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Background Estimated date of birth (EDB) is used to guide the care provided to women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined. Aims To explore women’s expectations of giving birth on or near their EDB, and their attitudes to alternative estimates for timing of birth. Methods A survey of pregnant women attending four public hospitals in Sydney, Australia, between July and December 2012. Results Among 769 surveyed women, 42% expected to birth before their due date, 16% after the due date, 15% within a day or so of the due date, and 27% had no expectations. Nulliparous women were more likely to expect to give birth before their due date. Women in the earlier stages of pregnancy were more likely to have no expectations or to expect to birth before the EDB while women in later pregnancy were more likely to expect birth after their due date. For timing of birth information, only 30% of women preferred an EDB; the remainder favoured other options. Conclusions Most women understood the EDB is imprecise. The majority of women expressed a preference for timing of birth information in a format other than an EDB. In support of woman-centred care, clinicians should consider discussing other options for estimated timing of birth information with the women in their care.

To examine the prevalence and determinants of iron supplement use and the amount of iron consumed from iron-containing supplements.A cross-sectional survey was performed in antenatal clinics in two tertiary hospitals in Sydney, Australia between January and March 2014.Of 612 (91% response rate) pregnant women, 589 with complete data were analysed. Overall iron-containing supplement use was 88.0%, of which 70.1% was multivitamin (MV) only, 7.2% was iron-only and 22.2% was both. Use of iron-containing supplements was associated with increased gestational age, a diagnosis of anaemia or iron deficiency (ID) in the current pregnancy and pre-pregnancy use of an iron-containing supplement. Several risk factors for ID or anaemia such as non-red meat eating and previous miscarriage were not associated with current iron supplement use. About 65% of women diagnosed with ID, and 62.3% of women diagnosed with anaemia were taking an iron-only supplement, with or without a MV. The proportion of women consuming low (30), preventative (30-99) and treatment (≥100) mg/day doses were 36.8%, 45.4%, and 17.8%, respectively. Only 46.7% of women diagnosed with ID were taking ≥100 mg/day iron from supplements, while 23.3% were taking30 mg/day.Women are consuming varying doses of iron and some high-risk women are taking inadequate doses of iron to prevent or treat ID or iron deficiency anaemia. Healthcare professionals are best positioned to advise women on iron supplement use in pregnancy and should educate women individually about the type and dose of supplement best suited to their needs.

Background: American evidence suggests women are not well informed about the optimal duration of pregnancy or the earliest time for safe birth. Similar evidence does not exist in Australia. Aims: To explore pregnant women’s beliefs about the duration of pregnancy and the earliest time for safe birth, and to compare the results with US data. Methods: A cross-sectional survey of pregnant women attending antenatal clinics at four public hospitals in Sydney, Australia, included collection of maternal and pregnancy characteristics, and two questions exploring women’s beliefs about the duration of pregnancy, and the earliest time for safe birth. Responses were grouped as: late preterm (34-36 weeks), early term (37-38 weeks), and full term (39-40 weeks). Results: Of 784 surveyed women, 52% chose 39-40 weeks as the duration of a full term pregnancy, while for the earliest time for safe birth, 10% chose 39-40 weeks and 57% chose 37-38 weeks. Some maternal characteristics were associated with women’s beliefs, including having a medical and/or pregnancy complication, country of birth, level of education, employment status, and attending a tertiary hospital. The associations were different for each question. In comparison with US studies, Australian women were more likely to choose later gestations for both the duration of pregnancy and the earliest time for safe birth. Conclusions: A significant proportion of Australian women believe that full term pregnancy and earliest time for safe birth occur before 39 weeks, suggesting opportunities for antenatal education. The authors would like to thank the women who participated in the survey, and acknowledge the contribution of the research midwives, Jill Milligan, Rachel Reid, Jocelyn Sedgley and Katrina White-Mathews, as well as Dr. Antonia Shand for assisting with participant recruitment. This work was supported by an Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence Grant (1001066). CLR is supported by an NHMRC Senior Research Fellowship (#APP1021025).

Background: Low serum 25-hydroxyvitamin D [25(OH)D] concentrations during pregnancy have been associated with adverse pregnancy outcomes in a few studies but not in other studies. Objectives: We assessed the serum 25(OH)D concentration at 10– 14 wk pregnancy and its association with adverse pregnancy outcomes and examined the predictive accuracy. Design: In this nested case-control study, we measured serum 25(OH)D in 5109 women with singleton pregnancies who were attending first-trimester screening in New South Wales, Australia. Multivariate logistic regression was conducted to examine the association between low 25(OH)D concentrations and adverse pregnancy outcomes (small for gestational age, preterm birth, preeclampsia, gestational diabetes, miscarriage, and stillbirth). The predictive accuracy of models was assessed. Results: The median (IQR) 25(OH)D concentration for the total population was 56.4 nmol/L (43.3–69.8 nmol/L). Serum 25(OH)D concentrations showed significant variation by parity, smoking, weight, season of sampling, country of birth, and socioeconomic status. After adjustment for maternal and clinical risk factors, low 25(OH)D concentrations were not associated with most adverse pregnancy outcomes. The area under the receiver operating characteristic curve (AUC) and likelihood ratio for a composite of severe adverse pregnancy outcomes of 25(OH)D concentrations ,25 nmol/L were 0.51 and 1.44, respectively, and, for risk factors alone, were 0.64 and 2.87, respectively. The addition of 25(OH)D information to maternal and clinical risk factors did not improve the ability to predict severe adverse pregnancy outcomes (AUC: 0.64; likelihood ratio: 2.32; P = 0.39). Conclusion: Low 25(OH)D serum concentrations in the first trimester of pregnancy are not associated with adverse pregnancy outcomes and do not predict complications any better than routinely assessed clinical and maternal risk-factor information. Am J Clin Nutr doi: 10.3945/ajcn.113.065672.

Aims To determine occurrence and recurrence rates of gestational diabetes among women having at least two consecutive pregnancies. Risk factors for recurrence of gestational diabetes and rates of second/third pregnancy pre-existing diabetes mellitus were also assessed. Methods Population-based study using longitudinally linked hospital discharge and birth records (2001–2009) in NSW, Australia. Participants included women without a pre-existing diagnosis of Type 1 or Type 2 diabetes at time of first pregnancy and with at least a first and second birth. Factors associated with recurrence of gestational diabetes were examined using multivariate log-binomial models to adjust for correlation within mothers and estimate relative risks and 95% confidence intervals. Results First occurrence of gestational diabetes was 3.7% (5315/142 843) in the first pregnancy and 2.7% (3689/137 528) in the second pregnancy. The recurrence rate of gestational diabetes in a second consecutive pregnancy was 41.2%. Risk of pre-existing diabetes in a pregnancy subsequent to one with first occurrence of gestational diabetes was 2.2% and 2.0% in the second or third pregnancy, respectively. Among women with a diagnosis of gestational diabetes in the first pregnancy, independent predictors of gestational diabetes recurrence were maternal age ≥ 35 years, ethnicity (Middle East/North Africa and Asia), pregnancy hypertension, large for gestational age infant and preterm birth in the first pregnancy, longer inter-pregnancy birth interval and pregnancy hypertension and multiple pregnancy in the second pregnancy. Conclusions Gestational diabetes in a previous pregnancy is a strong indicator of future risk and a useful clinical marker for identifying women at elevated risk in a subsequent pregnancy.

