89 results on '"Parkin, Patricia C."'
Search Results
2. Oxygen Saturation Targets in Infants Hospitalized With Bronchiolitis: A Multicenter Cohort Study
- Author
-
Im, James H.B., Wahi, Gita, Giglia, Lucy, Bayliss, Ann, Kanani, Ronik, Pound, Catherine M., Sakran, Mahmoud, Schuh, Suzanne, Gill, Peter J., Parkin, Patricia C., Barrowman, Nicholas, and Mahant, Sanjay
- Abstract
To examine 2 hospital oxygen saturation target policies and clinical outcomes in infants hospitalized with bronchiolitis.This multicenter cohort study used data collected from a randomized clinical trial of infants aged 4 weeks to 24 months, hospitalized with bronchiolitis at children’s and community hospitals from 2016 to 2019. We modeled the association between hospital oxygen saturation target policy, either 90% while awake and 88% while asleep (90%/88%) or 90% while awake and asleep (90%/90%), and clinical outcomes.A total of 162 infants were enrolled at 4 hospitals using a 90%/88% oxygen saturation target and 67 infants at 2 hospitals using a 90%/90% target policy. No significant differences between the 90%/88% group and 90%/90% groups were observed for time to discharge (adjusted hazard ratio, 0.83; 95% confidence interval [CI], 0.61–1.14; P = .25), initiation of supplemental oxygen (adjusted odds ratio [aOR], 0.98; 95% CI, 0.47–2.02; P = .95), time to discontinuation of supplemental oxygen (adjusted hazard ratio, 0.75; 95% CI, 0.44–1.27; P = .28), revisits (aOR, 1.38; 95% CI, 0.52–3.71; P = .52), and parent days missed from work (aOR, 2.41; 95% CI, 0.90–6.41; P = .08). Three infants in the 90%/88% group and none in the 90%/90% group were transferred to the ICU.Among infants hospitalized with bronchiolitis, clinical outcomes were similar between a hospital oxygen saturation target policy of 90% while awake and 88% while asleep compared with 90% while awake and asleep. These findings may inform the design of future trials of oxygen saturation targets in bronchiolitis hospital care.
- Published
- 2024
- Full Text
- View/download PDF
3. Xylitol for the prevention of acute otitis media episodes in children aged 1–5 years: a randomised controlled trial
- Author
-
Persaud, Navindra, Azarpazhooh, Amir, Keown-Stoneman, Charles, Birken, Catherine S, Isaranuwatchai, Wanrudee, Maguire, Jonathon L, Mamdani, Muhammad, Allen, Christopher, Mason, Dalah, Kowal, Christine, Jaleel, Mateenah, Bazeghi, Farnaz, Thorpe, Kevin E, Laupacis, Andreas, and Parkin, Patricia C
- Abstract
ObjectiveTo investigate the regular use of xylitol, compared with sorbitol, to prevent acute otitis media (AOM), upper respiratory tract infections (URTIs) and dental caries.DesignBlinded randomised controlled trial with a 6-month study period.SettingEnrolment took place at 11 primary care practices in Ontario, Canada.PatientsChildren aged 1–5 years who did not use xylitol or sorbitol at enrolment.InterventionsChildren were randomly assigned to use a placebo syrup with sorbitol or xylitol syrup two times per day for 6 months.Main outcome measuresPrimary outcome was the number of clinician-diagnosed AOM episodes over 6 months. Secondary outcomes were caregiver-reported URTIs and dental caries.ResultsAmong the 250 randomised children, the mean (SD) age was 38±14 months and there were 124 girls (50%). There were three clinician-diagnosed AOM episodes in the 125 placebo group participants and six in the 125 xylitol group participants (OR 2.04; 95% CI 0.43, 12.92; p=0.50). There was no difference in number of caregiver-reported URTI episodes (rate ratio (RR) 0.88; 95% CI 0.70, 1.11) between the placebo (4.2 per participant over 6 months; 95% CI 3.6, 5.0) and xylitol (3.7; 95% CI 3.2, 4.4) groups. Dental caries were reported for four participants in the placebo group and two in the xylitol group (OR 0.42; 95% CI 0.04, 3.05; p=0.42). In a post-hoc analysis of URTIs during the COVID-19 pandemic, the rate among the 59 participants receiving placebo was 2.3 per participant over 6 months (95% CI 1.8, 3.0) and for the 55 receiving xylitol, 1.3 over 6 months (95% CI 0.92, 1.82; RR 0.56; 95% CI 0.36, 0.87). The most common adverse event was diarrhoea (28% with placebo; 34% with xylitol).ConclusionsRegular use of xylitol did not prevent AOM, URTIs or dental caries in a trial with limited statistical power. A post-hoc analysis indicated that URTIs were less common with xylitol exposure during the COVID-19 pandemic, but this finding could be spurious.Trial registration numberNCT03055091.
- Published
- 2024
- Full Text
- View/download PDF
4. A Feeding Adequacy Scale for Children With Bronchiolitis: Prospective Multicenter Study
- Author
-
Sebastian, Agnes, Borkhoff, Cornelia M., Wahi, Gita, Giglia, Lucy, Bayliss, Ann, Kanani, Ronik, Pound, Catherine M., Sakran, Mahmoud, Breen-Reid, Karen, Gill, Peter J., Parkin, Patricia C., and Mahant, Sanjay
- Abstract
To determine the measurement properties of the Feeding Adequacy Scale (FAS) in young children hospitalized with bronchiolitis.Multicenter cohort study of infants hospitalized with bronchiolitis at children’s and community hospitals in Ontario, Canada. Caregivers and nurses completed the FAS, a 10-cm visual analog scale anchored by “not feeding at all” (score 0) and “feeding as when healthy” (score 10). The main outcome measures were feasibility, reliability, validity, and responsiveness of the FAS.A total of 228 children were included with an average (SD) age of 6.3 (5.4) months. Completing the FAS was feasible for caregivers and nurses, with no floor or ceiling effects. Test–retest reliability was moderate for caregivers (intraclass correlation coefficient [ICC] 2,1 0.73; 95% confidence interval [CI] 0.63–0.80) and good for nurses (ICC 2,1 0.75; 95% CI 0.62–0.83). Interrater reliability between 1 caregiver and 1 nurse was moderate (ICC 1,1 0.55; 95% CI 0.45–0.64). For construct validity, the FAS was negatively associated with length of hospital stay and positively associated with both caregiver and nurse readiness for discharge scores (P values <.0001). The FAS demonstrated clinical improvement from the first FAS score at admission to the last FAS score at discharge, with significant differences between scores for both caregivers and nurses (P values for paired t test <.0001).These results provide evidence of the feasibility, reliability, validity, and responsiveness of caregiver-completed and nurse-completed FAS as a measure of feeding adequacy in children hospitalized with bronchiolitis.
- Published
- 2023
- Full Text
- View/download PDF
5. Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children: A Systematic Review and Meta-analysis
- Author
-
Yang, Sarah, Gill, Peter J., Anwar, Mohammed Rashidul, Nurse, Kimberly, Mahood, Quenby, Borkhoff, Cornelia M., Bijelic, Vid, Parkin, Patricia C., and Mahant, Sanjay
- Abstract
IMPORTANCE: Controversy exists on the clinical utility of kidney ultrasonography after first febrile urinary tract infection (UTI), and clinical practice guideline recommendations vary. OBJECTIVE: To determine the prevalence of urinary tract abnormalities detected on kidney ultrasonography after the first febrile UTI in children. DATA SOURCES: The MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched for articles published from January 1, 2000, to September 20, 2022. STUDY SELECTION: Studies of children with first febrile UTI reporting kidney ultrasonography findings. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened titles, abstracts, and full texts for eligibility. Study characteristics and outcomes were extracted from each article. Data on the prevalence of kidney ultrasonography abnormalities were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES: The primary outcome was prevalence of urinary tract abnormalities and clinically important abnormalities (those that changed clinical management) detected on kidney ultrasonography. Secondary outcomes included the urinary tract abnormalities detected, surgical intervention, health care utilization, and parent-reported outcomes. RESULTS: Twenty-nine studies were included, with a total of 9170 children. Of the 27 studies that reported participant sex, the median percentage of males was 60% (range, 11%-80%). The prevalence of abnormalities detected on renal ultrasonography was 22.1% (95% CI, 16.8-27.9; I2 = 98%; 29 studies, all ages) and 21.9% (95% CI, 14.7-30.1; I2 = 98%; 15 studies, age <24 months). The prevalence of clinically important abnormalities was 3.1% (95% CI, 0.3-8.1; I2 = 96%; 8 studies, all ages) and 4.5% (95% CI, 0.5-12.0; I2 = 97%; 5 studies, age <24 months). Study recruitment bias was associated with a higher prevalence of abnormalities. The most common findings detected were hydronephrosis, pelviectasis, and dilated ureter. Urinary tract obstruction was identified in 0.4% (95% CI, 0.1-0.8; I2 = 59%; 12 studies), and surgical intervention occurred in 1.4% (95% CI, 0.5-2.7; I2 = 85%; 13 studies). One study reported health care utilization. No study reported parent-reported outcomes. CONCLUSIONS AND RELEVANCE: Results suggest that 1 in 4 to 5 children with first febrile UTI will have a urinary tract abnormality detected on kidney ultrasonography and 1 in 32 will have an abnormality that changes clinical management. Given the considerable study heterogeneity and lack of comprehensive outcome measurement, well-designed prospective longitudinal studies are needed to fully evaluate the clinical utility of kidney ultrasonography after first febrile UTI.
- Published
- 2023
- Full Text
- View/download PDF
6. Predictive Validity of the Infant Toddler Checklist in Primary Care at the 18-month Visit and School Readiness at 4 to 6 Years.
- Author
-
Nurse, Kimberly M., Janus, Magdalena, Birken, Catherine S., Keown-Stoneman, Charles D. G., Omand, Jessica A., Maguire, Jonathon L., Reid-Westoby, Caroline, Duku, Eric, Mamdani, Muhammad, Tremblay, Mark S., Parkin, Patricia C., and Borkhoff, Cornelia M.
