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Li X, Keown-Stoneman CDG, Borkhoff CM, Wong PD, Arafeh D, Tavares E, Thadani S, Maguire JL, Birken CS. Factors associated with research participation in a large primary care practice-based pediatric cohort: Results from the TARGet Kids! longitudinal cohort study. PLoS One 2023; 18:e0284192. [PMID: 37040376 PMCID: PMC10089319 DOI: 10.1371/journal.pone.0284192] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/25/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND All longitudinal cohort studies strive for high participant retention, although attrition is common. Understanding determinants of attrition is important to inform and develop targeted strategies to improve study participation. We aimed to identify factors associated with research participation in a large children's primary care cohort study. METHODS In this longitudinal cohort study between 2008 and 2020, all children who participated in the Applied Research Group for Kids (TARGet Kids!) were included. TARGet Kids! is a large primary care practice-based pediatric research network in Canada with ongoing data collection at well-child visits. Several sociodemographic, health, and study design factors were examined for their associations with research participation. The primary outcome was attendance of eligible research follow-up visits. The secondary outcome was time to withdrawal from the TARGet Kids! study. Generalized linear mixed effects models and Cox proportional hazard models were fitted. We have engaged parent partners in all stages of this study. RESULTS A total 10,412 children with 62,655 total eligible research follow-up visits were included. Mean age at enrolment was 22 months, 52% were male, and 52% had mothers of European ethnicity. 68.4% of the participants attended at least 1 research follow-up visit. Since 2008, 6.4% of the participants have submitted a withdrawal request. Key factors associated with research participation included child age, ethnicity, maternal age, maternal education level, family income, parental employment, child diagnosis of chronic health conditions, certain study sites, and missingness in questionnaire data. CONCLUSIONS Socioeconomic status, demographic factors, chronic conditions, and missingness in questionnaire data were associated with research participation in this large primary care practice-based cohort study of children. Results from this analysis and input from our parent partners suggested that retention strategies could include continued parent engagement, creating brand identity and communication tools, using multiple languages and avoiding redundancy in the questionnaires.
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Affiliation(s)
- Xuedi Li
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter D Wong
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Arafeh
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Sharon Thadani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Khoury M, Bigras JL, Cummings EA, Harris KC, Hegele RA, Henderson M, Morrison KM, St-Pierre J, Wong PD, McCrindle BW. The Detection, Evaluation, and Management of Dyslipidemia in Children and Adolescents: A Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Clinical Practice Update. Can J Cardiol 2022; 38:1168-1179. [PMID: 35961755 DOI: 10.1016/j.cjca.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 12/20/2022] Open
Abstract
Atherosclerosis begins in youth and is directly linked with the presence and severity of cardiovascular risk factors, including dyslipidemia. Thus, the timely identification and management of dyslipidemia in childhood might slow atherosclerotic progression and decrease the risk of cardiovascular disease in adulthood. This is particularly true for children with genetic disorders resulting in marked dyslipidemia, including familial hypercholesterolemia, which remains frequently undiagnosed. Universal and cascade screening strategies can effectively identify cases of pediatric dyslipidemia. In the clinical evaluation of children with dyslipidemia, evaluating for secondary causes of dyslipidemia, including medications and systemic disorders is essential. The first line therapy generally centres around lifestyle modifications, with dietary changes specific to the dyslipidemia phenotype. Indications for medication depend on the severity of dyslipidemia and an individualized assessment of cardiovascular risk. Despite an expanding evidence base supporting the detection and timely management of pediatric dyslipidemia, numerous knowledge gaps remain, including a sufficient evidence base to support more widespread screening, thresholds for initiation of pharmacotherapy, and treatment targets. Further studies on the most appropriate age for statin initiation and long-term safety studies of statin use in youth are also required. The most pressing matter, however, is the development of knowledge translation strategies to improve the screening and detection of lipid disorders in Canadian youth.