Purpose The purpose of this study was to determine the prevalence, sociodemographic distribution, and co-occurrence of five potentially obesogenic behavioral risk factors (low physical activity, high screen time, low fruit and vegetable intake, high soft drink consumption, and high snack intake) among adolescents. Methods Cross-sectional representative population survey (n = 1,568) of grade 6, 8, and 10 students (49% male) randomly selected from 70 primary and secondary schools in New South Wales, Australia, between February and May 2007. Co-occurrence was assessed using an observed-to-expected ratio (O/E) method. Results Only 5% of boys and 9% of girls had none of the five obesogenic behavioral risk factors studied. Overall, 51.4% of boys and 42.9% of girls had three or more risk factors. Prevalence of multiple risk factors (3+) was higher among boys and girls from lower income households and among girls whose mothers had less than grade 12 education. For both boys and girls, the occurrence of all five risk factors was 160% greater than expected (O/E ratio: 2.6). Conclusions There was clear evidence of a co-occurrence of obesogenic risk factors among adolescents, especially among those from lower socioeconomic backgrounds, indicating this group would benefit from targeted prevention strategies.

Aim: The aim of this study was to compare maternal and infant characteristics by mode of VK administration. Methods: De-identified computerised birth files of all babies born in New South Wales (NSW), Australia between January 2007 and December 2009 (when VK prophylaxis was measured) were included in the present study. The outcome variable, mode of VK prophylaxis, was recorded by checkbox as oral, IM injection, none or not stated. Results: We analysed population-based birth data from 2007 to 2009 in NSW, Australia and found that IM injection was the most prevalent mode of administration (96.3%, n = 263, 555), followed by oral (2.6%, n = 7023) and none (1.2%, n = 3136). Compared to neonates receiving IM VK, those with oral or none were more likely to have vaginal births without medical interventions at birth centres or planned home births and were less likely to receive hepatitis B vaccination. Among neonates administered oral VK, a larger proportion were preterm births and breastfed at discharge compared to neonates administered VK as an IM injection. Neonates with no VK recorded were more likely to be admitted to neonatal intensive care, but may have received VK later in the birth admission. Conclusions: A small proportion of the Australian neonates may be at risk of inadequate protection from VKBD due to parental concerns about the safety of IM injection of VK to neonates.

For many developing countries undergoing rapid economic growth and urbanization, trends in nutritional status indicate a decrease in malnutrition with an associated rise in the prevalence of obesity. An understanding of the situation among children in Malaysia is lacking.To examine the prevalence, trends and sociodemographic factors described for underweight and overweight children in Malaysia.The literature from January 1996 to November 2010 on the prevalence of underweight and overweight among children in Malaysia was reviewed.Twelve studies were identified that reported on both underweight and overweight among children in Malaysia, of which only one was a nationally representative survey. Based on the National Health and Morbidity Survey in 2006, 13.2% (95% CI, 12.6 to 13.9) of children aged 0 to 18 years were underweight (weight-for-age-2SD), and 8.0% (95% CI, 7.5 to 8.6) of those aged 0 to 13 years were overweight (weight-for-height+2SD). Both underweight and overweight were more prevalent in males than females. Children in rural areas were more likely to be underweight and less likely to be overweight than urban children. Ethnic differences between Malays, Chinese, and Indians were inconsistent across studies and less clear. Aborigines were more likely to be underweight and less likely to be overweight than the general population. The available evidence, although limited and sparse, suggests that over the past decade the prevalence of both underweight and overweight among children in Malaysia has been stable or has shown an increasing trend.Long-term national monitoring and longitudinal cohort studies will be critical for understanding, preventing, and managing the double burden of malnutrition among children in Malaysia.

Aim: To compare overweight and obese adolescents with accurate and inaccurate self-reported weight perception across a range of behaviours and measures of psychological well-being. Methods: This study uses a cross-sectional survey of grade 7–12 high school students in New South Wales, Australia, conducted in 2008 (n= 7553). Overweight and obese students based on body mass index were classified as accurate perceivers (weight perception was ‘too fat’) or inaccurate perceivers (weight perception was ‘about right’). Results: Nearly a third of adolescents had incongruity between self-perceived body weight status and body mass index-determined weight category. Compared with boys, girls were less likely to underestimate their body weight (odds ratio: 0.26; 95% confidence interval: 0.25, 0.27) and more likely to overestimate their body weight (odds ratio: 3.4; 95% confidence interval: 3.3, 3.5). Accurate body weight perception was higher in obese adolescents compared with overweight adolescents (69.5% vs. 44.0%). Compared with mis-perceivers, accurate overweight and obese perceivers had significantly higher odds of trying to lose weight and being more physically active; however, they showed a combination of unhealthy and healthy behaviours (i.e. dietary patterns and sedentary activities). Accurate weight perception among overweight and obese adolescents was associated with increased odds of feeling sad or depressed in the past 6 months. Conclusions: Further research on social, familial and psychological factors that predict or mediate healthy and unhealthy weight-related behaviours among adolescents by accuracy of weight perception is needed. Accurate weight perception should be considered in counselling and behavioural interventions.

An international perspective of the magnitude of anemia in indigenous peoples is currently lacking. The present systematic review was performed to characterize the global prevalence, severity, and etiology of anemia in indigenous peoples by conducting a systematic search of original research published in English from 1996 to February 2010 using PubMed, Medline, and Embase. A total of 50 studies, representing the following 13 countries, met the inclusion criteria: Australia, Brazil, Canada, Guatemala, India, Kenya, Malaysia, Mexico, New Zealand, Sri Lanka, Tanzania, the United States, and Venezuela. Results indicate major deficiencies in the coverage and quality of anemia monitoring data for indigenous populations worldwide. The burden of anemia is overwhelmingly higher among indigenous groups compared to the general population and represents a moderate (20-39.9%) to severe (≥40%) public health problem. For the most part, the etiology of anemia is preventable and includes inadequate diet, poor living conditions, and high infection rates (i.e., malaria and intestinal parasites). A concerted global effort is needed to reduce the worldwide burden of anemia in these marginalized populations.

The aim of the study was to examine the association of corticosteroid exposure and other skeletal risk factors with bone mineral density (BMD) and fractures following pediatric liver transplantation (LT) at a large single center.Lumbar spine BMD, measured using dual-energy x-ray absorptiometry (DXA), was corrected for bone age in 52 ambulatory children ages 4 to 18 years, at least 1 year post-LT. Potential risk factors for skeletal health such as corticosteroid exposure, dietary and lifestyle factors, and growth and fracture occurrence, were related to BMD using univariate and multivariate regression analyses.The prevalence of low BMD (z score-2) and post-LT fractures was 3 of 52 (5.8%) and 11 of 52 (21%), respectively. Univariate analysis revealed age10 years at LT and body mass index (BMI)85th percentile at time of DXA were significantly associated with BMD (both P = 0.02). BMD did not correlate with corticosteroid dosage in the first year post-LT, the year before DXA or cumulative lifetime exposure. A cholestatic primary LT indication, acute rejection episodes, and fractures post-LT were not associated with BMD. Extracurricular physical activity, vitamin D, and calcium intake were not associated with BMD or fractures. Multivariate linear regression revealed increased time post-LT (P = 0.04) and higher BMI z score at time of DXA (P = 0.02) as the strongest independent variables associated with greater BMD.Neither corticosteroid exposure nor a cholestatic primary indication for LT influenced BMD, which was largely normal in this ambulatory group. Children and adolescents undergoing LT after the age of 10 years and those with low BMI post-LT may be at greatest risk of poor skeletal health later in life, and thus a potential target patient population to benefit from preventive interventions.