- Subjects
DIAGNOSIS of child development deviations ,CONFIDENCE intervals ,RESEARCH methodology evaluation ,RESEARCH methodology ,MULTIVARIATE analysis ,MEDICAL screening ,REGRESSION analysis ,PRIMARY health care ,SCHOOLS ,DESCRIPTIVE statistics ,RESEARCH funding ,PREDICTIVE validity ,LOGISTIC regression analysis ,LONGITUDINAL method ,EVALUATION ,CHILDREN - Abstract
OBJECTIVE: The American Academy of Pediatrics recommends developmental surveillance and screening in early childhood in primary care. The 18-month visit may be an ideal time for identification of children with delays in language and communication, or symptoms of autism spectrum disorder (ASD). Little is known about the predictive validity of developmental screening tools administered at 18 months. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at the 18-month health supervision visit, using school readiness at kindergarten age as the criterion measure. METHODS: We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit. Teachers completed the Early Development Instrument (EDI) when the children were in Kindergarten, age 4-6 years. We calculated screening test properties with 95% confidence intervals (CIs). We used multivariable logistic and linear regression analyses adjusted for important covariates. RESULTS: Of 293 children (mean age 18 months), 30 (10.2%) had a positive ITC including: concern for speech delay (n = 11, 3.8%), concern for other communication delay (n = 13, 4.4%), and concern for both (n = 6, 2.0%). At followup (mean age 5 years), 54 (18.4%) had overall EDI vulnerability, 19 (6.5%) had vulnerability on the 2 EDI communication domains. The ITC sensitivity ranged from 11% to 32%, speci- ficity from 91% to 96%, false positive rates from 4% to 9%, PPV from 16% to 35%, NPV from 83% to 95%. A positive ITC screen and ITC concern for speech delay were associated with lower scores in EDI communication skills and general knowledge (β = -1.08; 95% CI: -2.10, -0.17; β = -2.35; 95% CI: -3.63, -1.32) and EDI language and cognitive development (β = -0.62; 95% CI: -1.25, -0.18; β = -1.22; 95% CI: -2.11, -0.58). CONCLUSIONS: The ITC demonstrated high specificity suggesting that most children with a negative ITC screen will demonstrate school readiness at 4-6 years, and low false positive rates, minimizing over-diagnosis. The ITC had low sensitivity highlighting the importance of ongoing developmental surveillance and screening. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
7. Variation in the Management of Hospitalized Children With Orbital Cellulitis Over 10 Years
- Author
-
Nguyen, Emily Lan-Vy, Hersi, Leo, Mahant, Sanjay, Cichon, Jessica, Drouin, Olivier, Pound, Catherine, Quet, Julie, Wahi, Gita, Bayliss, Ann, Vomiero, Gemma, Foulds, Jessica L., Kanani, Ronik, Sakran, Mahmoud, Sehgal, Anupam, Borkhoff, Cornelia M., Pullenayegum, Eleanor, Widjaja, Elysa, Reginald, Arun, Wolter, Nikolaus E., Oni, Semipe, Anwar, Rashid, Louriachi, Hossam, Ge, Yipeng, Kirolos, Nardin, Patel, Ashaka, Jasani, Hardika, Kornelsen, Emily, Chugh, Ashton, Gouda, Sandra, Akbaroghli, Susan, McKerlie, Morgyn, Parkin, Patricia C., and Gill, Peter J.
- Abstract
No previous study has examined the management of hospitalized children with orbital cellulitis at both children’s and community hospitals across multiple sites in Canada. We describe variation and trends over time in diagnostic testing and imaging, adjunctive agents, empiric antibiotics, and surgical intervention in children hospitalized with orbital cellulitis.Multicenter cohort study of 1579 children aged 2 months to 18 years with orbital cellulitis infections admitted to 10 hospitals from 2009 to 2018. We assessed hospital-level variation in the use of diagnostic tests, imaging, antibiotics, adjunctive agents, surgical intervention, and clinical outcomes using X2, Mann-Whitney U, and Kruskal-Wallis tests. The association between clinical management and length of stay was evaluated with median regression analysis with hospital as a fixed effect.There were significant differences between children’s hospitals in usage of C-reactive protein tests (P < .001), computed tomography scans (P = .004), MRI scans (P = .003), intranasal decongestants (P < .001), intranasal corticosteroids (P < .001), intranasal saline spray (P < .001), and systemic corticosteroids (P < .001). Children’s hospital patients had significantly longer length of hospital stay compared with community hospitals (P = .001). After adjustment, diagnostic testing, imaging, and subspecialty consults were associated with longer median length of hospital stay at children’s hospitals. From 2009 to 2018, C-reactive protein test usage increased from 28.8% to 73.5% (P < .001), whereas erythrocyte sedimentation rate decreased from 31.5% to 14.1% (P < .001).There was significant variation in diagnostic test usage and treatments, and increases in test usage and medical intervention rates over time despite minimal changes in surgical interventions and length of stay.
- Published
- 2023
- Full Text
- View/download PDF
8. Evaluation of Bronchiolitis-Related Emergency Department Visits From 2004 to 2018: A Population-Based Cohort Study
- Author
-
Brunet, Justin, Gill, Peter J., Imsirovic, Haris, Parkin, Patricia C., To, Teresa, Schuh, Suzanne, and Mahant, Sanjay
- Published
- 2022
- Full Text
- View/download PDF
9. Rates in Bronchiolitis Hospitalization, Intensive Care Unit Use, Mortality, and Costs From 2004 to 2018
- Author
-
Mahant, Sanjay, Parkin, Patricia C., Thavam, Thaksha, Imsirovic, Haris, Tuna, Meltem, Knight, Braden, Webster, Richard, Schuh, Suzanne, To, Teresa, and Gill, Peter J.
- Abstract
IMPORTANCE: Over the last 2 decades, bronchiolitis guidelines and improvement efforts focused on supportive care and reducing unnecessary tests, treatments, and hospitalization. There have been limited population-based studies examining hospitalization outcomes over time. OBJECTIVE: To describe rates and trends in bronchiolitis hospitalization, intensive care unit (ICU) use, mortality, and costs. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used population-based health administrative data from April 1, 2004, to March 31, 2018, to identify bronchiolitis encounters using hospital discharge diagnosis codes in Ontario, Canada. Children younger than 2 years with and without bronchiolitis hospitalization were included. Data were analyzed from January 2020 to July 2021. MAIN OUTCOMES AND MEASURES: Bronchiolitis hospitalization per 1000 person-years, ICU use per 1000 hospitalizations, mortality per 100 000 person-years, and costs per 1000 person-years adjusted to 2018 Canadian dollars and reported in 2018 US dollars. RESULTS: Among 2 336 446 included children, 1 199 173 (51.3%) were male. During the study period, 43 993 children (1.9%) younger than 2 years had 48 058 bronchiolitis hospitalizations at 141 hospitals. Bronchiolitis accounted for 48 058 of 360 920 all-cause hospitalizations (13.3%) and 215 654 of 2 566 348 all-cause hospital days (8.4%) in children younger than 2 years. Bronchiolitis hospitalization was stable over time, at 14.0 (95% CI, 13.6-14.4) hospitalizations per 1000 person-years in 2004-2005 and 12.7 (95% CI, 12.2-13.1) hospitalizations per 1000 person-years in 2017-2018 (annual percent change [APC], 0%; 95% CI, −1.6 to 1.6; P = .97). ICU admission increased significantly from 38.1 (95% CI, 32.2-44.8) per 1000 hospitalizations in 2004-2005 to 87.8 (95% CI, 78.3-98.0) per 1000 hospitalizations in 2017-2018 (APC, 7.2%; 95% CI, 5.4-8.9; P < .001). Over the study period, bronchiolitis mortality was 2.8 (95% CI, 2.3-3.4) per 100 000 person-years and remained stable (APC, 1.1%; 95% CI, −8.4 to 11.7; P = .85). Hospitalization costs per 1000 person-years increased from $49 640 (95% CI, $49 617-$49 663) in 2004-2005 to $58 632 (95% CI, $58 608-$58 657) in 2017-2018 (APC, 3.0%; 95% CI, 1.3-4.8; P = .002). CONCLUSIONS AND RELEVANCE: From 2004 to 2018, bronchiolitis hospitalization and mortality rates remained stable; however, ICU use and costs increased substantially. This represents a major increase in high-intensity hospital care and costs for one of the most common and cumulatively expensive conditions in pediatric hospital care.
- Published
- 2022
- Full Text
- View/download PDF
10. Association Between Corticosteroids and Outcomes in Children Hospitalized With Orbital Cellulitis
- Author
-
Gill, Peter J., Mahant, Sanjay, Hall, Matt, Parkin, Patricia C., Shah, Samir S., Wolter, Nikolaus E., Mestre, Marcos, and Markham, Jessica L.
- Abstract
To examine the association between systemic corticosteroid use and outcomes for children hospitalized with orbital cellulitis at US children’s hospitals.We conducted a multicenter observational study using administrative data from the Pediatric Health Information System database from 2007 to 2019. Children between the ages of 2 months and 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification or 10th Revision, Clinical Modification discharge diagnostic codes of orbital cellulitis were included. The primary exposure was receipt of systemic corticosteroids on the day of hospital admission. The primary outcome was hospital length of stay, and secondary outcomes included surgical intervention, ICU admissions, revisits, and health care costs. We used generalized logit model with inverse probability weighting logistic regression to adjust for demographic factors and assess for differences in clinical outcomes reported.Of the 5832 patients hospitalized with orbital cellulitis, 330 (5.7%) were in the corticosteroid group and 5502 (94.3%) were in the noncorticosteroid group. Patients in the corticosteroid group were older, had more severe illness, and received broad spectrum antibiotics. In adjusted analyses, corticosteroid exposure was not associated with differences in length of hospital stay, need for surgical intervention, ICU admissions, emergency department revisits, 30-day hospital readmissions, or hospital costs. Restricting the analysis to only those patients who received broad spectrum antibiotics did not change the findings.Early use of systemic corticosteroids in hospitalized children with orbital cellulitis is not associated with improved clinical outcomes. Use of corticosteroids in hospitalized children with orbital cellulitis should be discouraged outside of clinical trials.