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Affiliation(s)
- Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
| | - Jean-Luc Bigras
- Division of Pediatric Cardiology, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Elizabeth A Cummings
- Division of Pediatric Endocrinology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kevin C Harris
- Children's Heart Centre, BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Mélanie Henderson
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada; Centre de Recherche CHU Sainte-Justine, Montreal, Quebec, Canada; School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Katherine M Morrison
- Centre for Metabolism, Obesity and Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Julie St-Pierre
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Peter D Wong
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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3
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Tsang J, Etoom Y, Wong JP, Wong PD. 17-year-old boy with syncope and cardiac arrest. Paediatr Child Health 2022; 27:198-200. [DOI: 10.1093/pch/pxab087] [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] [Received: 01/15/2021] [Accepted: 10/21/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jackie Tsang
- Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
| | - Yousef Etoom
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
- Department of Paediatrics, St. Joseph’s Health Centre , Toronto, Ontario , Canada
- SickKids Research Institute , Toronto, Ontario , Canada
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Jonathan P Wong
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
- Division of Paediatric Cardiology, The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Peter D Wong
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
- SickKids Research Institute , Toronto, Ontario , Canada
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4
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Vanderhout SM, Birken CS, Wong PD, Weir S, Batten J, Maguire JL. Parent Engagement in a COVID-19 Cohort Study of Children and Families: Successes, Challenges and Next Steps. Healthc Q 2022; 24:31-34. [PMID: 35467508 DOI: 10.12927/hcq.2022.26777] [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: 10/18/2022]
Abstract
This article describes the methods, successes and challenges of engaging parents while studying the impacts of COVID-19 on healthy children and families. Parent partners in a Parent and Clinician Team (PACT) informed study aims, supported feasibility and recommended changes to enhance participation. PACT members stated that they felt a sense of connectedness and purpose by contributing to COVID-19 research. Engagement increased by parents acquiring new roles, attending more frequent meetings and co-creating alternative methods of engagement. Recruiting new PACT members was challenging, likely due to limited time and resources available to parents of young children during a pandemic.
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Affiliation(s)
- Shelley M Vanderhout
- A registered dietitian and postdoctoral researcher at the University of Ottawa and Children's Hospital of Eastern Ontario in Ottawa, ON and St. Michael's Hospital in Toronto, ON
| | - Catherine S Birken
- A pediatrician at The Hospital for Sick Children and a professor in the Department of Pediatrics at the University of Toronto in Toronto, ON. She co-leads TARGet Kids! and is the Edwin S.H. Leong chair in Child Health Intervention
| | - Peter D Wong
- A community pediatrician and an associate professor at the Department of Paediatrics and Dalla Lana School of Public Health, University of Toronto in Toronto, ON
| | - Shannon Weir
- A parent volunteer from Toronto, ON, and co-leads the TARGet Kids! Parent and Clinician Team
| | - Jennifer Batten
- A parent volunteer and a mother of two daughters from Toronto, ON
| | - Jonathon L Maguire
- A pediatrician at the St. Michael's Hospital, Unity Health Toronto, and co-leads TARGet Kids! He is a professor of Pediatrics and Lawson Family Chair in Patient Engagement in Child Nutrition at the University of Toronto in Toronto, ON. He can be contacted at
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5
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Sivarajah V, Bhatnagar P, Tom KN, Wong JP, Gerstle JT, Moodie RG, Wong PD. Late Complication of Congenital Diaphragmatic Hernia Repair: Recurrent Small Bowel Obstruction. Pediatr Emerg Care 2022; 38:e1028-e1029. [PMID: 33900715 DOI: 10.1097/pec.0000000000002345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Congenital diaphragmatic hernia (CDH) is associated with high early mortality. However, advances in newborn care have led to improved survival into adolescence and early adulthood. We report a 17-year-old adolescent boy with recurrent small bowel obstruction after CDH repair at 2 days of age. Emergency physicians should be aware of late complications after neonatal CDH repair.
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Affiliation(s)
| | | | | | - Jonathan P Wong
- Department of Pediatrics, Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - J Ted Gerstle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rosemary G Moodie
- Department of Pediatrics, Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada
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6
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Asad I, Lee MS, Banihani R, Wong PD, Etoom Y. Coarctation of the Aorta in Adolescence: Significance of Detailed Cardiac Examination in Pediatric Hypertension. Pediatr Emerg Care 2021; 37:e1724-e1725. [PMID: 30973498 DOI: 10.1097/pec.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although coarctation of the aorta (CoAo) is a congenital anomaly, it can pose a diagnostic challenge in those presenting beyond neonatal period, as some patients can remain asymptomatic until complications of hypertension develop later in life. Careful physical examination can play an important role in timely diagnosis and prevention of complications.We present 2 cases of adolescents with undiagnosed CoAo who both presented with nonspecific headaches and hypertension. Both were initially misdiagnosed as essential hypertension until careful detailed physical examination later detected weak/absent femoral pulses and discrepancy in upper and lower limb blood pressures. These findings raised the clinical suspicion of CoAo, which was confirmed on further investigations.Our cases highlight the importance of considering CoAo in the differential diagnosis of hypertension in adolescents. These cases also stress the significance of detailed cardiac examination including 4-limb blood pressure and femoral pulses in a patient presenting to the emergency department with high blood pressure irrespective of the primary complaint.