Prenatal risk ratios for Down syndrome adjust for maternal weight because maternal serum 2 biomarker levels decrease with increasing maternal weight. This is accomplished by converting 3 serum biomarker values into a multiple of the expected median (MOM) for women of the same 4 gestational age. Weight is frequently not recorded and the impact of using MOMs not adjusted for 5 weight for calculating risk ratios is unknown. The aim of this study is to examine the effect of 6 missing weight on first trimester Down syndrome risk ratios by comparing risk ratios calculated 7 using weight-unadjusted-and –adjusted MOMs. Findings at the population level indicate that the 8 impact of not adjusting for maternal weight on first trimester screening results for chromosomal 9 anomalies would lead to under-identification of 84 per 10,000 pregnancies. NHMRC

OBJECTIVE: The goal was to determine whether an office-based, educational intervention for parents of 9-month-old children could reduce bottle use and iron depletion at 2 years of age. METHODS: Between January 2006 and 2007, 251 healthy, 9-month-old infants attending a routine health maintenance visit were assigned randomly to intervention or control groups. Parents in the intervention group were introduced to a 1-week protocol to wean their children from the bottle. Iron depletion (ferritin levels of RESULTS: A total of 201 children were monitored to 2 years of age (follow-up rate: 81%). Rates of iron depletion (10 [10%] of 102 children vs 13 [13%] of 99 children; P = .42) and milk consumption of >16 oz (16 [16%] of 102 children vs 17 [17%] of 99 children; P = .7) were not significantly different between the 2 groups at 2 years of age. However, children in the intervention group started using a cup 3 months earlier (9 vs 12 months; P = .001), were weaned from the bottle 4 months earlier (12 vs 16 months; P = .004), and were more than one-half as likely to be using a bottle at 2 years of age (15 [15%] of 102 children vs 39 [40%] of 99 children; P = .0004). CONCLUSIONS: This simple intervention administered during a health maintenance visit did not result in a decrease in iron depletion at 2 years of age but did result in a 60% reduction in prolonged bottle use.

BACKGROUND There is a growing interest in periconceptional iron supplementation in developing countries by researchers and policy makers; however, there are no randomized controlled trials that examine the effectiveness of this strategy in decreasing anemia during pregnancy. OBJECTIVE The aim was to determine whether periconceptional iron supplementation reduces anemia during pregnancy. DESIGN A randomized, double-blind, controlled trial was conducted in rural Bangladesh. Married, nulliparous women were randomly assigned to receive daily iron and folic acid (IFA; 60 mg ferrous fumarate and 400 microg folic acid) (n = 134) or folic acid (FA; 400 microg) (n = 138) in the form of a powdered supplement added to food. Women were followed until pregnancy or the end of 9 mo. Primary outcomes included hemoglobin, plasma ferritin, and plasma transferrin receptor concentrations. RESULTS Among 88 pregnant women, periconceptional IFA in comparison with FA did not affect anemia or iron status at 15 wk gestation. However, each 1% increase in adherence was associated with a 10-g/L increase in change in hemoglobin from baseline (P = 0.03), and those who initiated supplementation at a mean (+/-SD) time of 72.9 +/- 57.8 d before conception showed a 7.3-g/L increase in change in hemoglobin from baseline compared with those who initiated supplementation at 26.3 +/- 12.3 d after conception (P = 0.01). Among 146 nonpregnant women, IFA decreased anemia (odds ratio: 0.19; 95% CI: 0.04, 0.95) and improved iron stores (P = 0.001) more than did FA. CONCLUSION Good adherence and initiation of supplementation before conception are needed to reduce anemia during early pregnancy. This trial was registered at www.clinicaltrials.gov as NCT00953134.

Background: There are several biomarkers for measuring iron deficiency (ID) in pregnancy, but evidence of their prevalence in association with inflammation and adverse pregnancy outcomes is inconclusive. Objectives: To describe the prevalence and determinants of ID in women in the first trimester of pregnancy and associations with pregnancy and birth outcomes. Design: A record-linkage cohort study of archived serum samples of women attending first trimester screening and birth and hospital data to ascertain maternal characteristics and pregnancy outcomes. Sera were analysed for iron stores (ferritin; μg/L), tissue iron (soluble transferrin receptor, sTfR; nmol/L) and inflammatory (C-reactive protein, CRP; mg/L) biomarkers. Total body iron (TBI) was calculated from serum ferritin and sTfR concentrations. Multivariate logistic regression analyzed risk factors and pregnancy outcomes associated with ID using the definitions: serum ferritin

Aim High iron measured using dietary intake and biomarkers is associated with Type 2 diabetes. It is uncertain whether a similar association exists for gestational diabetes mellitus. The aim of this systematic review was to conduct a cohort study examining first trimester body iron stores and subsequent risk of gestational diabetes, and to include these findings in a systematic review of all studies examining the association between maternal iron status, iron intake (dietary and supplemental) and the risk of gestational diabetes. Methods Serum samples from women with first trimester screening were linked to birth and hospital records for data on maternal characteristics and gestational diabetes diagnosis. Blood was analysed for ferritin, soluble transferrin receptor and C–reactive protein. Associations between iron biomarkers and gestational diabetes were assessed using multivariate logistic regression. A systematic review and meta-analysis, registered with PROSPERO (CRD42014013663) included studies of all designs published in English from January 1995 to July 2015 that examined the association between iron and gestational diabetes and included an appropriate comparison group. Results Of 3776 women, 3.4% subsequently developed gestational diabetes. Adjusted analyses found increased odds of gestational diabetes for ferritin (OR 1.41; 95% CI 1.11, 1.78), but not for soluble transferrin receptor (OR 1.00; 95% CI 0.97, 1.03) per unit increase of the biomarker. Two trials of iron supplementation found no association with gestational diabetes. Increased risk of gestational diabetes was associated with higher levels of ferritin and serum iron and dietary haem iron intakes. Conclusions Increased risk of gestational diabetes among women with high serum ferritin and iron levels and dietary haem iron intakes warrants further investigation.

Previous studies have reported inconsistent associations between maternal serum ferritin concentrations and the risk of spontaneous preterm birth (sPTB). The aim of the present study was to examine the association between Fe biomarkers, including serum ferritin concentrations, and the risk of total ( sd 0·9) weeks was analysed for Fe biomarkers, including serum ferritin and soluble transferrin receptor (sTfR), and the inflammatory biomarker C-reactive protein. Multivariate logistic regression analysis evaluated the association between low and high Fe levels and sPTB. Women with elevated serum ferritin concentrations were more likely to be older, nulliparous or have gestational diabetes. The multivariate analysis found increased odds of sPTB for women with elevated ferritin levels defined as >75th percentile ( ≥ 43 μg/l) (OR 1·49, 95 % CI 1·06, 2·10) and >90th percentile ( ≥ 68 μg/l) (OR 1·92, 95 % CI 1·25, 2·96). Increased odds of early and moderate-to-late sPTB were associated with ferritin levels >90th percentile (OR 2·50, 95 % CI 1·32, 4·73) and >75th percentile (OR 1·56, 95 % CI 1·03, 2·37), respectively. No association was found between the risk of sPTB and elevated sTfR levels or Fe deficiency. In conclusion, elevated maternal serum ferritin levels in early pregnancy are associated with an increased risk of sPTB from 34 weeks of gestation. The usefulness of early pregnancy ferritin levels in identifying women at risk of sPTB warrants further investigation.