- Published
- 2022
- Full Text
- View/download PDF
11. Defining Anaemia across the Lifecycle in Healthy Reference Populations: An Analysis for Guideline Development
- Author
-
Fielding, Katherine L, Braat, Sabine, Davidson, Eliza, Moir-Meyer, Gemma, Zaloumis, Sophie, Xu Hui Xu, Jessica, Blaauwendraad, Sophia M, Jaddoe, Vincent W.V., Gaillard, Romy, Parkin, Patricia C, Borkhoff, Cornelia M, Keown-Stoneman, Charles D., Birken, Catherine S, Maguire, Jonathon L, and Pasricha, Sant-Rayn
- Published
- 2022
- Full Text
- View/download PDF
12. Defining Anaemia across the Lifecycle in Healthy Reference Populations: An Analysis for Guideline Development
- Author
-
Fielding, Katherine L, Braat, Sabine, Davidson, Eliza, Moir-Meyer, Gemma, Zaloumis, Sophie, Xu Hui Xu, Jessica, Blaauwendraad, Sophia M, Jaddoe, Vincent W.V., Gaillard, Romy, Parkin, Patricia C, Borkhoff, Cornelia M, Keown-Stoneman, Charles D., Birken, Catherine S, Maguire, Jonathon L, and Pasricha, Sant-Rayn
- Published
- 2022
- Full Text
- View/download PDF
13. Hemoglobin Threshold for Blood Transfusion in Young Children Hospitalized with Iron Deficiency Anemia.
- Author
-
Sun, Dou Lin Rose, Puran, Allan, Al Nuaimi, Mohammed, AlRiyami, Layla, Kinlin, Laura M., Kirby-Allen, Melanie, Mahant, Sanjay, Gill, Peter J., Borkhoff, Cornelia M., and Parkin, Patricia C.
- Published
- 2024
- Full Text
- View/download PDF
14. Association Between Family Income and Positive Developmental Screening Using the Infant Toddler Checklist at the 18-Month Health Supervision Visit.
- Author
-
Nurse, Kimberly M., Parkin, Patricia C., Keown-Stoneman, Charles D.G., Bayoumi, Imaan, Birken, Catherine S., Maguire, Jonathon L., Macarthur, Colin, and Borkhoff, Cornelia M.
- Published
- 2024
- Full Text
- View/download PDF
15. Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis: A Randomized Clinical Trial
- Author
-
Mahant, Sanjay, Wahi, Gita, Bayliss, Ann, Giglia, Lucy, Kanani, Ronik, Pound, Catherine M., Sakran, Mahmoud, Kozlowski, Natascha, Breen-Reid, Karen, Arafeh, Dana, Moretti, Myla E., Agarwal, Amisha, Barrowman, Nick, Willan, Andrew R., Schuh, Suzanne, and Parkin, Patricia C.
- Abstract
IMPORTANCE: There is low level of evidence and substantial practice variation regarding the use of intermittent or continuous monitoring in infants hospitalized with bronchiolitis. OBJECTIVE: To compare the effect of intermittent vs continuous pulse oximetry on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, pragmatic randomized clinical trial included infants 4 weeks to 24 months of age who were hospitalized with bronchiolitis from November 1, 2016, to May 31, 2019, with or without supplemental oxygen after stabilization at community and children’s hospitals in Ontario, Canada. INTERVENTIONS: Intermittent (every 4 hours, n = 114) or continuous (n = 115) pulse oximetry, using an oxygen saturation target of 90% or higher. MAIN OUTCOMES AND MEASURES: The primary outcome was length of hospital stay from randomization to discharge. Secondary outcomes included length of stay from inpatient unit admission to discharge and outcomes measured from randomization: medical interventions, safety (intensive care unit transfer and revisits), parent anxiety and workdays missed, and nursing satisfaction. RESULTS: Among 229 infants enrolled (median [IQR] age, 4.0 [2.2-8.5] months; 136 [59.4%] male; 101 [44.1%] from community hospital sites), the median length of hospital stay from randomization to discharge was 27.6 hours (interquartile range [IQR], 18.8-49.6 hours) in the intermittent group and 25.4 hours (IQR, 18.3-47.6 hours) in the continuous group (difference of medians, 2.2 hours; 95% CI, −1.9 to 6.3 hours; P = .17). No significant differences were observed between the intermittent and continuous groups in the median length of stay from inpatient unit admission to discharge: 49.1 (IQR, 37.2-87.0) hours vs 46.0 (IQR, 32.5-73.8) hours (P = .13) or in frequencies or durations of hospital interventions, such as oxygen supplementation initiation: 4 of 114 (3.5%) vs. 9 of 115 (7.8%) (P = .16) and median duration of oxygen supplementation: 20.6 (IQR, 7.6-46.1) hours vs. 21.4 (11.6-52.9) hours (P = .66). Similarly, there were no significant differences in frequencies of intensive care unit transfer: 1 of 114 (0.9%) vs 2 of 115 (2.7%) (P = .76); readmission to hospital: 3 of 114 (2.6%) in the intermittent group vs 4 of 115 (3.5%) in the continuous group (P > .99); parent anxiety: mean (SD) parent anxiety score, 2.9 (0.9) in the intermittent group vs 2.8 (0.9) in the continuous group (P = .40); or parent workdays missed: median workdays missed, 1.5 (IQR, 0.5-3.0) vs 1.5 (IQR, 0.5-2.5) (P = .36). Mean (SD) nursing satisfaction with monitoring was significantly greater in the intermittent group: 8.6 (1.7) vs 7.1 (2.8) of 10 workdays; the mean difference was 1.5 (95% CI, 0.9-2.2; P < .001). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, among infants hospitalized with stabilized bronchiolitis with and without hypoxia and managed using an oxygen saturation target of 90% or higher, clinical outcomes, including length of hospital stay and safety, were similar with intermittent vs continuous pulse oximetry. Nursing satisfaction was greater with intermittent monitoring. Given that other important clinical practice considerations favor less intense monitoring, these findings support the standard use of intermittent pulse oximetry in stable infants hospitalized with bronchiolitis. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02947204
- Published
- 2021
- Full Text
- View/download PDF
16. Body Weight at Age Four Years and Readiness to Start School: A Prospective Cohort Study
- Author
-
Omand, Jessica A., Li, Xuedi, Keown-Stoneman, Charles D.G., Borkhoff, Cornelia M., Duku, Eric, Lebovic, Gerald, Maguire, Jonathon L., Mamdani, Muhammad M., Parkin, Patricia C., Reid-Westoby, Caroline, Randall Simpson, Janis, Tremblay, Mark S., Janus, Magdalena, and Birken, Catherine S.
- Abstract
Background:Adolescents with obesity have lower academic performance, but little is known about the association between body weight in early childhood and school readiness. The objective was to examine the association between age- and sex-standardized body mass index (zBMI) and body weight status and school readiness in young children.Methods:A prospective cohort study in Toronto, Canada, was conducted in young children enrolled in TARGet Kids!. Children's weight and height were measured before the start of kindergarten. Children's school readiness was measured by the Early Development Instrument (EDI), a validated teacher-completed instrument that assesses children's skills and behaviors in five developmental domains in kindergarten. Generalized estimating equations, adjusted for relevant confounders, were used in the analysis.Results:The study included 1015 children (1217 observations): 52% were male and mean age at zBMI was 4.2 years [50 months (SD 12.1)] and school readiness was 5.2 years [62.7 months (SD 6.9)]. There was no evidence found that zBMI was associated with school readiness. However, in a post hocanalysis, being classified as overweight or with obesity in kindergarten was associated with twofold higher odds of vulnerability in school readiness and a lower social competence score compared with their normal weight peers.Conclusions:Being classified as overweight or with obesity was associated with poor school readiness in year 2 of kindergarten. Early interventions to promote healthy growth before school entry may help promote development and school readiness in young children. www.clinicaltrials.gov(NCT01869530).
- Published
- 2024
- Full Text
- View/download PDF
17. Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children.
- Author
-
Wong, Peter D., Parkin, Patricia C., Moodie, Rosemary G., Dai, David W.H., Maguire, Jonathon L., Birken, Catherine S., and Borkhoff, Cornelia M.