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7
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Tse TT, Chan AS, Moodie RG, Etoom Y, Durno CA, Muise AM, Wong PD. A 5-month-old boy with bloody stools. Paediatr Child Health 2021; 25:4-6. [PMID: 33390732 DOI: 10.1093/pch/pxz028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/16/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tiffanie T Tse
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Amy S Chan
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Rosemary G Moodie
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Yousef Etoom
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, St. Joseph's Health Centre, Toronto, Ontario
| | - Carol A Durno
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
| | - Aleixo M Muise
- SickKids Research Institute, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
| | - Peter D Wong
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
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8
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Philteos JG, Abraham ES, Wong PD. The natural progression of bow-leggedness in a 6-month-old boy. Paediatr Child Health 2020; 25:479-480. [DOI: 10.1093/pch/pxz139] [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] [Received: 02/16/2019] [Accepted: 08/20/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Emy S Abraham
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Peter D Wong
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
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9
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Khurana P, Cushing SL, Chakraborty PK, Dunn JK, Papaioannou VA, Moodie RG, Papsin BC, Wong PD. Early hearing detection and intervention in Canada. Paediatr Child Health 2020; 26:141-144. [PMID: 33936331 DOI: 10.1093/pch/pxaa064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/19/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Puneeta Khurana
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Pranesh K Chakraborty
- Division of Metabolics, Department of Paediatrics, University of Ottawa, Ottawa, Ontario
| | - Jessica K Dunn
- Division of Infectious Diseases, Department of Paediatrics, University of Ottawa, Ottawa, Ontario
| | - Vicky A Papaioannou
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Rosemary G Moodie
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
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10
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Jiang SX, Chow BCN, Moodie RG, Abraham ES, Etoom Y, Wong JP, Wong PD. An 11-month-old boy with transaminitis. Paediatr Child Health 2019; 26:16-18. [PMID: 33542770 DOI: 10.1093/pch/pxz173] [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] [Received: 06/01/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Rosemary G Moodie
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Emy S Abraham
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Yousef Etoom
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, St. Joseph's Health Centre, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario.,Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario
| | - Jonathan P Wong
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Division of Paediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario
| | - Peter D Wong
- Department of Paediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
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11
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Wong PD, Parkin PC, Moodie RG, Dai DWH, Maguire JL, Birken CS, Borkhoff CM. Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children. Acad Pediatr 2019; 19:884-890. [PMID: 30831248 DOI: 10.1016/j.acap.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/17/2018] [Revised: 01/24/2019] [Accepted: 02/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Health care policy positions breastfeeding as an important part of the solution to household food insecurity; however, there are critical gaps in our knowledge of the relationship between breastfeeding duration (exposure variable) and household food insecurity (outcome variable). Our objective was to examine this relationship. METHODS A cross-sectional study was conducted from 2008 to 2016 of healthy urban children (N = 3838) who were 0 to 3 years old and recruited from The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Total breastfeeding duration was collected from parent-reported questionnaires. Household food insecurity was measured using 1-item and 2-item food insecurity screens. Multivariable regression analysis was performed adjusting for prespecified covariates. RESULTS The median total breastfeeding duration was 10.5 months (interquartile range, 6.0-14.0), and 14.7% of households were food insecure. After adjusting for child characteristics (age, sex), maternal characteristics (age, ethnicity, education, employment), and family characteristics (number of children, single parent family, neighborhood equity score), there was no significant association between total breastfeeding duration and household food insecurity (odds ratio, 0.99; 95% confidence interval, 0.98-1.01). Although low-income families had an increased odds of being household food insecure (P ≤ .001), we found no significant association between total breastfeeding duration and household food insecurity at varying income levels. CONCLUSIONS We found no association between breastfeeding duration and household food insecurity, regardless of family income. Although breastfeeding is associated with improved child health outcomes and considered to be part of the solution to household food insecurity, interventions focused on social determinants may provide more promising targets for the prevention of household food insecurity.
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Affiliation(s)
- Peter D Wong
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children.