Objective We sought to describe the clinical characteristics and complications of children with acquired lipodystrophy (LD). Methods We conducted a retrospective chart review at a tertiary, academic children's hospital of children clinically given a diagnosis of acquired LD between January 1997 and December 2004. Results During the study period, 23 patients were identified. Their mean age at diagnosis was 9.74 ± 3.98 years. Of patients, 61% were girls. The length of the follow-up was 4.8 ± 3.5 years from the time of LD diagnosis. Of patients, 30% had evidence of localized disease (7 of 23), 26% (6 of 23) had localized partial disease, and 44% (10 of 23) had generalized LD. The most common underlying diagnosis was dermatomyositis (78%), alone or in association with other autoimmune diseases (juvenile rheumatoid arthritis 17%). Panniculitis with autoimmunity was noted in 17% of the patients. More than half of the patients had at least one complication attributable to LD such as acanthosis nigricans (22%), hyperpigmentation (22%), hepatomegaly (13%), hypertension (13%), protuberant abdomen (9%), and hyperlipidemia (4%). The only predictor for development of complications was the age of diagnosis of LD, with younger age being associated with increased risk (7 vs 12 years, P = .04). Limitations Limitations were inherent to the retrospective design. Conclusions Childhood acquired LD is seen more frequently in the context of autoimmunity. Affected children should be monitored for the development of complications, particularly if given a diagnosis of LD at a younger age.

Objective. To evaluate the influence of average family income in a geographic area on the effectiveness of helmet legislation on observed helmet use by children (5–14 years).Methods. The study was conducted in East York, a health district of Metropolitan Toronto, in collaboration with the East York Health Unit. In 1996, the total population was 107 822, 11 340 of which were children 5 to 14 years. Census data were used to group the 21 census tracts in East York into 7 geographically distinct areas. The boundaries of these areas are natural barriers to travel, such as expressways, ravines, railway tracks, and hydroelectric power lines. The areas were also ranked according to average family income (based on Statistics Canada data). For analytical purposes, areas were defined as low-, mid-, and high-income areas. Census data profiles of the areas have been previously described. For each consecutive year from 1990 to 1997 inclusive, direct observations of children riding bicycles in East York during the months of April through October were made. In 1995, observations were completed before the introduction of the law on October 1, 1995. Only children who were between 5 and 14 years of age and riding a 2-wheeled bicycle were included in the study. In total, 111 sites across all 7 areas were selected for observation. Observational sites included school yards of all elementary and middle schools (kindergarten to grade 8) and all parks in East York. In addition, 5 major intersections and 5 residential streets from each area were randomly selected. Observers were trained and used a standardized data collection form. A pilot study showed that the data collected by observers were reliable and valid. Observers remained at each site for 1 hour and collected data on helmet use and sex. Ethical approval for the study was obtained from the Hospital for Sick Children Research Ethics Board, the East York Board of Education, and the Metropolitan Separate School Board. The proportion of children who were wearing a bicycle helmet was estimated by year (1990–1997, inclusive), sex (male, female), location (school, park, major intersection, residential street), and income area (low, mid, high). For estimating the effect of legislation on helmet use, data from the year immediately after legislation (1996) were compared with data from the year preceding legislation (1995). The relative risk (RR) of helmet use (after vs before legislation) was calculated along with a 95% confidence interval (CI). Logistic regression analysis was used to adjust for potential confounding variables (sex and location).Results. During the 8-year study period, 9768 observations were made (range: 914-1879 observations per year). The proportion of child cyclists who wore a bicycle helmet increased steadily during the first 4 years of the study period, from 4% in 1990 (34 of 914), to 16% in 1991 (303 of 1879), to 25% in 1992 (383 of 1563), and to 45% in 1993 (438 of 984). During 1994 (460 of 1083) and 1995 (568 of 1227), helmet use remained relatively stable at approximately 44%. Helmet use rose markedly in 1996 (the first year after helmet legislation was introduced) to 68% (818 of 1202) and remained stable at 66% (609 of 916) in 1997. Throughout the study period, girls were consistently more likely to wear helmets than were boys. In total, 47% (1420 of 3047) of girls wore helmets, compared with 33% (2193 of 6721) of boys (RR: 1.43; 95% CI: 1.36–1.50). In addition, children who were riding to school were more likely to use helmets, compared with children who were riding on residential streets, major intersections, and parks. Overall, 48% (1497 of 3129) of children who were riding to school wore bicycle helmets, compared with 32% (2116 of 6639) of children who were riding at other locations (RR: 1.50; 95% CI: 1.43–1.58). Children in the high-income areas were consistently more likely to wear helmets, compared with children in the mid- and low-income areas. Helmet legislation was associated with a significant increase in helmet use by children in East York. In 1995, 46% (568 of 1227) of children wore bicycle helmets, compared with 68% (818 of 1202) of children in 1996 (RR: 1.47; 95% CI: 1.37–1.58). The effect of legislation, however, varied by income area. In low-income areas, helmet use increased by 28% after legislation, from 33% (213 of 646) in 1995 to 61% (442 of 721) in 1996 (RR: 1.86; 95% CI: 1.64–2.11). In mid-income areas, helmet use increased by 29% after legislation, from 50% (150 of 300) in 1995 to 79% (185 of 234) in 1996 (RR: 1.58; 95% CI: 1.39–1.80). In high-income areas, helmet use increased by only 4%, from 73% (205 of 281) in 1995 to 77% (191 of 247) in 1996 (RR: 1.06; 95% CI: 0.96–1.17). This finding of a significant increase in helmet use after legislation in low- and mid-income areas but not in high-income areas remained even after logistic regression analysis adjusted for sex and location.Conclusions. This study showed that bicycle helmet use by children increased significantly after helmet legislation. In this urban area with socioeconomic diversity and in the context of prelegislation promotion and educational activities, the legislative effect was most powerful among children who resided in low-income areas.

Aim To describe the use of dietary vitamin, mineral and herbal supplements before and during pregnancy. Materials and Methods Pregnant women attending for antenatal care at two tertiary Sydney hospitals between January and March 2014 completed an anonymous survey. Information on general maternal and pregnancy characteristics and the use of dietary and herbal supplements, including type, duration and sources of information, was collected. Frequency and contingency tabulations were performed. Results A total of 612 women agreed to participate (91% response rate). Of 589 women included in the analysis, mean gestational age at the time of survey was 28.5 weeks (SD 8.3), 55% had no children, and 67% were tertiary-educated. Overall, 62.9% of women reported taking a multivitamin (MV) and/or folic acid (FA) supplement in the 3 months prepregnancy, and 97.5% took a MV and/or FA in the first trimester. At the time of the survey, 93.8% of women were taking at least one supplement (median 2, range 1–13). During pregnancy, 79.1% of women were taking MVs, including 59.2% taking MV only and 19.9% taking MV and FA. The five most common supplements outside of a MV were FA (31%), iron (30%), vitamin D (23%), calcium (13%) and fish oil (12%). Reported herbal supplement rates were low. Conclusion Folic acid, MVs and other supplements use during and prepregnancy is relatively high, although prepregnancy FA supplementation rates could still be improved. Further research on the actual dosages and dietary intakes consumed is needed to examine whether pregnant women have adequate intake of nutrients, regardless of supplement use.