- Subjects
AGE distribution ,BREASTFEEDING ,CHILDREN'S health ,CONFIDENCE intervals ,EMPLOYMENT ,ETHNIC groups ,FAMILIES ,INCOME ,QUESTIONNAIRES ,SEX distribution ,TIME ,URBAN health ,MULTIPLE regression analysis ,EDUCATIONAL attainment ,CROSS-sectional method ,FOOD security ,HEALTH & social status ,ODDS ratio ,CHILDREN - Abstract
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. 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. 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. 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. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
18. 46 Association of Empiric Antibiotic Selection on Clinical Outcomes in Hospitalized Children with Severe Orbital Infections: A Multicenter Cohort Study
- Author
-
Nguyen, Emily, Mahant, Sanjay, Cichon, Jessica, Borkhoff, Cornelia M, Drouin, Olivier, Pound, Catherine, Quet, Julie, Wahi, Gita, Bayliss, Ann, Vomiero, Gemma, Foulds, Jessica, Kanani, Ronik, Sakran, Mahmoud, Sehgal, Anupam, Pullenayegum, Eleanor, Widjaja, Elysa, Reginald, Arun, Wolter, Nikolaus E, Parkin, Patricia C, Gill, Peter J, and Krueger, Carsten
- Published
- 2023
- Full Text
- View/download PDF
19. Temperament Is Associated With Outdoor Free Play in Young Children: A TARGet Kids! Study
- Author
-
Sharp, Julia R., Maguire, Jonathon L., Carsley, Sarah, Abdullah, Kawsari, Chen, Yang, Perrin, Eliana M., Parkin, Patricia C., Birken, Catherine S., Birken, Catherine S., Maguire, Jonathon L., Lau, Eddy, Laupacis, Andreas, Parkin, Patricia C., Salter, Michael, Szatmari, Peter, Weir, Shannon, Abdullah, Kawsari, Aglipay, Mary, Ali, Yamna, Anderson, Laura N., Bayoumi, Imaan, Birken, Catherine S., Borkhoff, Cornelia M., Carsley, Sarah, Chen, Shiyi, Chen, Yang, Dai, David W.H., Darmawikarta, Denise, Dennis, Cindy-Lee, Eny, Karen, Erdle, Stephanie, Furlong, Kayla, Kavikondala, Kanthi, Koroshegyi, Christine, Kowal, Christine, Lee, Grace Jieun, Maguire, Jonathon L., Mason, Dalah, Omand, Jessica, Parkin, Patricia C., Persaud, Navindra, Plumptre, Lesley, van den Heuvel, Meta, Vanderhout, Shelley, Wong, Peter, Zabih, Weeda, Abdurrahman, Murtala, Anderson, Barbara, Anderson, Kelly, Arbess, Gordon, Baker, Jillian, Barozzino, Tony, Bergeron, Sylvie, Bhagat, Dimple, Blanchette, Nicholas, Bloch, Gary, Bonifacio, Joey, Bowry, Ashna, Brown, Anne, Bugera, Jennifer, Calpin, Caroline, Campbell, Douglas, Cheema, Sohail, Cheng, Elaine, Chisamore, Brian, Constantin, Evelyn, Culbert, Erin, Danayan, Karoon, Das, Paul, Derocher, Mary Beth, Do, Anh, Dorey, Michael, Doukas, Kathleen, Egger, Anne, Farber, Allison, Freedman, Amy, Freeman, Sloane, Fung, Keewai, Gazeley, Sharon, Goldenberg, Donna, Guiang, Charlie, Ha, Dan, Hafiz, Shuja, Handford, Curtis, Hanson, Laura, Harrington, Leah, Hatch, Hailey, Hughes, Teresa, Jacobson, Sheila, Jagiello, Lukasz, Jansz, Gwen, Kadar, Paul, Kiran, Tara, Kitney, Lauren, Knowles, Holly, Kwok, Bruce, Lakhoo, Sheila, Lam-Antoniades, Margarita, Lau, Eddy, Leung, Fok-Han, Li, Alan, Li, Patricia, Loo, Jennifer, Louis, Joanne, Mahmoud, Sarah, Male, Roy, Mascoll, Vashti, Moodie, Rosemary, Morinis, Julia, Nader, Maya, Naymark, Sharon, Neelands, Patricia, Owen, James, Parry, Jane, Peer, Michael, Pena, Kifi, Perlmutar, Marty, Persaud, Navindra, Pinto, Andrew, Pitt, Tracy, Porepa, Michelle, Qi, Vikky, Ramji, Nasreen, Ramji, Noor, Rana, Jesleen, Rosenthal, Alana, Rouleau, Katherine, Saunderson, Janet, Saxena, Rahul, Schiralli, Vanna, Sgro, Michael, Shepherd, Susan, Smiltnieks, Barbara, Srikanthan, Cinntha, Taylor, Carolyn, Turner, Suzanne, Uddin, Fatima, Vaughan, Joanne, Weisdorf, Thea, Wijayasinghe, Sheila, Wong, Peter, Wormsbecker, Anne, Ying, Ethel, Young, Elizabeth, Zajdman, Michael, Bustos, Marivic, Camacho, Charmaine, Dalwadi, Dharma, Jegathesan, Thivia, Malhi, Tarandeep, Thadani, Sharon, Thompson, Julia, Thompson, Laurie, Allen, Christopher, Boodhoo, Bryan, Hall, Judith, Juni, Peter, Lebovic, Gerald, Pope, Karen, Shim, Jodi, Thorpe, Kevin, and Azad, Azar
- Abstract
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.
- Published
- 2018
- Full Text
- View/download PDF
20. Total Breast-Feeding Duration and Dental Caries in Healthy Urban Children
- Author
-
Wong, Peter D., Birken, Catherine S., Parkin, Patricia C., Venu, Isvarya, Chen, Yang, Schroth, Robert J., Maguire, Jonathon L., Abdullah, Kawsari, Anderson, Laura N., Birken, Catherine S., Borkhoff, Cornelia M., Carsley, Sarah, Chen, Yang, Katz-Lavigne, Mikael, Kavikondala, Kanthi, Lee, Grace Jieun, Maguire, Jonathon L., Mason, Dalah, Omand, Jessica, Parkin, Patricia C., Persaud, Navindra, van den Heuvel, Meta, Zabih, Weeda, Baker, Jillian, Barozzino, Tony, Bonifacio, Joey, Campbell, Douglas, Cheema, Sohail, Chisamore, Brian, Danayan, Karoon, Das, Paul, Derocher, Mary Beth, Do, Anh, Dorey, Michael, Freeman, Sloane, Fung, Keewai, Guiang, Charlie, Handford, Curtis, Hatch, Hailey, Jacobson, Sheila, Kiran, Tara, Knowles, Holly, Kwok, Bruce, Lakhoo, Sheila, Lam-Antoniades, Margarita, Lau, Eddy, Leung, Fok-Han, Loo, Jennifer, Mahmoud, Sarah, Moodie, Rosemary, Morinis, Julia, Naymark, Sharon, Neelands, Patricia, Owen, James, Peer, Michael, Perlmutar, Marty, Persaud, Navindra, Pinto, Andrew, Porepa, Michelle, Ramji, Nasreen, Ramji, Noor, Rosenthal, Alana, Saunderson, Janet, Saxena, Rahul, Sgro, Michael, Shepherd, Susan, Smiltnieks, Barbara, Taylor, Carolyn, Weisdors, Thea, Wijayasinghe, Sheila, Wong, Peter, Ying, Ethel, and Young, Elizabeth
- Abstract
To determine if there is an association between longer breast-feeding duration and dental caries in healthy urban children.
- Published
- 2017
- Full Text
- View/download PDF
21. Association Between Meat and Meat-Alternative Consumption and Iron Stores in Early Childhood
- Author
-
Cox, Kelly Anne, Parkin, Patricia C., Anderson, Laura N., Chen, Yang, Birken, Catherine S., Maguire, Jonathon L., Macarthur, Colin, Borkhoff, Cornelia M., Abdullah, Kawsari, Anderson, Laura N., Bayoumi, Imaan, Birken, Catherine S., Borkhoff, Cornelia M., Carsley, Sarah, Chen, Yang, Katz-Lavigne, Mikael, Kavikondala, Kanthi, Koroshegyi, Christine, Kowal, Christine, Lee, Grace Jieun, Maguire, Jonathon L., Mason, Dalah, Omand, Jessica, Parkin, Patricia C., Persaud, Navindra, van den Heuvel, Meta, Wong, Peter, Zabih, Weeda, Baker, Jillian, Barozzino, Tony, Bonifacio, Joey, Campbell, Douglas, Cheema, Sohail, Chisamore, Brian, Danayan, Karoon, Das, Paul, Derocher, Mary Beth, Do, Anh, Dorey, Michael, Freeman, Sloane, Fung, Keewai, Guiang, Charlie, Handford, Curtis, Hatch, Hailey, Jacobson, Sheila, Kiran, Tara, Knowles, Holly, Kwok, Bruce, Lakhoo, Sheila, Lam-Antoniades, Margarita, Lau, Eddy, Leung, Fok-Han, Loo, Jennifer, Mahmoud, Sarah, Moodie, Rosemary, Morinis, Julia, Naymark, Sharon, Neelands, Patricia, Owen, James, Peer, Michael, Perlmutar, Marty, Persaud, Navindra, Pinto, Andrew, Porepa, Michelle, Ramji, Nasreen, Ramji, Noor, Rosenthal, Alana, Saunderson, Janet, Saxena, Rahul, Sgro, Michael, Shepherd, Susan, Smiltnieks, Barbara, Taylor, Carolyn, Weisdors, Thea, Wijayasinghe, Sheila, Wong, Peter, Ying, Ethel, Young, Elizabeth, Barozzino, Tony, Chisamore, Brian, Feldman, Mark, Ipp, Moshe, Abreo, Kathleen, Dalwadi, Dharma, Malhi, Tarandeep, Pugliese, Antoinetta, Smith, Megan, and Thompson, Laurie
- Abstract
To prevent iron deficiency, 2014 Canadian recommendations for healthy term infants from 6 to 24 months recommend iron-rich complementary foods such as meat and meat alternatives 2 or more times a day. The purpose of our study was to evaluate the association between meat and meat-alternative consumption and iron status in young children and the association between red meat consumption and iron status among children meeting recommendations.
- Published
- 2016
- Full Text
- View/download PDF
22. Persistent High Non-High-Density Lipoprotein Cholesterol in Early Childhood: A Latent Class Growth Model Analysis.
- Author
-
Albaum, Jordan M, Carsley, Sarah, Chen, Yang, Dai, David W H, Lebovic, Gerald, McCrindle, Brian W, Maguire, Jonathon L, Parkin, Patricia C, Birken, Catherine S, and TARGet Kids! Collaboration
- Abstract
Objectives: To examine patterns of non-high-density lipoprotein (HDL) cholesterol in early childhood and identify factors associated with persistent high non-HDL cholesterol in healthy urban children.Study Design: We identified all children enrolled in a primary care practice-based research network called TARGet Kids! (The Applied Research Group for Kids) with ≥3 laboratory measurements of non-HDL cholesterol. Latent class growth model analysis was performed to identify distinct trajectory groups for non-HDL cholesterol. Trajectory groups were then categorized into "normal" vs "persistent-high" non-HDL cholesterol based on guideline cut-off values and logistic regression was completed to examine the association between trajectory group and the presence of anthropometric and cardiometabolic risk factors.Results: A total of 608 children met inclusion criteria for the trajectory analysis (median age at enrolment = 18.3, IQR = 27.9 months). Four trajectory groups were identified with 2 groups (n = 451) categorized as normal non-HDL cholesterol and 2 groups (n = 157) as persistent high non-HDL cholesterol. Family history of high cholesterol (OR 2.04, 95% CI 1.27-3.28) was associated significantly with persistent high non-HDL cholesterol, whereas East/Southeast Asian vs European ethnicity (OR 0.33, 95% CI 0.14-0.78), longer breastfeeding duration (OR 0.96, 95% CI 0.93-1.00), and greater birth weight (OR 0.69, 95% CI 0.48-1.00) were associated with lower odds of persistent high non-HDL cholesterol.Conclusions: Patterns of non-HDL cholesterol are identified during early childhood, and family history of high cholesterol was associated most strongly with persistent high non-HDL cholesterol. Future research should inform the development of a clinical prediction tool for lipids in early childhood to identify children who may benefit from interventions to promote cardiovascular health. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
23. Effect of High-Dose Vitamin D Supplementation on Upper Respiratory Tract Infection Symptom Severity in Healthy Children
- Author
-
Hueniken, Katrina, Aglipay, Mary, Birken, Catherine S., Parkin, Patricia C., Loeb, Mark B., Thorpe, Kevin E., Dai, David W. H., Laupacis, Andreas, Mamdani, Muhammad, Mazzulli, Tony, and Maguire, Jonathon L.
