Search

Objective: To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. Method: This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. Results: Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74–8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78–7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48–13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self‐poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow‐up. Discussion: Suicide attempt admission is associated with the long‐term risk of eating disorder hospitalization in adolescent girls. Public Significance: This study of adolescent girls suggests that suicide attempt admission is associated with the long‐term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long‐term follow‐up to help prevent the exacerbation or development of eating disorders. [ABSTRACT FROM AUTHOR]

Aim: We assessed the association between caesarean birth and age‐specific risks of childhood cancer. Methods: We followed a cohort of 1 034 049 children between 2006 and 2020 in Quebec, Canada, from birth until age 14 years. The exposure was caesarean, operative vaginal, or spontaneous vaginal birth. The outcome included haematopoietic or solid tumours. We calculated hazard ratios (HR) and 95% confidence intervals (CI) for the association between mode of delivery and childhood cancer in age‐lagged analyses, adjusted for potential confounders. Results: A total of 249 415 (24.1%) children were born by caesarean and 97 411 (9.4%) by operative vaginal delivery. Compared with spontaneous vaginal birth, caesarean was associated with 1.16 times the risk of any cancer (95% CI 1.04–1.30), 1.12 times the risk of haematopoietic cancer (95% CI 0.92–1.36) and 1.21 times the risk of solid tumours (95% 1.06–1.39). Associations strengthened at 2 years of age and were greatest for lymphoma and sarcoma. Operative vaginal birth was not significantly associated with the risk of cancer. Conclusion: Caesarean birth may be associated with selected childhood cancers, including lymphoma and sarcoma early in childhood. The underlying reasons for the associations require further investigation, including whether mucosal dysbiosis or labour hormone exposure explain the excess risk. [ABSTRACT FROM AUTHOR]

This study assessed whether suicide attempts before 20 years of age were associated with medical morbidity later in life. We carried out a cohort study of 169,806 girls under age 20 years between 1989 and 2019 in Quebec, Canada. The cohort included 8086 girls admitted for suicide attempts, matched on age and year with 161,720 girls with no attempt. Outcomes included hospitalization for medical conditions, such as infection, allergic disorders, autoimmune disease, cardiovascular disease, cancer, and death from nonpsychiatric causes during 31 years of follow-up. We computed hazard ratios (HR) and 95% confidence intervals (CI) for the association of adolescent suicide attempt with these health outcomes using Cox regression models adjusted for preexisting mental illness, substance use disorders, and socioeconomic deprivation. Compared with matched controls, adolescent girls with suicide attempts had a greater risk of hospitalization for infection (HR 1.55, 95% CI 1.44–1.68), allergic disorders (HR 1.72, 95% CI 1.45–2.05), cardiovascular disease (HR 1.31, 95% CI 1.12–1.52), and mortality (HR 3.11, 95% CI 1.69–5.70). Associations were present regardless of the age at the time of the suicide attempt, but were stronger for girls with repeated attempts. Associations were also more pronounced within the first 5 years of the attempt, although suicide attempts remained strongly associated with mortality throughout the 31-year follow-up period. The findings suggest that adolescent girls with suicide attempts have an elevated risk of medical morbidity and mortality and may benefit from closer clinical management to prevent adverse health outcomes. • Adolescent girls with suicide attempts have a greater risk of morbidity later on. • Associations are present with infectious, allergic, and cardiovascular conditions. • Associations with these conditions are stronger in the first 5 years of follow-up. • Suicide attempt is associated with premature death over 31 years of follow-up. • There is no clear association with autoimmune disease and cancer. [ABSTRACT FROM AUTHOR]

Pneumonia is a leading cause of morbidity. Pneumonia is defined as a lung inflammation of infectious etiology. It can be subcategorized into Community Acquired Pneumonia, Hospital Acquired Pneumonia and Ventilator Acquired Pneumonia. Validated scores including the CRB-65, CURB-65 and PSI can guide decision-making between inpatient and outpatient management of pneumonia. While mild presentations can be managed through empiric treatment alone, more acute cases require identification of the infectious agent, initiation of empiric therapy, and subsequent de-escalation of treatment to the identified pathogen. This article aims to provide a framework for junior trainees to diagnose and manage pneumonia. [ABSTRACT FROM AUTHOR]

It is supposed that cesarean birth is implicated in the development of autoimmunity. We evaluated the association between cesarean delivery and the risk of hospitalization for autoimmune disease in children up to 14 years of age. We performed a longitudinal cohort study of 934,873 children born between 2006 and 2019 in Quebec, Canada. The main exposure measure was cesarean delivery versus vaginal delivery (spontaneous or induced). Outcomes included hospitalization for type 1 diabetes, celiac disease, or other autoimmune disorders before 14 years of age. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between cesarean delivery and hospitalization for autoimmune disorders, adjusted for patient characteristics. A total of 248,963 children (27%) were delivered by cesarean. Median length of follow-up was 7.4 years. The hospitalization rate for autoimmune disorders was 69.1 per 100,000 person-years for cesarean and 65.9 per 100,000 person-years for vaginal delivery. Cesarean delivery was not associated with autoimmune disorders overall (HR 1.02, 95% CI 0.96–1.10). There was no association with type 1 diabetes (HR 1.00, 95% CI 0.85–1.17), celiac disease (HR 0.86, 95% CI 0.71–1.04), inflammatory bowel disease (HR 1.15, 95% CI 0.88–1.49), or idiopathic thrombocytopenic purpura (HR 1.01, 95% CI 0.82–1.25). Cesarean delivery was not associated with autoimmune disorders at different ages. Conclusion: This study suggests that cesarean delivery is not associated with the risk of hospitalization for autoimmune disorders before 14 years of age. Delivery mode does not seem to mediate the risk of autoimmunity in childhood. What is Known: • Children born by cesarean may be at risk of abnormal immune development. • The association between cesarean delivery and risk of pediatric autoimmune disorders is unclear. What is New: • In this cohort study of over 900,000 children, cesarean delivery was not associated with the risk of hospitalization for a range of autoimmune disorders before 14 years of age. • Cesarean delivery may not be related to the development of autoimmunity. [ABSTRACT FROM AUTHOR]

Background: Research is beginning to implicate early life characteristics in the development of pediatric nonalcoholic fatty liver disease, however the relationship with perinatal characteristics is poorly understood.Aims: We evaluated the association between perinatal characteristics and nonalcoholic fatty liver disease in childhood.Study Design: Nested case-control study.Subjects: 5104 children born in Quebec, Canada between 2006 and 2019. Exposures included maternal diabetes, obesity, prematurity, and other birth complications.Outcome Measures: The outcome was nonalcoholic fatty liver disease diagnosed in hospital before 14 years of age. We calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between birth characteristics and nonalcoholic fatty liver disease.Results: A total of 104 children with nonalcoholic fatty liver disease were included. Gestational diabetes (OR 2.17, 95% CI 1.15-4.10), preexisting diabetes (OR 5.75, 95% CI 2.67-12.4), and maternal obesity (OR 3.06, 95% CI 1.71-5.45) were associated with childhood nonalcoholic fatty liver disease. Prematurity (OR 1.93, 95% CI 1.06-3.54) and neonatal intensive care unit admission (OR 2.18, 95% CI 1.10-4.33) were also associated with nonalcoholic fatty liver disease. However, there was no association with low birthweight, small-for-gestational age birth, and macrosomia.Conclusions: Maternal metabolic disorders and prematurity may initiate processes early in life that lead to the development of nonalcoholic fatty liver disease in childhood. [ABSTRACT FROM AUTHOR]