Background A lack of reproducible methods for classifying women having an induction of labour (IOL) has led to controversies regarding IOL and related maternal and perinatal health outcomes. Objectives To evaluate articles that classify IOL and to develop a novel IOL classification system. Search strategy Electronic searches using CINAHL, EMBASE, WEB of KNOWLEDGE, and reference lists. Selection criteria Two reviewers independently assessed studies that classified women having an IOL. Data collection and analysis For the systematic review, data were extracted on study characteristics, quality, and results. Pre-specified criteria were used for evaluation. A multidisciplinary collaboration developed a new classification system using a clinically logical model and stakeholder feedback, demonstrating applicability in a population cohort of 909 702 maternities in New South Wales, Australia, over the period 2002–2011. Main results All seven studies included in the systematic review categorised women according to the presence or absence of varying medical indications for IOL. Evaluation identified uncertainties or deficiencies across all studies, related to the criteria of total inclusivity, reproducibility, clinical utility, implementability, and data availability. A classification system of ten groups was developed based on parity, previous caesarean, gestational age, number, and presentation of the fetus. Nulliparous and parous women at full term were the largest groups (21.2 and 24.5%, respectively), and accounted for the highest proportion of all IOL (20.7 and 21.5%, respectively). Author's conclusions Current methods of classifying women undertaking IOL based on medical indications are inadequate. We propose a classification system that has the attributes of simplicity and clarity, uses information that is readily and reliably collected, and enables the standard characterisation of populations of women having an IOL across and within jurisdictions. Tweetable abstract Methods classifying pregnant women having IOL are inadequate; we suggest a new classification system

Background: Increasing gestational diabetes (GDM) places greater demand on resources to manage high-risk pregnancies and prevent adverse perinatal outcomes. High levels of serum ferritin (SF) have been associated with type 2 diabetes; however it is uncertain whether elevated SF are associated with GDM and reflect increased iron stores or inflammation. Aim: To determine whether first trimester SF is associated with subsequent GDM in absence of inflammation. Methods: Serum samples for women with first trimester screening were linked to birth and hospital discharge records for data on maternal characteristics and GDM diagnosis. Blood was analysed for iron stores (SF; µg/L), tissue iron (transferrin receptor, TfR; nmol/L) and inflammation (C-reactive protein, CRP; mg/L). Women with CRP >5 or pre-existing diabetes were excluded. Odds ratios for GDM adjusted for age, parity, plurality, country of birth, smoking, private vs. public hospital, low SES, gestational age, and maternal weight. Results: Of 3, 143 pregn...

Objective: To determine if intravenous morphine is associated with acute chest syndrome (ACS) in children with homozygous for hemoglobin S sickle cell disease (SCD) hospitalized with acute pain. Methods: Health records of patients with homozygous for hemoglobin S SCD aged 2 to 18 years hospitalized with acute pain were reviewed. Patients developed ACS at least 12 hours after emergency department triage; controls did not develop ACS. Survival analyses were performed. Results: There were 38 cases and 45 randomly selected controls. The mean hourly dose of morphine 1, 2, and 3 hours before ACS and cumulative mean morphine dose up to 5 hours before ACS were significantly associated with ACS (P < .05). Adjusted analysis showed that 1 hour before ACS, the mean morphine dose was significantly higher in cases (40 µg/kg) compared with controls (34 µg/kg), and the risk of ACS increased by 23% for each additional 10 µg/kg of morphine received (P = .02). Conclusions: We recommend close observation for ACS in hospitalized patients with SCD who are receiving morphine.

Alopecia areata is an idiopathic cause of hair loss with limited therapeutic repertoire.To compare the efficacy and safety of a high- vs low-potency topical corticosteroid in pediatric patients.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.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.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.

Contact burns from domestic appliances are common in young children. Recently, gas fireplaces have been recognized as a potential cause of contact burns in young children. We sought to quantify the frequency of gas fireplace contact burns in young children, to identify the etiology of contact, to describe the clinical presentation, and to describe clinical outcomes. Children with gas fireplace contact burn injuries presenting to The Hospital for Sick Children in Toronto (1999–2002) were identified using three data sources: the Canadian Hospitals Injury Reporting and Prevention Program Database, the Burn Unit Registry, and the Rehabilitation Services Database. Demographic, clinical, and outcomes data were collected on all children. During the 4-year study period, 27 children presented to the hospital because of a gas fireplace contact burn (approximately 9% of all contact burns). The median age of the children was 14 months (range, 8–36 months), with 16 boys (59%). Most children were burned in their own home. With regard to etiology, 10 children (37%) lost their balance near the fireplace, 2 (7%) walked too close to the glass front, and 8 (30%) touched the glass front out of curiosity. Almost half (44%) of the children burned the palms and digits of both hands. The median total burn surface area was 1% (range, 0.2–2.5%). In total, 30% of children were admitted to hospital, and 11% required skin grafts. All children had full wound closure after 4 to 43 days. Given the etiology of these burns (loss of balance or curiosity), passive prevention, such as barriers or changes in the composition of glass panels, may be the most effective approach to combat them.

To compare the estimated date of birth (eDOB) from the last menstrual period (LMP) and ultrasound scans at varying gestations (7(0), 7(0)-10(6), 11(0)-14(0), 14(1)-19(6), and 20(0)-27(6)weeks) with the actual date of birth (aDOB).In a retrospective study, data were analyzed from 18 708 women with spontaneous labor who delivered a single neonate without major anomalies in a local health district in Australia between 2007 and 2011. Data were sourced from a computerized population birth database. The study outcomes were duration of pregnancy expressed as total days, and the difference between aDOB and eDOB by dating method.Only 5% of births occurred on the eDOB, regardless of the dating method or timing of the dating. Approximately 66% of births occurred within 7days of the eDOB, and there was little difference among the ultrasound examinations performed at varying gestational weeks. The ultrasound scans at 11(0)-14(0)weeks of gestation performed as well as ultrasound scans conducted at other gestational ages.On a population basis, there were no meaningful differences in the prediction of date of birth by ultrasound scan date. An early dating scan (≤10weeks) is unnecessary if LMP is reliable.