- Abstract
Supplemental Digital Content is available in the text.
- Published
- 2019
- Full Text
- View/download PDF
24. A Quality Improvement Bundle to Improve Informed Choice for Children With Typical, Newly Diagnosed Immune Thrombocytopenia
- Author
-
Beck, Carolyn E., Carcao, Manuel, Cada, Michaela, Porter, Stephen, Blanchette, Victor S., and Parkin, Patricia C.
- Abstract
IVIG has been the predominant therapy for the initial management of children with newly diagnosed immune thrombocytopenia at our hospital. With current guidelines supporting more conservative management, we undertook a quality improvement initiative to lead practice change. Over a 2-year time period (2013 to 2015), we strove to decrease use of hospital resources (use of IVIG, length of stay) while optimizing family satisfaction. An interdisciplinary working group was struck and a quality improvement bundle was implemented. The bundle comprised a patient information sheet; an evidence-informed, consensus-based protocol; and promotion of shared decision-making via stakeholder engagement and education. Data were collected prospectively; baseline data from a 2007 to 2009 audit were used for comparison. In total, 27 patients were included. Mean initial platelet count was 4×109/L. Bleeding was classified as none or mild in 56% of patients. IVIG use decreased from 88% to 55% of patients, corticosteroid prescription increased from 6% to 15%, and observation increased from 6% to 30% of patients. Hospital length of stay decreased from 47 to 36 hours. Family satisfaction was stable across treatment groups. Through introduction of a quality improvement initiative, we were able to improve family-centered care and decrease use of hospital resources.
- Published
- 2018
- Full Text
- View/download PDF
25. Cost-effectiveness of a quality improvement initiative for the clinical management of children with newly diagnosed immune thrombocytopenia.
- Author
-
Moskalewicz, Alexandra, Beck, Carolyn E., Parkin, Patricia C., Cada, Michaela, and Moretti, Myla E.
- Abstract
Objective: To assess the cost-effectiveness of an evidence-informed institutional protocol for physicians that encouraged management of children with newly diagnosed immune thrombocytopenia with observation over active therapy, where appropriate.Study Design: We conducted a probabilistic cost-effectiveness analysis from an institutional perspective using a decision tree with a one year time horizon. Patient-level data was retrospectively ascertained for children diagnosed in pre-protocol (2007-2009) and post-protocol (2013-2018) time periods. ITP resolution was defined as achieving a sustained platelet count of >100×103/μL at 9-12 months after diagnosis. Outpatient care and inpatient costs were obtained from the institution and provincial sources. Intervention costs accounted for QI initiative preparation and staff physician training. Incremental costs, incremental effects, and confidence intervals were calculated from 10 000 model iterations.Results: Forty-eight patients were followed for one year in the pre-protocol period and 84 in the post-protocol period. After protocol implementation, an average cost savings per child managed of $2055 (95% CI: $656, $3890) CAD was observed, as was a higher proportion of resolved ITP cases. The implementation strategy remained less costly and more effective in 99.7% of model iterations.Conclusions: Implementation of an evidence-informed institutional protocol to guide physicians towards increased uptake of observation over active therapy when managing children with newly diagnosed ITP resulted in significant cost savings on a per case basis, even after accounting for training-related costs. Though the long-term cost implications regarding the sustainability of the intervention are not yet known, it is anticipated that continued institutional savings could occur. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF
26. 45 Variation in the Management of Hospitalized Children with Orbital Cellulitis over Ten Years
- Author
-
Nguyen, Emily, Mahant, Sanjay, Cichon, Jessica, Drouin, Olivier, Pound, Catherine, Quet, Julie, Wahi, Gita, Bayliss, Ann, Vomiero, Gemma, Foulds, Jessica L, Kanani, Ronik, Sakran, Mahmoud, Sehgal, Anupam, Borkhoff, Cornelia M, Pullenayegum, Eleanor, Widjaja, Elysa, Reginald, Arun, Wolter, Nikolaus E, Oni, Semipe, Anwar, Rashid, Louriachi, Hossam, Ge, Yipeng, Kirolos, Nardin, Patel, Ashaka, Jasani, Hardika, Kornelsen, Emily, Chugh, Ashton, Gouda, Sandra, Akbaroghli, Susan, McKerlie, Morgyn, Parkin, Patricia C, Gill, Peter J, and Hersi, Leo
- Published
- 2023
- Full Text
- View/download PDF
27. Re-Evaluation of Serum Ferritin Cut-Off Values for the Diagnosis of Iron Deficiency in Children Aged 12-36 Months.
- Author
-
Abdullah, Kawsari, Birken, Catherine S., Maguire, Jonathon L., Fehlings, Darcy, Hanley, Anthony J., Thorpe, Kevin E., and Parkin, Patricia C.
- Abstract
An ongoing challenge has been determining clinically relevant serum ferritin cut-offs in the diagnosis of iron deficiency in children aged 1-3 years. We identified 2 potential clinically relevant serum ferritin cut-off values through their association with clinically important cut-off of hemoglobin as the indicator of anemia. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
28. Parent reported nutritional risk and laboratory indices of cardiometabolic risk and in preschool-aged children.
- Author
-
Persaud, Navindra, Ziai, Hedyeh, Lebovic, Gerald, Maguire, Jonathon L., Khovratovich, Marina, Simpson, Janis A. Randall, Adeli, Khosrow, Hamilton, Jill, McCrindle, Brian W., Parkin, Patricia C., and Birken, Catherine S.
- Abstract
Background: Eating habits formed during childhood may contribute to the increasing prevalence of cardiometabolic disorders. Assessing nutritional risk in young children may help to prevent later cardiometabolic disease. The objective of this study was to determine whether parent-reported nutritional risk in preschool-aged children was associated with laboratory indices of cardiometabolic risk, namely leptin and insulin. Methods: In this cross-sectional study, the relationship between nutritional risk as determined by the parentcompleted NutriSTEP® questionnaire was assessed and compared to the serum leptin and insulin concentrations, hormones involved in regulation of food intake and biomarkers of adiposity and cardiometabolic risk. The community-based primary care research network for children in Toronto, Canada (TARGet Kids!) was used. The participants were children aged 3-5 years recruited from TARGet Kids! A total of 1856 children were recruited from seven primary care practices. Of these, 1086 children completed laboratory testing. Laboratory data for leptin and insulin were available for 714 and 1054 of those individuals, respectively. Results: The total NutriSTEP® score was significantly associated with serum leptin concentrations (p = 0.003); for each unit increase in the total NutriSTEP® score, there was an increase of 0.01 ng/mL (95% confidence interval [CI] 0.004-0.018) in serum leptin concentrations after adjusting for potential confounders. The total NutriSTEP® score was not significantly associated with serum insulin concentration. Conclusions: Parent reported nutritional risk is associated with serum leptin, but not insulin, concentrations in preschool-aged children. The NutriSTEP® questionnaire may be an effective tool for predicting future cardiometabolic risk in preschool-aged children. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
29. Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario
- Author
-
Satkunam, Meloja, Anderson, Laura, Carsley, Sarah, Maguire, Jonathon L., Parkin, Patricia C., Sprague, Ann, Ball, Geoff, and Birken, Catherine
- Abstract
International data suggest the prevalence of severe obesity in young children may be increasing, yet no Canadian data are available. The objectives of this study were to examine definitions of severe obesity and to evaluate associated risk factors among young children in Ontario. A cross-sectional study was conducted in children 17 to 24 months of age using two Ontario data sources: TARGet Kids! (n= 3713) and BORN Ontario (n= 768). Body mass index zscore (zBMI) definitions were adapted from the World Health Organization (WHO) (zscore > 3) and the US Centers for Disease Control (CDC) (> 120% of the 95th percentile) and applied to define severe obesity in young children. Multinomial logistic regression was used to evaluate associations between demographic and pregnancy risk factors and zBMI categories. A total of 1.1% (95% CI, 0.8–1.4) of children met the adapted WHO definition of severe obesity compared to 0.3% (95% CI, 0.2–0.6) using the CDC definition. Median neighbourhood household income (OR = 0.80, 95% CI, 0.69–0.93) and maternal pre-pregnancy BMI (OR = 1.08, 95% CI, 1.01–1.15) were associated with severe obesity in unadjusted analyses. After adjustment for potential confounders, the OR for the association between maternal pre-pregnancy BMI and severe obesity was 1.04 (95% CI, 0.94–1.15). More than 1% of Ontario children met the adapted WHO definition of severe obesity in very early childhood. Modifiable risk factors were identified. Future studies are needed to understand the terminology, prevalence, and risk factors for severe obesity in young children across Canada. Selon les données internationales, la prévalence de l’obésité sévère chez les jeunes enfants pourrait être en hausse, mais il n’existe pas de données canadiennes à ce sujet. Nous avons voulu examiner les définitions de l’obésité sévère et évaluer les facteurs de risque associés chez les jeunes enfants en Ontario. Nous avons mené une étude transversale auprès d’enfants de 17 à 24 mois à l’aide de deux sources de données ontariennes : TARGet Kids! (n= 3713) et BORN Ontario (n= 768). Nous avons adapté les définitions du score-z de l’indice de masse corporelle (IMC) de l’Organisation mondiale de la santé (OMS) (score-z > 3) et des Centers for Disease Control américains (CDC) (>120% du 95ecentile) et nous les avons appliquées pour définir l’obésité sévère chez les jeunes enfants. Par régression logistique multinomiale, nous avons évalué les associations entre les facteurs de risque démographiques et liés à la grossesse et les catégories du score-z de l’IMC. Un total de 1,1% (IC de 95% : 0,8–1,4) des enfants répondaient à la définition de l’obésité sévère adaptée de celle de l’OMS, et 0,3% (IC de 95% : 0,2–0,6) répondaient à la définition adaptée de celle des CDC. Le revenu médian des ménages selon le quartier (rapport de cotes [RC] = 0,80, IC de 95% : 0,69–0,93) et l’IMC maternel avant la grossesse (RC = 1,08, IC de 95% : 1,01–1,15) étaient associés à l’obésité sévère dans nos analyses non ajustées. En tenant compte des facteurs confusionnels possibles, le RC de l’association entre l’IMC maternel avant la grossesse et l’obésité sévère était de 1,04 (IC de 95% : 0,94–1,15). Plus de 1% des enfants ontariens répondent à la définition de l’obésité sévère de l’OMS pour les très jeunes enfants. Nous avons repéré des facteurs de risque modifiables. Il faudrait pousser la recherche pour comprendre la terminologie, la prévalence et les facteurs de risque de l’obésité sévère chez les jeunes enfants à l’échelle du Canada.