| | - Patricia C Parkin
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
| | - Rosemary G Moodie
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Division of Neonatology (RG Moodie)
| | - David W H Dai
- Li Ka Shing Knowledge Institute (DWH Dai and JL Maguire), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Department of Paediatrics (JL Maguire); Li Ka Shing Knowledge Institute (DWH Dai and JL Maguire), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
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12
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Uruthirakumar R, Fagbola E, Tse TT, Moodie RG, Etoom Y, Laxer RM, Wong PD. A 5-year-old girl with recurrent fever. Paediatr Child Health 2019; 24:368-370. [DOI: 10.1093/pch/pxy184] [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] [Received: 10/02/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Tiffanie T Tse
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Rosemary G Moodie
- The Hospital for Sick Children
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Yousef Etoom
- The Hospital for Sick Children
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Department of Paediatrics, St. Joseph’s Health Centre, Toronto, Ontario
| | - Ronald M Laxer
- The Hospital for Sick Children
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Peter D Wong
- The Hospital for Sick Children
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
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13
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Wong PD, Al-Hashmi I, Agnihotri R, Moodie RG. Iron deficiency in young children: Surveillance versus screening? Paediatr Child Health 2019; 24:330. [DOI: 10.1093/pch/pxz062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Peter D Wong
- Community Paediatric Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Ibrahim Al-Hashmi
- Community Paediatric Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Richa Agnihotri
- Community Paediatric Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Rosemary G Moodie
- Community Paediatric Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario
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14
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Anderson LN, van den Heuvel M, Omand JA, Wong PD. Practical tips for paediatricians: Baby-led weaning. Paediatr Child Health 2019; 25:77-78. [PMID: 32189974 DOI: 10.1093/pch/pxz069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/08/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario.,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario
| | - Meta van den Heuvel
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Jessica A Omand
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario
| | - Peter D Wong
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
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15
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Wong JP, Venu I, Moodie RG, Arivudainambi VC, Stewart H, Schroth RJ, Nicolae A, Zweig KN, van den Heuvel M, Ford-Jones EL, Wong PD. Keeping caries at bay in breastfeeding babies. J Fam Pract 2019; 68:E1-E4. [PMID: 31039219] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As an infant grows, human milk may become the substrate for cariogenic bacteria. Here's what to watch for and how to counsel parents.
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Affiliation(s)
| | - Isvarya Venu
- Trinity College Dublin, University of Dublin, Ireland
| | | | | | | | - Robert J Schroth
- Department of Preventive Dental Science, College of Dentistry, University of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | | | - Elizabeth L Ford-Jones
- Department of Paediatrics, University of Toronto, Canada; Social Paediatrics, Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Peter D Wong
- Department of Paediatrics, University of Toronto, Canada; SickKids Research Institute, Toronto, Canada.
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16
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Wong PD, Thadani SH, Brown LL, Moodie RG. Consider the full spectrum of household food insecurity. CMAJ 2019; 191:E20. [PMID: 30617230 DOI: 10.1503/cmaj.69952] [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: 11/01/2022] Open
Affiliation(s)
- Peter D Wong
- Associate professor, Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Ont
| | - Sharon H Thadani
- Research assistant, TARGetKids!, St. Michael's Hospital, Toronto, Ont
| | - Laura L Brown
- Assistant professor, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Rosemary G Moodie
- Associate professor, Division of Neonatology, Department of Paediatrics, Faculty of Medicine, University of Toronto, Ont
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17
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Borkhoff CM, Dai DWH, Jairam JA, Wong PD, Cox KA, Maguire JL, Birken CS, Macarthur C, Parkin PC. Breastfeeding to 12 mo and beyond: nutrition outcomes at 3 to 5 y of age. Am J Clin Nutr 2018; 108:354-362. [PMID: 30101330 DOI: 10.1093/ajcn/nqy124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/14/2018] [Indexed: 02/04/2023] Open
Abstract
Background Little is known about nutrition outcomes in preschoolers associated with breastfeeding duration beyond 12 mo of age. Objective The aim was to examine the association between total breastfeeding duration and nutrition outcomes at 3 to 5 y of age. Design A cross-sectional study in healthy children, ages 3-5 y, recruited from 9 primary care practices in Toronto was conducted through the TARGet Kids! (The Applied Research Group for Kids) research network. Parents completed standardized surveys, including the Nutrition Screening for Every Preschooler (NutriSTEP) used to assess nutrition risk. Results A total of 2987 children were included. Ninety-two percent of children were breastfed, and the mean ± SD breastfeeding duration was 11.4 ± 8.4 mo. The prevalence of nutrition risk (score >20) was 17.0%. We examined breastfeeding duration as a continuous variable. With the use of restricted cubic spline modeling, we confirmed a nonlinear relation between breastfeeding duration and NutriSTEP score, dietary intake and eating behavior subscores, and sugar-sweetened beverage and sweet-savory snack consumption. Segmented linear regression was used to examine this nonlinear relation in a piecewise approach. We found a decreasing trend in NutriSTEP score for children who were breastfed for 0-6 mo (β = -0.14; 95% CI: -0.29, 0.004), a significant decrease in NutriSTEP score for children breastfed for 6-12 mo (β = -0.20; 95% CI: -0.33, -0.07), and no significant change after 12 mo (β = 0.09; 95% CI: -0.07, 0.24) and beyond. The mean ± SD NutriSTEP scores were 17.1 ± 7.4 for no breastfeeding, 15.9 ± 6.5 for breastfeeding >0-6 mo, 13.9 ± 6.2 for >6-12 mo, 13.7 ± 6.3 for >12-18 mo, 14.6 ± 6.7 for >18-24 mo, and 14.3 ± 6.8 for >24-36 mo. Conclusions Breastfeeding for ≤12 mo was associated with decreased nutrition risk and healthier eating behaviors and dietary intake at 3-5 y of age. We found insufficient evidence of additional benefit for breastfeeding beyond 12 mo of age. The TARGet Kids! practice-based research network is registered at www.clinicaltrials.gov as NCT01869530.