To describe the use of episiotomy among Vietnamese-born women in Australia, including risk factors for, and pregnancy outcomes associated with, episiotomy.This population-based, retrospective cohort study included data on 598 305 singleton, term (i.e. ≥ 37 weeks' gestation) and vertex-presenting vaginal births between 2001 and 2010. Data were obtained from linked, validated, population-level birth and hospitalization data sets. Contingency tables and multivariate analysis were used to compare risk factors and pregnancy outcomes in women who did or did not have an episiotomy.The episiotomy rate in 12 208 Vietnamese-born women was 29.9%, compared with 15.1% in Australian-born women. Among Vietnamese-born women, those who had an episiotomy were significantly more likely than those who did not to be primiparous, give birth in a private hospital, have induced labour or undergo instrumental delivery. In these women, having an episiotomy was associated with postpartum haemorrhage (adjusted odds ratio, aOR: 1.26; 95% confidence interval, CI: 1.08-1.46) and postnatal hospitalization for more than 4 days (aOR: 1.14; 95% CI: 1.00-1.29). Among multiparous women only, episiotomy was positively associated with a third- or fourth-degree perineal tear (aOR: 2.00; 95% CI: 1.31-3.06); in contrast, among primiparous women the association was negative (aOR: 0.47; 95% CI: 0.37-0.60).Episiotomy was performed in far fewer Vietnamese-born women giving birth in Australia than in Viet Nam, where more than 85% undergo the procedure, and was not associated with adverse outcomes. A lower episiotomy rate should be achievable in Viet Nam.Décrire le recours à l'épisiotomie chez les femmes nées au Viet Nam et accouchant en Australie, y compris les facteurs de risque et les répercussions sur la grossesse associées à l'épisiotomie.Cette étude de cohorte rétrospective axée sur la population a inclus des données de 598 305 singletons nés par voie vaginale, à terme (à savoir ≥ 37 semaines) et en présentation céphalique entre 2001 et 2010. Ces données ont été obtenues à partir d'informations associées et validées sur les naissances au niveau de la population et les hospitalisations. Des tableaux de contingence et une analyse multicritères ont été utilisés pour comparer les facteurs de risque et l’aboutissement de la grossesse chez les femmes qui ont ou n'ont pas subi d'épisiotomie.Le taux d'épisiotomie chez 12 208 femmes nées au Viet Nam a été de 29,9%, par rapport à 15,1% chez les femmes nées en Australie. Parmi les femmes nées au Viet Nam, la probabilité d’être primipares, d'avoir accouché dans un hôpital privé, d'avoir induit le travail ou subi un accouchement par instruments était considérablement supérieure chez celles qui avaient subi une épisiotomie que chez celles qui n'en avaient pas subi. Chez ces femmes, l’épisiotomie a été associée à une hémorragie du post-partum (odds ratio ajusté, ORa: 1,26; intervalle de confiance IC à 95%: de 1,08 à 1,46) et à une hospitalisation postnatale pendant plus de 4 jours (ORa: 1,14; IC 95%: 1,00-1,29). Chez les femmes multipares seulement, l'épisiotomie a été positivement associée à une déchirure périnéale du troisième ou quatrième degré (ORa: 2,00; IC 95%: 1,31 à 3,06); en revanche, chez les femmes primipares, l'association a été négative (ORa: 0,47; IC 95%: 0,37 à 0,60).L'épisiotomie a été réalisée chez beaucoup moins de femmes nées au Viet Nam et accouchant en Australie que chez celles qui ont accouché au Viet Nam, où plus de 85% subissent la procédure, et elle n'a pas été associé à des résultats négatifs. Une baisse du taux d'épisiotomie devrait être possible au Viet Nam.Describir el uso de la episiotomía entre mujeres vietnamitas en Australia, incluidos los factores de riesgo y los resultados en el embarazo asociados a esta.Este estudio de cohortes retrospectivo basado en la población incluyó datos de 598 305 partos vaginales únicos, prematuros (esto es, ≥ 37 semanas de gestación) y en posición cefálica entre 2001 y 2010. Los datos se obtuvieron de conjuntos de datos de nacimientos y hospitalización asociados y validados a nivel de la población. Se utilizaron tablas de contingencia y análisis multivariados para comparar los factores de riesgo y los resultados de los embarazos entre las mujeres que tuvieron o no una episiotomía.La tasa de episiotomías entre 12 208 mujeres vietnamitas fue del 29,9%, comparada con el 15,1% de las mujeres australianas. Entre las mujeres vietnamitas, aquellas que se habían sometido a una episiotomía tenían muchas más probabilidades de ser primíparas, dar a luz en un hospital privado, tener un parto provocado o someterse a un parto instrumental. En estas mujeres, someterse a una episiotomía se asoció con hemorragias postparto (cociente de posibilidades ajustado, CPa: 1,26; intervalo de confianza del 95%, IC: 1,08–1,46) y hospitalización postnatal durante más de 4 días (CPa: 1,14; 95% IC: 1,00–1,29). La episiotomía se asoció de forma positiva con un desgarro perineal de tercer o cuarto grado solo entre las mujeres multíparas (CPa:) 2,00; 95% IC: 1,31–3,06); mientras que dicha asociación fue negativa entre las mujeres primíparas (CPa: 0,47; 95% IC: 0,37-0,60).La incidencia de la episiotomía en mujeres vietnamitas que dieron a luz en Australia fue mucho menor que en Viet Nam, donde más del 85% se somete a este procedimiento, y no estuvo asociada a resultados adversos. Debería ser posible alcanzar una tasa de episiotomía menor en Viet Nam.وصف استخدام بضع الفرج بين النساء من مواليد فييت نام في أستراليا، بما في ذلك عوامل الاختطار الخاصة ببضع الفرج وحصائل الحمل المرتبطة به.شملت الدراسة الأترابية الاستطلاعية المستندة إلى السكان بيانات عن 598305 طفلاً منفرداً ومدة الحمل (أي ≥ 37 أسبوعاً) والولادات المهبلية عن طريق المجيء القمي في الفترة من 2001 إلى 2010. وتم الحصول على بيانات من فئات البيانات المرتبطة والمعتمدة الخاصة بالإدخال إلى المستشفيات والولادات على صعيد السكان. واستخدمت جداول الطوارئ والتحليل متعدد المتغيرات لمقارنة عوامل الاختطار وحصائل الحمل لدى السيدات اللاتي أُجري أو لم يجرى لهن بضع الفرج.بلغ معدل بضع الفرج لدى 12208 امرأة من مواليد فييت نام 29.9 %، مقارنة بنسبة 15.1 % لدى النساء من مواليد أستراليا. ومن بين النساء من مواليد فييت نام، كان من المرجح أكثر أن تكن النساء اللاتي أجري لهن بضع الفرج عن اللاتي لم يجرى لهن بضع الفرج حاملات للمرة الأولى أو يلدن في إحدى المستشفيات الخاصة أو يلدن ولادة محرضة أو يلدن باستخدام الأدوات. وارتبط بضع الفرج لدى هؤلاء النساء بنزيف بعد الوضع (نسبة الاحتمال المصححة: 1.26؛ فاصل الثقة 95 %، من 1.08 إلى 1.46) والإدخال إلى المستشفى بعد الولادة لأكثر من أربعة أيام (نسبة الاحتمال المصححة: 1.14؛ فاصل الثقة 95 %، من 1.00 إلى 1.29). وارتبط بضع الفرج بين النساء اللاتي ولدن مرات متكررة فقط إيجابياً بتمزق العضلات العجانية من الدرجة الثالثة أو الرابعة (نسبة الاحتمال المصححة: 2.00؛ فاصل الثقة 95 %، من 1.31 إلى 3.06)؛ وعلى النقيض، كان الارتباط سلبياً بين السيدات الحاملات للمرة الأولى (نسبة الاحتمال المصححة: 0.47؛ فاصل الثقة 95 %، من 0.37 إلى 0.60).قل إجراء بضع الفرج لدى السيدات من مواليد فييت نام اللاتي يلدن في أستراليا عن تلك اللاتي يلدن في فييت نام التي خضعت فيها أكثر من نشبة 85 % لهذا الإجراء ولم يكن ذلك مرتبطاً بحصائل ضائرة. وينبغي تحقيق انخفاض في معدل بضع الفرج في فييت نام.描述澳大利亚的越南女人接受会阴侧切手术的情况，包括会阴切开术的风险因素和相关的妊娠结局。这项基于人群的回顾性队列研究包括2001 年至2010 年之间598305 个单胎、足月（即37 孕周）和头位阴道分娩的数据。数据来源于经链接、确证的群体水平出生和住院数据集。使用列联表和多变量分析比较接受和不接受会阴切开术的女性的风险因素及妊娠结局。较之生于澳大利亚的女性15.1% 的手术比率，在12208 名生于越南的女性中的会阴侧切手术比率为29.9%。在越南出生的女性中，较之不接受会阴切开术的患者，接受此手术的患者在私人医院进行分娩时更有可能引产或接受器械助产。在这些女性中，会阴切开术与产后出血（调整后的优势比，aOR：1.26；95% 置信区间，CI：1.08 - 1.46）和4 天以上的产后住院（aOR：1.14；95% 置信区间：1.00 - 1.29）相关。会阴切开术仅在经产妇中与三级或四度会阴撕裂（aOR：2.00；95% 置信区间：1.31 - 3.06）正相关；相反，在初产妇中，关系为负相关（aOR：0.47；95% 置信区间：0.37 - 0.60）。越南出生的产妇在越南的手术比率为85%，相比之下在澳大利亚进行分娩的越南产妇执行会阴切开手术的情况少很多，且与不良结局并无相关。在越南应该可以实现更低的会阴切开手术比率。Описать применение эпизиотомии среди вьетнамских женщин в Австралии, включая факторы риска эпизиотомии и связанных с ней исходов беременности.Данное проспективное когортное исследование населения включало данные по 598 305 одноплодным беременностям, срокам (т.е. вынашивание ≥ 37 недель) и родоразрешениям при затылочном предлежании плода в период с 2001 г. по 2010 г. Данные были получены из объединенных, утвержденных наборов данных по рождению и госпитализации на национальном уровне. Для сопоставления факторов риска и исходов беременности у женщин, подвергшихся и не подвергшихся эпизиотомии, использовались таблицы статистической структуры изучаемой выборки и средства многофакторного анализа.Показатель эпизиотомии у 12 208 рожденных во Вьетнаме женщин составил 29,9%, по сравнению с 15,1% у австралийских женщин. Из числа рожденных во Вьетнаме женщин вероятность проведения эпизиотомии была гораздо выше у первородящих женщин, чем у повторнородящих, рожающих в частной больнице, при индуцированных родах или оперативном родовспоможении. У этих женщин проведение эпизиотомии было статистически связано с послеродовым кровотечением (скорректированный относительный риск, сОР: 1,26; 95% доверительный интервал, ДИ: 1,08–1,46) и послеродовой госпитализацией длительностью более четырех дней (сОР: 1,14; 95% ДИ: 1,00-1,29). Среди исключительно повторнородящих женщин эпизиотомия имела положительную статистическую связь с третьей и четвертой степенями разрыва промежности (сОР: 2,00; 95% ДИ: 1,31–3,06); для сравнения, среди первородящих женщин статистическая связь была отрицательной (сОР: 0,47; 95% ДИ: 0,37-0,60).Эпизиотомия проводилась у гораздо меньшего числа рожденных во Вьетнаме женщин, рожающих в Австралии, чем во Вьетнаме, где более 85% женщин подвергаются данной процедуре, и не была связана с неблагоприятными исходами. Во Вьетнаме могут быть достигнуты показатели эпизиотомии, ниже наблюдающихся сейчас.