- Published
- 2018
- Full Text
- View/download PDF
30. Severe Obesity, Obesity, and Cardiometabolic Risk in Children 0 to 6 Years of Age
- Author
-
Carsley, Sarah E., Anderson, Laura N., Plumptre, Lesley, Parkin, Patricia C., Maguire, Jonathon L., and Birken, Catherine S.
- Abstract
AbstractBackground: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.
- Published
- 2017
- Full Text
- View/download PDF
31. Emergency Department Revisits by Urban Immigrant Children in Canada: A Population-Based Cohort Study.
- Author
-
Saunders, Natasha Ruth, To, Teresa, Parkin, Patricia C., and Guttmann, Astrid
- Abstract
Objectives: To examine the relationship between family immigrant status and unscheduled 7-day revisits to the emergency department (ED) and to test this relationship within subgroups of immigrants by visa class (family, economic, refugee), native tongue on landing in Canada, and region of origin.Study Design: Population-based cohort study that used multiple linked health administrative and demographic datasets of landed immigrant and nonimmigrant children (<18 years) in urban Ontario who visited an ED and were discharged between April 2003 and March 2010. Logistic regression was used to model the odds of 7-day ED revisits with family immigrant status, with adjustment for patient and ED characteristics.Results: Of 3,322,901 initial visits to the ED, 249,648 (7.5%) resulted in a 7-day revisit. There was no significant association of immigrant status with either ED revisits or poor revisit outcomes (greater acuity visit or need for admission) in the adjusted models. Within immigrants, the odds of revisit were not associated with immigrant classes or region of origin; however, immigrants whose native tongue was not English or French had a slightly greater odds of revisiting the ED (aOR 1.05; 95% CI 1.01, 1.09). Significant predictors of revisits included younger age, greater triage acuity score, greater predilection for using an ED, daytime shifts, and greater deprivation index.Conclusions: Immigrant children are not more likely to have short-term revisits to the ED, but there may be barriers to care related to language fluency that need to be addressed. These findings may be relevant for improving translation services in EDs. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
32. Parent reported nutritional risk and laboratory indices of cardiometabolic risk and in preschool-aged children
- Author
-
Persaud, Navindra, Ziai, Hedyeh, Lebovic, Gerald, Maguire, Jonathon L., Khovratovich, Marina, Simpson, Janis A. Randall, Adeli, Khosrow, Hamilton, Jill, McCrindle, Brian W., Parkin, Patricia C., and Birken, Catherine S.
- Published
- 2017
- Full Text
- View/download PDF
33. Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children
- Author
-
Plumptre, Lesley, Anderson, Laura N., Chen, Yang, Carsley, Sarah, Narang, Indra, Hamilton, Jill, McCrindle, Brian, Parkin, Patricia C., Maguire, Jonathon L., and Birken, Catherine S.
- Abstract
AbstractBackground: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.
- Published
- 2017
- Full Text
- View/download PDF
34. Temperament and fracture in preschool-aged children.
- Author
-
Ryckman, Kandace, Richmond, Sarah A, Anderson, Laura N, Birken, Catherine S, Parkin, Patricia C, Macarthur, Colin, Maguire, Jonathon L, and Howard, Andrew W
- Abstract
Approximately one-half of all children will sustain a fracture before adulthood. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. The purpose of this study was to examine the association between temperament and fracture risk in preschool-aged children.
- Published
- 2017
- Full Text
- View/download PDF
35. Major Depressive Disorder Among Preadolescent Canadian Children: Rare Disorder or Rarely Detected?
- Author
-
Korczak, Daphne J., Ofner, Marianna, LeBlanc, John, Wong, Sam, Feldman, Mark, and Parkin, Patricia C.
- Abstract
Despite agreement that preadult onset of depression is associated with greater illness severity, and that children can meet the diagnostic criteria for major depressive disorder (MDD), few studies have examined the presentation of MDD among young children. This is the first nationwide study of MDD among preadolescent children in Canada.
- Published
- 2017
- Full Text
- View/download PDF
36. Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis
- Author
-
Principi, Tania, Coates, Allan L., Parkin, Patricia C., Stephens, Derek, DaSilva, Zelia, and Schuh, Suzanne
- Abstract
IMPORTANCE: Reliance on pulse oximetry has been associated with increased hospitalizations, prolonged hospital stay, and escalation of care. OBJECTIVE: To examine whether there is a difference in the proportion of unscheduled medical visits within 72 hours of emergency department discharge in infants with bronchiolitis who have oxygen desaturations to lower than 90% for at least 1 minute during home oximetry monitoring vs those without desaturations. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study conducted from February 6, 2008, to April 30, 2013, at a tertiary care pediatric emergency department in Toronto, Ontario, Canada, among 118 otherwise healthy infants aged 6 weeks to 12 months discharged home from the emergency department with a diagnosis of acute bronchiolitis. MAIN OUTCOMES AND MEASURES: The primary outcome was unscheduled medical visits for bronchiolitis, including a visit to any health care professional due to concerns about respiratory symptoms, within 72 hours of discharge in infants with and without desaturations. Secondary outcomes included examination of the severity and duration of the desaturations, delayed hospitalizations within 72 hours of discharge, and the effect of activity on desaturations. RESULTS: A total of 118 infants were included (mean [SD] age, 4.5 [2.1] months; 69 male [58%]). During a mean (SD) monitoring period of 19 hours 57 minutes (10 hours 37 minutes), 75 of 118 infants (64%) had at least 1 desaturation event (median continuous duration, 3 minutes 22 seconds; interquartile range, 1 minute 54 seconds to 8 minutes 50 seconds). Among the 118 infants, 59 (50%) had at least 3 desaturations, 12 (10%) had desaturation for more than 10% of the monitored time, and 51 (43%) had desaturations lasting 3 or more minutes continuously. Of the 75 infants who had desaturations, 59 (79%) had desaturation to 80% or less for at least 1 minute and 29 (39%) had desaturation to 70% or less for at least 1 minute. Of the 75 infants with desaturations, 18 (24%) had an unscheduled visit for bronchiolitis as compared with 11 of the 43 infants without desaturation (26%) (difference, −1.6%; 95% CI, −0.15 to ∞; P = .66). One of the 75 infants with desaturations (1%) and 2 of the 43 infants without desaturations (5%) were hospitalized within 72 hours (difference, −3.3%; 95% CI, −0.04 to 0.10; P = .27). Among the 62 infants with desaturations who had diary information, 48 (77%) experienced them during sleep or while feeding. CONCLUSIONS AND RELEVANCE: The majority of infants with mild bronchiolitis experienced recurrent or sustained desaturations after discharge home. Children with and without desaturations had comparable rates of return for care, with no difference in unscheduled return medical visits and delayed hospitalizations.
- Published
- 2016
- Full Text
- View/download PDF
37. Risk factors, practice variation and hematological outcomes of children identified with non-anemic iron deficiency following screening in primary care setting.
- Author
-
Abdullah, Kawsari, Thorpe, Kevin E, Maguire, Jonathon L, Birken, Catherine S, Fehlings, Darcy, Hanley, Anthony J, and Parkin, Patricia C
- Abstract
To determine the prevalence, risk factors, physician practice patterns and longitudinal hematological outcome of children following screening for non-anemic iron deficiency (NAID).
- Published
- 2016
- Full Text
- View/download PDF
38. Mandatory labeling requirements and over-the-counter cough and cold medication use in early childhood
- Author
-
Degroot, Julie, Anderson, Laura N., Chen, Yang, Birken, Catherine S., Parkin, Patricia C., Carsley, Sarah, Khovratovich, Marina, Mamdani, Muhammad, and Maguire, Jonathon L.
- Abstract
OBJECTIVES:Due to rare but severe adverse events, Health Canada in October 2009 required manufacturers to relabel over-the-counter (OTC) cough and cold medication (CCM) to state that the products should not be used in children <6 years of age. The main objective of this study was to determine whether this labeling standard decreased OTC CCM use among young children with a recent cough, cold or flu.
- Published
- 2015
- Full Text
- View/download PDF
39. Shared Decision Making in the Management of Children With Newly Diagnosed Immune Thrombocytopenia
- Author
-
Beck, Carolyn E., Boydell, Katherine M., Stasiulis, Elaine, Blanchette, Victor S., Llewellyn-Thomas, Hilary, Birken, Catherine S., Breakey, Vicky R., and Parkin, Patricia C.
- Abstract
This study aimed to examine the treatment decision-making process for children hospitalized with newly diagnosed immune thrombocytopenia (ITP). Using focus groups, we studied children with ITP, parents of children with ITP, and health care professionals, inquiring about participants’ experience with decision support and decision making in newly diagnosed ITP. Data were examined using thematic analysis. Themes that emerged from children were feelings of “anxiety, fear, and confusion”; the need to “understand information”; and “treatment choice,” the experience of which was age dependent. For parents, “anxiety, fear, and confusion” was a dominant theme; “treatment choice” revealed that participants felt directed toward intravenous immune globulin (IVIG) for initial treatment. For health care professionals, “comfort level” highlighted factors contributing to professionals’ comfort with offering options; “assumptions” were made about parental desire for participation in shared decision making (SDM) and parental acceptance of treatment options; “providing information” was informative regarding modes of facilitating SDM; and “treatment choice” revealed a discrepancy between current practice (directed toward IVIG) and the ideal of SDM. At our center, families of children with newly diagnosed ITP are not experiencing SDM. Our findings support the implementation of SDM to facilitate patient-centered care for the management of pediatric ITP.