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Affiliation(s)
- Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation
| | | | - Jennifer A Jairam
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter D Wong
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Departments of Pediatrics
| | - Kelly Anne Cox
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon L Maguire
- Departments of Pediatrics.,Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation.,Departments of Pediatrics
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation.,Departments of Pediatrics
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation.,Departments of Pediatrics
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18
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Wong PD, Bowry A, Moodie RG. Re: Pound CM, Blair B. Energy and sports drinks in children and adolescents. Paediatr Child Health. 2017;22(7):406-10. Paediatr Child Health 2018; 23:300-301. [PMID: 30039811 PMCID: PMC6007325 DOI: 10.1093/pch/pxy064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Affiliation(s)
- Peter D Wong
- Board of Health, Toronto Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Ashna Bowry
- Board of Health, Toronto Department of Family and Community Medicine, University of Toronto, Toronto, Ontario
| | - Rosemary G Moodie
- Board Director, Providence Healthcare, St. Joseph’s Health Centre, St. Michael’s Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario
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19
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Au VA, Wong JP, Venu I, Moodie RG, Etoom Y, Kieswetter L, Gerstle JT, Wong PD. Failing to thrive, abdominal pain and vomiting: A hairy situation. Paediatr Child Health 2018; 23:173-175. [PMID: 29773958 DOI: 10.1093/pch/pxx210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Victoria A Au
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Jonathan P Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel
| | - Isvarya Venu
- Trinity College, University of Dublin, Dublin, Irel
| | - Rosemary G Moodie
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel
| | - Yousef Etoom
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel.,Department of Paediatrics, St. Joseph's Health Centre, Toronto, Ontario
| | - Luke Kieswetter
- Department of Paediatrics, McMaster University, Toronto, Ontario
| | - J Ted Gerstle
- Department of Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
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20
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Jacob G, van den Heuvel M, Jama N, Moore AM, Ford-Jones L, Wong PD. Adverse childhood experiences: Basics for the paediatrician. Paediatr Child Health 2018; 24:30-37. [PMID: 30792598 DOI: 10.1093/pch/pxy043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 1998, the Centers for Disease Control and Prevention Adverse Childhood Experiences study established the profound effects of early childhood adversity on life course health. The burden of cumulative adversities can affect gene expression, immune system development and condition stress response. A scientific framework provides explanation for numerous childhood and adult health problems and high-risk behaviours that originate in early life. In our review, we discuss adverse childhood experiences, toxic stress, the neurobiological basis and multigenerational and epigenetic transmission of trauma and recognized health implications. Further, we outline building resilience, screening in the clinical setting, primary care interventions, applying trauma-informed care and future directions. We foresee that enhancing knowledge of the far-reaching effects of adverse childhood events will facilitate mitigation of toxic stress, promote child and family resilience and optimize life course health trajectories.
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Affiliation(s)
| | - Meta van den Heuvel
- Department of Paediatrics, Hospital for Sick Children.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto
| | - Nimo Jama
- Department of Paediatrics, Hospital for Sick Children
| | - Aideen M Moore
- Department of Paediatrics, Hospital for Sick Children.,Division of Neonatology, Department of Paediatrics, Faculty of Medicine, University of Toronto
| | - Lee Ford-Jones
- Department of Paediatrics, Hospital for Sick Children.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto.,Social Paediatrics, Hospital for Sick Children
| | - Peter D Wong
- Department of Paediatrics, Hospital for Sick Children.,Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto.,SickKids Research Institute
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21
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Nicolae A, Levin L, Wong PD, Dave MG, Taras J, Mistry C, Ford-Jones EL, Wong M, Schroth RJ. Identification of early childhood caries in primary care settings. Paediatr Child Health 2018; 23:111-115. [PMID: 29686495 PMCID: PMC5905494 DOI: 10.1093/pch/pxx155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early childhood caries (ECC) is the most common chronic disease affecting young children in Canada. ECC may lead to pain and infection, compromised general health, decreased quality of life and increased risk for dental caries in primary and permanent teeth. A multidisciplinary approach to prevent and identify dental disease is recommended by dental and medical national organizations. Young children visit primary care providers at regular intervals from an early age. These encounters provide an ideal opportunity for primary care providers to educate clients about their children's oral health and its importance for general health. We designed an office-based oral health screening guide to help primary care providers identify ECC, a dental referral form to facilitate dental care access and an oral health education resource to raise parental awareness. These resources were reviewed and trialled with a small number of primary care providers.
