg/d dietary folate equivalents and 1.6 mg/d, respectively). Eight-seven percent of women had choline intakes less than the Adequate Intake (450 mg/d). Dietary intakes did not change appreciably during pregnancy. Fruits and vegetables and fortified foods contributed ∼57% to total dietary folate intake. Fruits and vegetables contributed ∼32% to total dietary vitamin B-6 intake and dairy and egg products contributed ∼37% to total dietary vitamin B-12 intake. CONCLUSIONS Vitamin supplements were an important source of one-carbon nutrients during pregnancy in our sample. Without supplements, many women would not have consumed quantities of folate and vitamin B-6 consistent with recommendations. Given the importance of choline in pregnancy, further research to consider inclusion in prenatal supplements is warranted. This trial was registered at clinicaltrials.gov as NCT02244684.
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Affiliation(s)
- Shannon P Masih
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Keenan Research Center for Biomedical Science
| | - Lesley Plumptre
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Keenan Research Center for Biomedical Science
| | - Anna Ly
- Keenan Research Center for Biomedical Science
| | - Howard Berger
- Keenan Research Center for Biomedical Science, Departments of Obstetrics and Gynecology and
| | - Andrea Y Lausman
- Keenan Research Center for Biomedical Science, Departments of Obstetrics and Gynecology and
| | - Ruth Croxford
- freelance statistics consultant, Toronto, Canada; and
| | - Young-In Kim
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Keenan Research Center for Biomedical Science, Medicine, St. Michael's Hospital, Toronto, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Research Institute, The Hospital for Sick Children, Toronto, Canada
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Visentin CE, Masih S, Plumptre L, Malysheva O, Nielsen DE, Sohn KJ, Ly A, Lausman AY, Berger H, Croxford R, El-Sohemy A, Caudill MA, O'Connor DL, Kim YI. Maternal Choline Status, but Not Fetal Genotype, Influences Cord Plasma Choline Metabolite Concentrations. J Nutr 2015; 145:1491-7. [PMID: 25972528 DOI: 10.3945/jn.115.211136] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/16/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Choline deficiency during pregnancy can lead to adverse birth outcomes, including impaired neurodevelopment and birth defects. Genetic variants of choline and one-carbon metabolism may also influence birth outcomes by altering plasma choline concentrations. The effects of maternal ad libitum choline intake during pregnancy and fetal genetic variants on maternal and cord concentrations of choline and its metabolites are unknown. OBJECTIVES This prospective study sought to assess the effect of 1) maternal dietary choline intake on maternal and cord plasma concentrations of choline and its metabolites, and 2) fetal genetic polymorphisms on cord plasma concentrations. METHODS The dietary choline intake of 368 pregnant Canadian women was assessed in early (0-16 wk) and late (23-37 wk) pregnancy with the use of a food frequency questionnaire. Plasma concentrations of free choline and its metabolites were measured in maternal samples at recruitment and delivery, and in the cord blood. Ten fetal genetic variants in choline and one-carbon metabolism were assessed for their association with cord plasma concentrations of free choline and its metabolites. RESULTS Mean maternal plasma free choline, dimethylglycine, and trimethylamine N-oxide (TMAO) concentrations increased during pregnancy by 49%, 17%, and 13%, respectively (P < 0.005), whereas betaine concentrations decreased by 21% (P < 0.005). Cord plasma concentrations of free choline, betaine, dimethylglycine, and TMAO were 3.2, 2.0, 1.3, and 0.88 times corresponding maternal concentrations at delivery, respectively (all P < 0.005). Maternal plasma concentrations of betaine, dimethylglycine, and TMAO (r(2) = 0.19-0.51; P < 0.0001) at delivery were moderately strong, whereas maternal concentrations of free choline were not significant (r(2) = 0.12; P = 0.06), predictors of cord plasma concentrations of these metabolites. Neither maternal dietary intake nor fetal genetic variants predicted maternal or cord plasma concentrations of choline and its metabolites. CONCLUSION These data collectively indicate that maternal choline status, but not fetal genotype, influences cord plasma concentrations of choline metabolites. This trial was registered at clinicaltrials.gov as NCT02244684.