Objective: To describe normative levels of PP13 in first trimester of pregnancy and determine the accuracy of PP13 in predicting preeclampsia and small for gestational age (SGA) infants. Methods: We measured PP13 in archived first trimester serum samples from an unselected maternal cohort of 2989 women. Associations of PP13 levels and diagnostic accuracy in predicting adverse pregnancy outcomes were assessed using multivariate logistic regression models. Due to inadequate number of cases we then conducted a systematic review and subsequent meta-analysis of predictive accuracy. Structured searches including all languages were completed in electronic databases and supplemented by cross-checking reference lists of relevant publications. Characteristics, data extraction and quality assessment of studies was conducted by independent assessors. Results: Overall, 2678 women were included in the in-house study with 71 (2.7%) preeclampsia cases, 5 (0.2%) early-onset preeclampsia (� 34 weeks) cases; and 191 (7.1%) and 41 (1.5%) infants SGA

Objective. To evaluate clinical and laboratory assessment of dehydration severity in children, 1 to 36 months, with acute gastroenteritis. Study design. Clinical and laboratory measures and weight change following rehydration were collected for enrolled children. Setting. Pediatric emergency department. Results. Likelihood ratio (LR+) and 95% confidence interval (CI): for a clinical score of 0, the LR+ was 2.2 (95% CI = 0.9-5.3); for a clinical score of 1 to 4, the LR+ was 1.3 (95% CI = 0.90-1.74); for a clinical score of 5 to 8, the LR+ was 5.2 (95% CI = 2.2-12.8); for a venous pH

Objective: To identify risk factors for unintentional injuries due to falls in children aged 0–6 years. Design: A systematic review of the literature. Methods: Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0–6 years and included a comparison group. Results: 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. Conclusion: Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0–6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children.

The purpose of this study was to examine whether maternal iron and/or folate status influences human milk folate secretion and is responsible for growth faltering of Otomi infants in Capulhuac, Mexico. Breast-feeding mothers (n = 71) were randomized at 22 +/- 13 d (baseline) postpartum to receive a daily multivitamin supplement containing folic acid (400 microg) with and without iron (18 mg). Mothers provided blood and milk samples at baseline, and at 82 +/- 15 and 138 +/- 18 d postpartum. Iron supplementation significantly improved hematocrit and transferrin receptor concentrations but had no influence on maternal folate status or milk folate or iron concentrations. Forty-three percent of mothers (29/68) had low blood folate concentrations at baseline, whereas only 6% (4/66) had low blood folate concentrations at approximately 138 d postpartum. Milk folate concentrations did not differ between Fe-deficient and Fe-sufficient women and provided adequate levels of dietary folate by approximately 82 d postpartum. While milk iron concentrations were unrelated to maternal iron status, they decreased during lactation, and, by approximately 138 d, they provided only 55% of the current recommendation. In conclusion, milk folate concentrations appear to be well preserved during maternal iron deficiency; hence, faltering growth among infants in Capulhuac, Mexico is unlikely the result of reduced milk folate concentration secondary to maternal Fe deficiency. However, milk Fe concentrations showed a temporal decline. Whether the disjuncture between recommended and actual Fe intakes among infants born with low Fe reserves and weaned to foods low in bioavailable Fe has functional consequences is worthy of further investigation.