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Affiliation(s)
| | - Leo Levin
- Social Pediatrics, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
- The Children’s Aid Society, Toronto, Ontario
| | - Peter D Wong
- SickKids Research Institute, Toronto, Ontario
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Malini G Dave
- Black Creek Community Health Centre, Toronto, Ontario
- Emergency Medicine, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Jillian Taras
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Chetna Mistry
- Faculty of Dentistry, University of Toronto, Toronto, Ontario
| | - Elizabeth L Ford-Jones
- Social Pediatrics, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | | | - Robert J Schroth
- Department of Preventive Dental Science, College of Dentistry, University of Manitoba, Winnipeg, Manitoba
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba
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22
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Wong PD, Anderson LN, Dai DDW, Parkin PC, Maguire JL, Birken CS. The Association of Breastfeeding Duration and Early Childhood Cardiometabolic Risk. J Pediatr 2018; 192:80-85.e1. [PMID: 29246362 DOI: 10.1016/j.jpeds.2017.09.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/18/2017] [Accepted: 09/26/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the association between breastfeeding duration and early childhood cardiometabolic risk. STUDY DESIGN A cross-sectional study of 1539 healthy children, 3-6 years of age, recruited through The Applied Research Group for Kids! practice-based research network between October 2009 and August 2015. Adjusted multivariable linear regression was used to examine the association between breastfeeding duration and cardiometabolic risk z score and individual cardiometabolic risk factors of waist circumference, systolic blood pressure, glucose, high-density lipoprotein cholesterol, and triglycerides. RESULTS The mean breastfeeding duration was 12.5 months (SD = 8.4). Breastfeeding duration was associated with lower cardiometabolic risk z score (beta = -0.03; 95% CI -0.05, -0.01). In analysis of cardiometabolic risk factors, each additional 3 months of breastfeeding was associated with a 0.13 cm (95% CI -0.20, -0.05) lower waist circumference and 0.16 mm Hg (95% CI -0.30, -0.02) lower systolic blood pressure. Compared with children who breastfed for 6-12 months, those who breastfed for 12-24 months had a lower systolic blood pressure of 1.07 mm Hg (95% CI -2.04, -0.10). There was no association between breastfeeding duration and cardiometabolic risk for those who breastfed beyond 24 months. CONCLUSIONS Breastfeeding duration is associated with lower cardiometabolic risk, although the magnitude of association is small. Causation cannot be inferred. Breastfeeding beyond 24 months may not have an added benefit for cardiometabolic health.
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Affiliation(s)
- Peter D Wong
- Division of Pediatric Medicine, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David D W Dai
- Department of Pediatrics, St. Michael's Hospital and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Pediatric Medicine, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Jonathan L Maguire
- Division of Pediatric Medicine, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, St. Michael's Hospital and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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23
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Jacob G, Ford-Jones L, Wong PD, Warman D, Lovett MW. Literacy promotion by health care professionals: A comprehensive biomedical and psychosocial approach. Paediatr Child Health 2017; 23:6-11. [PMID: 29479273 DOI: 10.1093/pch/pxx143] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Literacy is the ability to read, write and understand print. Proficiency in literacy is fundamental to social inclusion and strongly linked to health outcomes. Thus, improving literacy is important for lifelong health promotion. Poverty, inadequate hearing, speech and vision and learning disabilities may challenge literacy development. In our review, we explore these topics and suggest recommendations to: Mitigate the Effects of Poverty, Access Comprehensive Medical Assessments, Promote Early Childhood Education and Advocate for Early Intervention and Remediation Programs.