- Published
- 2014
- Full Text
- View/download PDF
40. The efficacy of trimethoprim in wound healing of patients with epidermolysis bullosa: A feasibility trial.
- Author
-
Lara-Corrales, Irene, Parkin, Patricia C., Stephens, Derek, Hamilton, Jill, Koren, Gideon, Weinstein, Miriam, Sibbald, Ronald G., and Pope, Elena
- Abstract
Background: There are no systemic therapies known to facilitate wound healing in patients with recessive dystrophic epidermolysis bullosa (RDEB). Objectives: We sought to assess the feasibility of a trial to examine the efficacy of trimethoprim (TMP) in healing chronic wounds in patients with RDEB and to examine the effect of TMP on lesion counts, quality of life, and emergence of antibiotic resistance. Methods: We conducted a feasibility study using a prospective, randomized, double-blinded, placebo-controlled, crossover design. The study took place between October 2006 and September 2007 in the epidermolysis bullosa clinic at the Hospital for Sick Children in Toronto, Ontario, Canada. Liquid TMP or placebo was given orally or via gastrostomy tube in two divided doses for 2 months; the main outcome measure was a decrease in surface area of selected chronic wounds. Results: Ten subjects with RDEB were enrolled in the study; 7 completed both study arms (4 male, 3 female). Age at enrollment was 14 ± 5.4 years. Although all patients showed improved wound healing on TMP, the crossover analysis, TMP versus placebo, approached but did not reach statistical significance (P = .08). While receiving TMP, 6 of 7 patients had more than 50% reduction in chronic wound surface area; while receiving placebo, 2 of 6 patients had more than 50% reduction in wound surface area (P = .03). Secondary outcome measures did not achieve statistical significance. Limitations: Small sample size is a limitation. Conclusions: This proof-of-concept study demonstrates the potential efficacy of TMP in improving wound healing in RDEB, and provides useful information for further prospective studies. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
41. Goat's Milk, Plant-based Milk, Cow's Milk, and Serum 25-hydroxyvitamin D Levels in Early Childhood.
- Author
-
Lee, Grace J., Birken, Catherine S., Lebovic, Gerald, Yang Chen, L'Abbe, Mary R., Maguire, Jonathon L., Parkin, Patricia C, Chen, Yang, and TARGet Kids! Collaboration
- Subjects
BEVERAGES ,CATTLE ,DIET ,MAMMALS ,MILK ,RESEARCH funding ,VITAMIN D ,VITAMIN D deficiency ,DIAGNOSIS - Published
- 2016
- Full Text
- View/download PDF
42. Pediatric blunt and penetrating trauma deaths in Ontario: a population-based study.
- Author
-
Diamond, Ivan R., Parkin, Patricia C., Wales, Paul W., Bohn, Desmond, Kreller, Margaret A., Dykes, Evelyn H., McLellan, Barry A., and Wesson, David E.
- Subjects
CHILDREN'S injuries ,CHILD mortality statistics ,PENETRATING wounds ,BLUNT trauma ,HEAD injuries - Abstract
Abstract: Purpose: The purpose of the study was to describe the mechanisms of injury and causes of death in children dying in a modern, integrated trauma system. Method: Records of all children (<16 years of age) who died in Ontario from 2001 through 2003 after blunt or penetrating trauma were obtained from the Chief Coroner. Demographics and the nature and causes of injury and the causes of death were recorded. Estimates of the mortality rate were determined using census data. Results: There were 234 injury deaths (222 blunt, 12 penetrating) over the 3 years. Thirty (13%) resulted from intentional injury. The median age was 10 (range, 0-15.9) years; 62% were male. Sixty-eight percent resulted from incidents involving motor vehicles (passenger, pedestrian, or cyclist). Most (74%) died at the scene; only 5% survived for more than 24 hours. Devastating craniocervical injury (Abbreviated Injury Scale 5 or 6) was present in 84% and was the only life-threatening injury in 40%. The annual mortality rate averaged 3.2 per 100,000 children. Conclusions: In a modern, integrated trauma system, most pediatric injury deaths occur at the scene from severe head injuries. In this population, strategies to reduce the death rate from pediatric trauma must focus on primary and secondary injury prevention. [Copyright &y& Elsevier]
- Published
- 2009
- Full Text
- View/download PDF
43. Corticosteroids Versus Intravenous Immune Globulin for the Treatment of Acute Immune Thrombocytopenic Purpura in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
- Author
-
Beck, Carolyn E., Nathan, Paul C., Parkin, Patricia C., Blanchette, Victor S., and Macarthur, Colin
- Abstract
Objective: To compare the effectiveness of corticosteroids with intravenous immune globulin (IVIG) for the initial treatment of children with acute immune thrombocytopenic purpura (ITP). Study design: A systematic review and meta-analysis of randomized controlled trials comparing corticosteroids with IVIG. Studies were identified from eight electronic databases, meeting abstracts, expert consultation, and hand-searched reference lists. Two authors independently reviewed potentially eligible studies and extracted data. The number of patients with a platelet count >20,000/mm
3 , 48 hours after treatment initiation, was the primary outcome. Relative risks (RR) and risk differences were pooled using a random effects model, and numbers needed to treat (NNT) were calculated. Results: A total of 1248 abstracts were reviewed, 55 articles were retrieved, and 10 studies were included. The RR (steroids vs IVIG) of achieving a platelet count >20,000/mm3 at 48 hours was 0.74 (95% CI: 0.65, 0.85), and the NNT was 4.55 (95% CI: 3.23, 7.69). Conclusion: Children treated with corticosteroids for acute ITP are 26% less likely to have a platelet count >20,000/mm3 after 48 hours of therapy, when compared with children treated with IVIG. Given the importance of low platelets in the pathogenesis of intracranial hemorrhage (ICH), this difference may hold important clinical implications. [Copyright &y& Elsevier]- Published
- 2005
- Full Text
- View/download PDF
44. What factors are associated with poor developmental attainment in young Canadian children?
- Author
-
To T, Guttmann A, Dick PT, Rosenfield JD, Parkin PC, Cao H, Vydykhan TN, Tassoudji M, Harris JK, To, Teresa, Guttmann, Astrid, Dick, Paul T, Rosenfield, Jay D, Parkin, Patricia C, Cao, Hongmei, Vydykhan, Tatiana N, Tassoudji, Marjan, and Harris, Jennifer K
- Abstract
Background: This study was undertaken to determine the association between poor developmental attainment (PDA) and biological, home environment and socio-demographic factors in a population-based sample of Canadian children.Methods: Cross-sectional data from two cycles (1994/95 and 1996/97) of the National Longitudinal Survey of Children and Youth were used. Children aged 1-5 years were included. PDA was defined as < or = 15th percentile for motor and social developmental skills (1-3 year olds) or Peabody Picture Vocabulary Test (4-5 year olds). Multiple logistic regression was used.Results: The proportion of children with PDA varies across Canada, between males and females, and by age. Among 1 year olds in Cycle I, having a low birthweight (OR=3.3; 95% CI: 2.1-5.2), being male (OR=1.6; 95% CI: 1.2-2.2) and having a mother who is an immigrant (OR=1.6; 95% CI: 1.1-2.2) increased the odds of PDA. Similar results were observed in Cycle II. Among children aged 4-5 years in Cycle II, having a mother who is an immigrant (OR=5.3; 95% CI: 4.1-6.9) and a mother with low educational attainment (OR=2.8; 95% CI: 2.1-3.9) increased the odds of PDA. Low income was a significant predictor of PDA across all age groups.Interpretation: The strong and consistent associations with living in a low-income household, having a mother with low educational attainment or a mother who is an immigrant highlight the need for targeting developmental assessments and services to this population. [ABSTRACT FROM AUTHOR]- Published
- 2004
45. What Factors Are Associated with Poor Developmental Attainment in Young Canadian Children?
- Author
-
To, Teresa, Guttmann, Astrid, Dick, Paul T., Rosenfield, Jay D., Parkin, Patricia C., Hongmei Cao, Vydykhan, Tatiana N., Tassoudji, Marjan, and Harris, Jennifer K.
- Subjects
CHILDREN & the environment ,CHILD development ,MOTOR ability in children ,MULTIPLE regression analysis ,LOW birth weight - Abstract
This study was undertaken to determine the association between poor developmental attainment (PDA) and biological, home environment and socio-demographic factors in a population-based sample of Canadian children. Cross-sectional data from two cycles (1994/95 and 1996/97) of the National Longitudinal Survey of Children anti Youth were used. Children aged 1–5 years were included. PDA was defined as ≤15th percentile for motor and social developmental skills (1–3 year olds) or Peabody Picture Vocabulary Test (4–5 year olds). Multiple logistic regression was used. The proportion of children with PDA varies across Canada, between males and females, anti by age. Among 1 year olds in Cycle I, having a low birthweight (OR=3.3; 95% Cl: 2.1–5.2), being male (OR=1.6; 95% Cl: 1.2–2.2) anti having a mother who is an immigrant (OR=1.6; 95% Cl: 1.1–2.2) increased the odds of PDA. Similar results were observed in Cycle II. Among children aged 4–5 years in Cycle II, having a mother who is an immigrant (OR=5.3; 95% Cl: 4.1–6.9) and a mother with low educational attainment (OR=2.8; 95% Cl: 2.1–3.9) increased the odds of PDA. Low income was a significant predictor of PDA across all age groups. The strong and consistent associations with living in a low-income household, having a mother with low educational attainment or a mother who is an immigrant highlight the need for targeting developmental assessments and services to this population. [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
46. Consumption of non–cow’s milk beverages and serum vitamin D levels in early childhood
- Author
-
Lee, Grace J., Birken, Catherine S., Parkin, Patricia C., Lebovic, Gerald, Chen, Yang, L’Abbé, Mary R., and Maguire, Jonathon L.