BACKGROUND Adults discharged from hospital on a Friday are more likely to be readmitted within 30 days than are adults discharged midweek. No study has examined readmission rates for children by day of discharge. OBJECTIVE To determine the risk of readmission within 30 days by day of discharge in the paediatric population. METHODS The Canadian Institute for Health Information provided data on children 29 days to 18 years of age who were discharged from hospitals in Ontario between January 1996 and December 2000. Two groups of children (those who were readmitted within 30 days and those who were not) were compared on demographic and clinical characteristics. Multivariable modelling was used to account for potential confounding variables: age, sex, length of hospital stay, number of diagnoses, in-hospital operative procedure, in-hospital complication and hospital admission in the previous six months. RESULTS A total of 506,035 hospitalizations (involving 334,959 children) occurred over the study period. Of these children, 3.4% were readmitted within 30 days of discharge. In total, 3.6% of children discharged on a Friday were readmitted within 30 days compared with 3.3% of children discharged on a Wednesday. After adjusting for patient and hospital factors, Friday discharge was not associated with readmission within 30 days (adjusted RR 1.07, 95% CI 0.99 to 1.15). More significant predictors of readmission included number of diagnoses, in-hospital complications and hospital admission in the six months previous to the index admission date. CONCLUSION Risk of readmission within 30 days is not significantly increased for children discharged on a Friday compared with children discharged midweek. Significant risk factors for hospital readmission are patient complexity and disease severity.

Background Data on efficacy and safety of treatments in children with vitiligo are limited. Objective We sought to describe the clinical outcomes and safety of children with vitiligo treated with high-potency topical corticosteroids. Methods Clinical improvement and laboratory data were retrospectively analyzed in 101 children (0-18 years) with vitiligo treated with moderate- to high-potency topical corticosteroids. Results Of patients, 64% (45 of 70) had repigmentation of the lesions, 24% (17 of 70) showed no change, and 11% (8 of 70) were worse than at the initial presentation. Local steroid side effects were noted in 26% of patients at 81.7 ± 44 days of follow-up. Cortisol levels were abnormal in 29% of patients (21 of 73). Two children with low cortisol levels were given the diagnosis of steroid-induced adrenal suppression. Children with normal and abnormal cortisol levels were not significantly different by sex, age of onset, potency of the corticosteroid use, or family history. However, children with head and/or neck affected areas were 8.36 times more likely to have an abnormal cortisol level compared with children affected in other body areas (RR 95% confidence interval: 1.19, 58.60, P = .003, n=72). Of patients, 8% (6 of 74) had an abnormal thyrotropin test result. Limitations The retrospective design of this study presents inherent limitations. Conclusion Moderate- to high-potency topical corticosteroids are efficacious in children with vitiligo, but may be associated with systemic absorption.

Background: Road traffic injury is the leading cause of death among Canadian children and youth. Transport Canada recommends four types of child restraint depending on the size of the child, and recent studies have demonstrated the effectiveness of recommended restraint use. Objectives: To determine community paediatricians’ knowledge of Transport Canada recommendations for child restraint use in vehicles, and to examine paediatricians’ counseling patterns in relation to child passenger safety. Methods: A mailed questionnaire survey of all community paediatricians affiliated with the Hospital for Sick Children, Toronto was conducted. A 16 item questionnaire gathered information on knowledge of Transport Canada recommendations for child restraint use, general counseling patterns in relation to child passenger safety, and demographic information. Results: In total, 60 community paediatricians in active practice were identified. Of these, 48 (80%) responded to the mailed questionnaire. Almost all paediatricians (92%) correctly identified the recommended weight for transition to a forward-facing car seat, whereas fewer paediatricians (63%) correctly identified the recommended weight for transition to a booster seat from a forward-facing car seat, and only one third of paediatricians correctly identified the recommended weight for transition from a booster seat to a seat belt. Conclusion: Community paediatricians’ knowledge of Transport Canada recommendations for child restraint use in vehicles is incomplete. There is a need for such recommendations to be better disseminated to paediatricians and parents so that information on child restraint use is delivered in a clear and consistent manner.

Objective To measure the association between daytime bottle-feeding and iron depletion in young children. Design Cross-sectional design with concurrent measurement of exposure and outcome. The exposure was the current container (bottle or cup) used for daytime milk consumption. Child, maternal, and dietary variables were collected. Setting Community-based pediatric practice serving a diverse population in an urban Canadian city. Participants One hundred fifty healthy children, aged 12 to 38 months, attending a well-child care visit. Main Outcome Measure Iron depletion (serum ferritin level, Results Of the 150 children, 82 (55%) were bottle-fed and 68 (45%) were cup fed. Iron depletion occurred in 29 (37%) of 78 bottle-fed and in 12 (18%) of 67 cup-fed children. The crude relative risk for iron depletion was 1.81 (95% confidence interval, 1.09-3.01). In the final logistic regression model, a significant association between bottle use and iron depletion was identified, beginning after the age of 16 months. At 18 months, the relative risk, adjusted for several child, maternal, and dietary variables, for the association between bottle use and iron depletion was 1.31 (95% confidence interval,1.24-1.47); at 24 months, the adjusted relative risk was 2.50 (95% confidence interval, 2.46-2.53). Milk consumption of more than 16 oz/d occurred in 55 (67%) of the 82 bottle-fed and in 22 (32%) of the 68 cup-fed children ( P Conclusions In the second and third years of life, there is an almost 2-fold association between iron depletion and daytime bottle-feeding compared with cup feeding. The child's age may be a modifier, and milk volume consumed may be a mediator, of this association. Duration of bottle use is a potentially modifiable practice.

Background No comprehensive assessment of diabetes prevalence in Nauru has been conducted since an extreme prevalence was documented more than two decades ago. This study aims to determine the prevalence and risk factors of diabetes and impaired fasting glucose. Methods A nationwide survey in 2004 of people aged 15- 64 years (n = 1592). Fasting plasma glucose levels were used to defined diabetes (≥7.0 mmol/l or 126 mg/dl) and prediabetes (6.1-6.9 mmol/l or 110-125 mg/dl). Results The sex-standardized prevalence of diabetes was 13.0% (95% CI: 10.6, 15.4) in men, 14.4% (11.9, 16.9) in women, and 13.7% (12.0, 15.4) combined. The sex-standardized prevalence of prediabetes was 6.4% (4.6, 8.2) for men, 5.5% (3.9, 7.2) for women, and 6.0% (4.8, 7.3) combined. The prevalence of diabetes for individuals 15-24, 25-34, 35-44, 45-54 and 55-64 years was 4.5%, 7.6%, 24.1%, 32.9%, and 42.7%, respectively. The prevalence of prediabetes for the same age categories was 4.2%, 8.8%, 5.9%, 6.6%, 7.1%, respectively. Multivariable, multinomial logit modeling found risk factors for prediabetes were high cholesterol levels (OR: 2.02, 95% CI: 1.66, 2.47) and elevated waist circumference (OR: 1.04, 95% CI: 1.00, 1.08), and for diabetes were age in years (OR: 1.06; 95% CI: 1.04, 1.07), cholesterol levels (OR: 1.84, 95% CI: 1.58, 2.14) and waist circumference (OR: 1.04, 95% CI: 1.02, 1.07). Conclusions Diabetes remains a major public health problem in Nauru, affecting one out of every ten people. While the prevalence of diabetes has declined, its burden has persisted among the old but also extended towards the younger age groups.