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Affiliation(s)
| | - Lee Ford-Jones
- Faculty of Medicine, University of Toronto.,The Hospital for Sick Children.,Department of Pediatrics.,Social Pediatrics
| | - Peter D Wong
- Faculty of Medicine, University of Toronto.,The Hospital for Sick Children
| | | | - Maureen W Lovett
- Faculty of Medicine, University of Toronto.,The Hospital for Sick Children.,Department of Pediatrics.,Learning Disabilities Research Program
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24
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Wong JP, Cuddalore Arivudainambi V, Venu I, Etoom Y, Moodie RG, Wong PD. A 6-week-old girl with weak cry and cardiac murmur. Paediatr Child Health 2017; 22:177-178. [PMID: 29479208 PMCID: PMC5804906 DOI: 10.1093/pch/pxx081] [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: 03/14/2024] Open
Affiliation(s)
- Jonathan P Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | | | - Isvarya Venu
- Department of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Yousef Etoom
- Department of Paediatrics, St. Joseph's Hospital Centre Toronto, Hospital for Sick Children, Toronto, Ontario
| | - Rosemary G Moodie
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario
| | - Peter D Wong
- Department of Paediatrics, University of Toronto, Toronto, Ontario
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25
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Venu I, van den Heuvel M, Wong JP, Borkhoff CM, Moodie RG, Ford-Jones EL, Wong PD. The breastfeeding paradox: Relevance for household food insecurity. Paediatr Child Health 2017; 22:180-183. [PMID: 29479210 DOI: 10.1093/pch/pxx067] [Citation(s) in RCA: 14] [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] [Indexed: 11/13/2022] Open
Abstract
Mitigating the harmful effects of adverse social conditions is critical to promoting optimal health and development throughout the life course. Many Canadians worry over food access or struggle with household food insecurity. Public policy positions breastfeeding as a step toward eradicating poverty. Breastfeeding fulfills food security criteria by providing the infant access to sufficient, safe and nutritious food that meets dietary needs and food preferences. Unfortunately, a breastfeeding paradox exists where infants of low-income families who would most gain from the health benefits, are least likely to breastfeed. Solving household food insecurity and breastfeeding rates may be best realized at the public policy level. Notably, the health care provider's competencies as medical expert, professional, communicator and advocate are paramount. Our commentary aims to highlight the critical link between breastfeeding and household food insecurity that may provide opportunities to affect clinical practice, public policy and child health outcomes.
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Affiliation(s)
- Isvarya Venu
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Meta van den Heuvel
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Jonathan P Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Rosemary G Moodie
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Elizabeth L Ford-Jones
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Social Paediatrics, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario
| | - Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
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26
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Wong PD, Birken CS, Parkin PC, Venu I, Chen Y, Schroth RJ, Maguire JL. Total Breast-Feeding Duration and Dental Caries in Healthy Urban Children. Acad Pediatr 2017; 17:310-315. [PMID: 28385327 DOI: 10.1016/j.acap.2016.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/28/2016] [Accepted: 10/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if there is an association between longer breast-feeding duration and dental caries in healthy urban children. METHODS We conducted a cross-sectional study of urban children aged 1 to 6 years recruited through The Applied Research Group for Kids (TARGet Kids!) practice-based research network between September 2011 and August 2013. The main outcome measure was parental report of dental caries. RESULTS The adjusted predicted probability of dental caries was 7%, 8%, 11%, and 16% with total duration of breast-feeding duration of 12, 18, 24, and 36 months, respectively. In the adjusted logistic regression analyses, relative to breast-feeding 0 to 5 months, the odds of dental caries with total breast-feeding duration >24 months was 2.75 (95% confidence interval 1.61-4.72). CONCLUSIONS Among healthy urban children, longer breast-feeding duration was associated with higher odds of dental caries. These findings support heightened awareness and enhanced anticipatory guidance for preventive dental care, particularly among children who breast-feed beyond 2 years of age.
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Affiliation(s)
- Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; SickKids Research Institute, Toronto, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; SickKids Research Institute, Toronto, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; SickKids Research Institute, Toronto, Canada
| | - Isvarya Venu
- Trinity College, University of Dublin, Dublin, Ireland
| | - Yang Chen
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Robert J Schroth
- Department of Preventive Dental Science, College of Dentistry and Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.
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27
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Wong PD, Wong JP, van den Heuvel M, Feller AE, Silver-Cohen J, Talarico S, Humphreys J, Ford-Jones L. The paediatrician and middle childhood parenting. Paediatr Child Health 2017; 22:26-29. [PMID: 29483792 DOI: 10.1093/pch/pxw008] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The 'forgotten years' of middle childhood, from age 6 to 12, represent a critical period in child development. Emotional, social and physical development during this time have a lifelong impact on health and adult contributions to society. Mental health conditions have displaced physical illness as the leading childhood disability. Positive parenting can improve child behaviour, prevent early-onset conduct problems and provide a buffer from adverse childhood events resulting in decreased toxic stress and improved health. Medical homes can play a key role in supporting parents with positive parenting skills that are practical, evidence-based and useful in everyday life. Paediatricians need to explore the domains that promote healthy development, including caring environments, fundamental needs and nurturing relationships. Our objective is to promote high-quality positive parenting through middle childhood by identifying opportunities for paediatricians to frame parenting discussions in the context of development, behaviour and safety and to provide access to valuable parenting resources.