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Affiliation(s)
- Carly E Visentin
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Shannon Masih
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Lesley Plumptre
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Olga Malysheva
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY; and
| | - Daiva E Nielsen
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Kyoung-Jin Sohn
- Departments of Medicine and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Anna Ly
- Departments of Medicine and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Andrea Y Lausman
- Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Howard Berger
- Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | | | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Marie A Caudill
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY; and
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Research Institute, the Hospital for Sick Children, Toronto, Canada
| | - Young-In Kim
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Departments of Medicine and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada;
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Kim D, Plumptre L, Masih S, Visentin C, Sohn K, Ly A, Lausman A, Berger H, Croxford R, O'Connor D, Kim Y. Maternal intake of vitamin B6 and maternal and cord plasma levels of pyridoxal 5' phosphate in a cohort of Canadian pregnant women and newborn infants. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.919.4] [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: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Anna Ly
- MedicineUniversity of TorontoCanada
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Plumptre L, Tammen S, Masih S, Visentin C, Ly A, Sohn K, Lausman A, Croxford R, Berger H, Choi S, O'Connor D, Kim Y. Effects of Maternal Blood Levels of One‐carbon Nutrients on Global DNA Methylation and Demethylation in Cord Blood Lymphocytes. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.749.6] [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: 11/11/2022]
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Visentin C, Masih S, Plumptre L, Schroder T, Sohn K, Ly A, Nielsen D, Lausman A, Berger H, Croxford R, Lamers Y, O'Connor D, Kim Y. Vitamin B12 Status in a Cohort of Canadian Pregnant Women and Newborn Infants. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.134.8] [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: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Anna Ly
- Fac. of Med. Univ. of TorontoCanada
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Barzilay E, Moon A, Plumptre L, Masih S, Visentin C, Ly A, Sohn KJ, Lausman A, Croxford R, O’Connor DL, Kim YI, Berger H. 638: Gestational diabetes and the folate-methionine cycle. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.844] [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: 11/29/2022]
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Masih S, Plumptre L, Ly A, Sohn K, Berger H, Lausman A, Croxford R, O'Connor D, Kim Y. Vitamin B
12
: dietary intake, supplement use and serum concentrations in a cohort of Canadian pregnant women and in umbilical cord blood (135.7). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.135.7] [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: 11/11/2022]
Affiliation(s)
- Shannon Masih
- St. Michael's HospitalTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Lesley Plumptre
- St. Michael's HospitalTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Anna Ly
- St. Michael's HospitalTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Kyoung‐Jin Sohn
- St. Michael's HospitalTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Howard Berger
- St. Michael's HospitalTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Andrea Lausman
- St. Michael's HospitalTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Ruth Croxford
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Deborah O'Connor
- The Hospital for Sick ChildrenTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
| | - Young‐In Kim
- St. Michael's HospitalTORONTOONCanada
- Nutritional SciencesUniversity of TORONTOTorontoONCanada
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Visentin C, Masih S, Plumptre L, Malysheva O, Sohn K, Ly A, Lausman A, Berger H, Croxford R, Caudill M, O'Connor D, Kim Y. Dietary intake and blood levels of choline in a cohort of Canadian pregnant women and newborn infants (827.9). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.827.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carly Visentin
- St. Michael's HospitalTORONTOONCanada
- University of TORONTOTorontoONCanada
| | - Shannon Masih
- St. Michael's HospitalTORONTOONCanada
- University of TORONTOTorontoONCanada
| | - Lesley Plumptre
- St. Michael's HospitalTORONTOONCanada
- University of TORONTOTorontoONCanada
| | | | - Kyoung‐Jin Sohn
- St. Michael's HospitalTORONTOONCanada
- University of TORONTOTorontoONCanada
| | - Anna Ly
- St. Michael's HospitalTORONTOONCanada
- University of TORONTOTorontoONCanada
| | | | | | - Ruth Croxford
- Inst. of Clinical Evaluative SciencesTORONTOONCanada
| | | | | | - Young‐In Kim
- St. Michael's HospitalTORONTOONCanada
- University of TORONTOTorontoONCanada
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Masih S, Plumptre L, Ly A, Berger H, Lausman AY, Croxford R, O'Connor DL, Kim Y. Intakes, sources and blood levels of folate in Canadian pregnant women in the post‐fortification era. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.246.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shannon Masih
- University of TorontoTorontoONCanada
- St. Michael's HospitalTorontoONCanada
| | - Lesley Plumptre
- University of TorontoTorontoONCanada
- St. Michael's HospitalTorontoONCanada
| | - Anna Ly
- St. Michael's HospitalTorontoONCanada
| | | | | | | | - Deborah L. O'Connor
- University of TorontoTorontoONCanada
- The Hospital for Sick ChildrenTorontoONCanada
| | - Young‐in Kim
- University of TorontoTorontoONCanada
- St. Michael's HospitalTorontoONCanada
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Plumptre L, Masih S, Ly A, Aufreiter S, Croxford R, Lausman AY, Berger H, O'Connor DL, Kim Y. Detectable levels of unmetabolized folic acid in Canadian pregnant women. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.1077.18] [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: 11/11/2022]
Affiliation(s)
- Lesley Plumptre
- University of TorontoTorontoONCanada
- St. Michael's HospitalTorontoONCanada
| | - Shannon Masih
- University of TorontoTorontoONCanada
- St. Michael's HospitalTorontoONCanada
| | - Anna Ly
- St. Michael's HospitalTorontoONCanada
| | | | | | | | | | - Deborah L O'Connor
- University of TorontoTorontoONCanada
- The Hospital for Sick ChildrenTorontoONCanada
| | - Young‐In Kim
- University of TorontoTorontoONCanada
- St. Michael's HospitalTorontoONCanada
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