- Abstract
Background:Vitamin D fortification of non–cow’s milk beverages is voluntary in North America. The effect of consuming non–cow’s milk beverages on serum 25-hydroxyvitamin D levels in children is unclear. We studied the association between non–cow’s milk consumption and 25-hydroxyvitamin D levels in healthy preschool-aged children. We also explored whether cow’s milk consumption modified this association and analyzed the association between daily non–cow’s milk and cow’s milk consumption.Methods:In this cross-sectional study, we recruited children 1–6 years of age attending routinely scheduled well-child visits. Survey responses, and anthropometric and laboratory measurements were collected. The association between non–cow’s milk consumption and 25-hydroxyvitamin D levels was tested using multiple linear regression and logistic regression. Cow’s milk consumption was explored as an effect modifier using an interaction term. The association between daily intake of non–cow’s milk and cow’s milk was explored using multiple linear regression.Results:A total of 2831 children were included. The interaction between non–cow’s milk and cow’s milk consumption was statistically significant (p= 0.03). Drinking non–cow’s milk beverages was associated with a 4.2-nmol/L decrease in 25-hydroxyvitamin D level per 250-mL cup consumed among children who also drank cow’s milk (p= 0.008). Children who drank only non–cow’s milk were at higher risk of having a 25-hydroxyvitamin D level below 50 nmol/L than children who drank only cow’s milk (odds ratio 2.7, 95% confidence interval 1.6 to 4.7).Interpretation:Consumption of non–cow’s milk beverages was associated with decreased serum 25-hydroxyvitamin D levels in early childhood. This association was modified by cow’s milk consumption, which suggests a trade-off between consumption of cow’s milk fortified with higher levels of vitamin D and non–cow’s milk with lower vitamin D content.
- Published
- 2014
- Full Text
- View/download PDF
47. Clobetasol Propionate, 0.05%, vs Hydrocortisone, 1%, for Alopecia Areata in Children: A Randomized Clinical Trial
- Author
-
Lenane, Patsy, Macarthur, Colin, Parkin, Patricia C., Krafchik, Bernice, DeGroot, Julie, Khambalia, Amina, and Pope, Elena
- Abstract
IMPORTANCE Alopecia areata is an idiopathic cause of hair loss with limited therapeutic repertoire. OBJECTIVE To compare the efficacy and safety of a high- vs low-potency topical corticosteroid in pediatric patients. DESIGN, SETTING, AND PARTICIPANTS This single-center, randomized, blind, 2-arm, parallel-group, superiority trial was carried out over a 24-week period at a tertiary referral academic dermatology clinic at The Hospital for Sick Children in Toronto, Ontario, Canada. Forty-two children attending the outpatients clinic, 2 to 16 years of age with alopecia areata affecting at least 10% of scalp surface area, were eligible; 1 declined to participate. There were no withdrawals from the study. INTERVENTIONS FOR CLINICAL TRIALS Patients were randomly assigned to receive clobetasol propionate, 0.05% cream, or hydrocortisone, 1%, cream. Patients applied a thin layer of the assigned cream twice daily to the areas of hair loss for 2 cycles of 6 weeks on, 6 weeks off, for a total of 24 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the change in scalp surface area with hair loss over 24 weeks following enrollment. RESULTS All participants were assessed at 6, 12, 18, and 24 weeks (except 1 participant who missed the 6-week visit). After adjusting for baseline hair loss, the clobetasol group had a statistically significant (P < .001) greater decrease in the surface area with hair loss, compared with the hydrocortisone group at all time points except at 6 weeks. One patient with extensive alopecia areata experienced skin atrophy that resolved spontaneously in 6 weeks. There was no difference observed in the number of patients with abnormal urinary cortisol at the beginning and the end of the study. CONCLUSIONS AND RELEVANCE Topical clobetasol propionate, 0.05%, cream is efficacious and safe as a first-line agent for limited patchy childhood alopecia areata. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01453686.
- Published
- 2014
- Full Text
- View/download PDF
48. Association between serum cholesterol and eating behaviours during early childhood: a cross-sectional study
- Author
-
Persaud, Navindra, Maguire, Jonathon L., Lebovic, Gerald, Carsley, Sarah, Khovratovich, Marina, Randall Simpson, Janis A., McCrindle, Brian W., Parkin, Patricia C., and Birken, Catherine
- Abstract
Background:Modifiable behaviours during early childhood may provide opportunities to prevent disease processes before adverse outcomes occur. Our objective was to determine whether young children’s eating behaviours were associated with increased risk of cardiovascular disease in later life.Methods:In this cross-sectional study involving children aged 3–5 years recruited from 7 primary care practices in Toronto, Ontario, we assessed the relation between eating behaviours as assessed by the NutriSTEP (Nutritional Screening Tool for Every Preschooler) questionnaire (completed by parents) and serum levels of non–high-density lipoprotein (HDL) cholesterol, a surrogate marker of cardiovascular risk. We also assessed the relation between dietary intake and serum non-HDL cholesterol, and between eating behaviours and other laboratory indices of cardiovascular risk (low-density lipoprotein [LDL] cholesterol, apolipoprotein B, HDL cholesterol and apoliprotein A1).Results:A total of 1856 children were recruited from primary care practices in Toronto. Of these children, we included 1076 in our study for whom complete data and blood samples were available for analysis. The eating behaviours subscore of the NutriSTEP tool was significantly associated with serum non-HDL cholesterol (p= 0.03); for each unit increase in the eating behaviours subscore suggesting greater nutritional risk, we saw an increase of 0.02 mmol/L (95% confidence interval [CI] 0.002 to 0.05) in serum non-HDL cholesterol. The eating behaviours subscore was also associated with LDL cholesterol and apolipoprotein B, but not with HDL cholesterol or apolipoprotein A1. The dietary intake subscore was not associated with non-HDL cholesterol.Interpretation:Eating behaviours in preschool-aged children are important potentially modifiable determinants of cardiovascular risk and should be a focus for future studies of screening and behavioural interventions.
- Published
- 2013
- Full Text
- View/download PDF
49. Modifiable Determinants of Serum 25-Hydroxyvitamin D Status in Early Childhood: Opportunities for Prevention
- Author
-
Maguire, Jonathon L., Birken, Catherine S., Khovratovich, Marina, DeGroot, Julie, Carsley, Sarah, Thorpe, Kevin E., Mamdani, Muhammad, and Parkin, Patricia C.
- Abstract
OBJECTIVES To determine the effect of modifiable dietary intake variables (current vitamin D supplementation and daily cow's milk intake) on 25-hydroxyvitamin D level in early childhood and to evaluate the relationship between these modifiable dietary factors and other largely nonmodifiable determinants of vitamin D status including skin pigmentation and season. DESIGN Cross-sectional study. SETTING Primary care pediatric and family medicine practices participating in the TARGet Kids! practice-based research network in Toronto, Ontario, Canada. PARTICIPANTS From December 2008 to June 2011, healthy children 1 to 5 years of age were recruited during a routine physician's visit. INTERVENTIONS Survey, anthropometric measurements, and laboratory data were collected. A multivariable linear regression model was developed to examine the independent effects of vitamin D supplementation and daily volume of cow's milk on 25-hydroxyvitamin D level. MAIN OUTCOME MEASURES 25-Hydroxyvitamin D level. RESULTS Blood was obtained in 1898 children. Two modifiable dietary intake variables, vitamin D supplementation and cow's milk, increased 25-hydroxyvitamin D level by 3.4 ng/mL (95% CI, 2-4 ng/mL) and 1.6 ng/mL per 250-mL cup per day (95% CI, 1-2 ng/mL), respectively. Two nonmodifiable variables reflecting cutaneous vitamin D synthesis (skin pigmentation and season) were also strongly associated with 25-hydroxyvitamin D status but accounted for a much smaller proportion of the explained variation in 25-hydroxyvitamin D level. The effect of vitamin D supplementation and milk intake on 25-hydroxyvitamin D level appeared similar regardless of skin pigmentation or season. CONCLUSION Two modifiable dietary intake variables (vitamin D supplementation and cow's milk intake) are the most important determinants of 25-hydroxyvitamin D status in early childhood.
- Published
- 2013
- Full Text
- View/download PDF
50. Randomized Trial of Oral Iron and Diet Advice versus Diet Advice Alone in Young Children with Nonanemic Iron Deficiency.
- Author
-
Parkin, Patricia C., Borkhoff, Cornelia M., Macarthur, Colin, Abdullah, Kawsari, Birken, Catherine S., Fehlings, Darcy, Koroshegyi, Christine, Maguire, Jonathon L., Mamak, Eva, Mamdani, Muhammad, Thorpe, Kevin E., Zlotkin, Stanley H., Zuo, Fei, and TARGet Kids! Collaboration
- Abstract
Objective: To compare the effects of 2 treatment options on neurodevelopmental and laboratory outcomes in young children with nonanemic iron deficiency.Study Design: A blinded, placebo-controlled, randomized trial of children 1-3 years with nonanemic iron deficiency (hemoglobin ≥110 g/L, serum ferritin <14 μg/L) was conducted in 8 primary care practices in Toronto, Canada. Interventions included ferrous sulfate or placebo for 4 months; all parents received diet advice. The primary outcome was the Early Learning Composite (ELC) using the Mullen Scales of Early Learning (mean 100, SD 15). Secondary outcomes included serum ferritin. Measurements were obtained at baseline and 4 and 12 months. Sample size was calculated to detect a between-group difference of 6-7 points in ELC.Results: At enrollment (n = 60), mean age was 24.2 (SD 7.4) months and mean serum ferritin was 10.0 (SD 2.4) μg/L. For ELC, the mean between-group difference at 4 months was 1.1 (95% CI -4.2 to 6.5) and at 12 months was 4.1 (95% CI -1.9 to 10.1). For serum ferritin, at 4 months, the mean between-group difference was 16.9 μg/L (95% CI 6.5 to 27.2), and no child randomized to ferrous sulfate had a serum ferritin <14 μg/L (0% vs 31%, P = .003).Conclusions: For young children with nonanemic iron deficiency, treatment options include oral iron and/or diet advice. We remain uncertain about which option is superior with respect to cognitive outcomes; however, adding ferrous sulfate to diet advice resulted in superior serum ferritin outcomes after 4 months. Shared decision-making between practitioners and parents may be considered when selecting either option.Trial Registration: Clinicaltrials.gov: NCT01481766. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.