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Affiliation(s)
- Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
| | - Jonathan P Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Meta van den Heuvel
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | | | - Justine Silver-Cohen
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Susanna Talarico
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Joanna Humphreys
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Lee Ford-Jones
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Social Paediatrics, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario
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28
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Wong PD, Dave MG, Tulloch T, Feldman ML, Ford-Jones EL, Parkin PC, Tetley A, Moodie RG. Community health centres: Potential opportunities for community paediatrics. From interprofessional clinical care to board governance. Paediatr Child Health 2015; 20:12-4. [PMID: 25722635 DOI: 10.1093/pch/20.1.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter D Wong
- Rexdale Community Health Centre; ; Community Paediatrics, Division of Paediatric Medicine, Department of Paediatrics, University of Toronto
| | - Malini G Dave
- Black Creek Community Health Centre; ; Emergency Medicine, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto
| | - Trisha Tulloch
- Barbara Black Community Health Centre, Ajax; ; Concurrent Youth Unit, Centre for Addiction and Mental Health, Department of Paediatrics, University of Toronto
| | - Mark L Feldman
- Continuing Education, Department of Paediatrics; ; Community Paediatrics and Integrated Medical Education; ; Faculty of Medicine, University of Toronto, The Hospital for Sick Children & Saint Joseph's Health Centre
| | | | - Patricia C Parkin
- The Applied Research Group for Kids (TARGetKids!); ; Paediatric Outcomes Research Team, Department of Paediatrics, Hospital for Sick Children
| | | | - Rosemary G Moodie
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, Ontario
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Wong PD, Parkin PC, Birken CS, Chen Y, Maguire JL. 209: Total Breastfeeding Duration and Dental Cavities in Early Childhood. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wong JP, Moodie RG, Wong PD. 135: Maternal Diet: A Social Determinant of Breastfeeding Practice. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wong PD. Molar incisor hypomineralization: clinical management in children. Ann R Australas Coll Dent Surg 2010; 20:45. [PMID: 22046733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
The response of the periodontal ligament to orthodontic extrusion of the incisor of a beagle was examined with light microscope and scanning electron microscope techniques. The ligament morphology was slightly altered by the procedure but was essentially normal. Teeth that were extruded and retained for 12 weeks exhibited partial relapse. Where a full thickness mucogingival flap was raised and immediately replaced in lieu of retention, continued extrusion was observed. Root resorption was observed at the interproximal region of the cervical third in three out of five specimens. The resorption had been repaired with cellular cementum.
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Affiliation(s)
- W T Weekes
- Westmead Hospital Dental Clinical School
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Heard SO, Edwards WT, Ferrari D, Hanna D, Wong PD, Liland A, Willock MM. Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective, double-blind study. Anesth Analg 1992; 74:822-6. [PMID: 1595914 DOI: 10.1213/00000539-199206000-00008] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effect of 20 mL of intraarticular bupivacaine (0.25%, with or without 1:200,000 epinephrine), morphine (0.03%, with or without 1:200,000 epinephrine), or normal saline on postoperative analgesia after arthroscopic knee surgery was studied in a randomized, prospective, double-blind trial in ASA I-III outpatients receiving general anesthesia (n = 112) or regional anesthesia (n = 27 [spinal (n = 25) or epidural (n = 2)]). The visual analogue pain scores in the postanesthesia care unit and 3, 6, 12, and 24 h after surgery, time to first analgesic use, and total 24-h analgesic requirements were recorded. In those who received general anesthesia, the visual analogue scores were significantly lower in the bupivacaine group compared with both the morphine- and placebo-treated patients (P less than 0.05). The time to first analgesic use was longer in both the bupivacaine and morphine groups when compared with the control group (P less than 0.05). No significant differences were detected in total 24-h analgesic requirements among the groups. Patients who had received regional anesthesia had lower visual analogue scores compared with patients who had received general anesthesia irrespective of the intraarticular treatment (P less than 0.05). Our results indicate that intraarticular injection of bupivacaine after arthroscopic knee surgery provides prolonged analgesia but that there is no significant prolonged analgesia provided by intraarticular morphine.
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Affiliation(s)
- S O Heard
- Department of Anesthesiology, University of Massachusetts Medical Center, Worcester 01655
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Affiliation(s)
- P D Wong
- Paediatric Dentistry, Westmead Hospital Dental Clinical School, New South Wales
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