25-hydroxyvitamin D and health service utilization for asthma in early childhood

Background: Asthma is the most common chronic illness of childhood and a common reason for hospital admission. Studies suggest that low vitamin D levels may be associated with health service utilization (HSU) for childhood asthma. The primary objective was to determine if vitamin D serum levels in early childhood were associated with HSU for asthma including: a) hospital admissions; b) emergency department visits; and c) outpatient sick visits. Secondary objectives were to determine whether vitamin D supplementation in pregnancy or childhood were associated with HSU for asthma.  Methods: Prospective cohort study of children participating in the TARGet Kids!practice-based research network between 2008 and 2013 in Toronto, Canada. HSU was determined by linking each child's provincial health insurance number to health administrative databases. Multi variable quasi-Poisson and logistic regression were used to evaluate the association between 25-hydroxyvitamin D concentrations, vitamin D supplementation in pregnancy, and childhood and HSU for asthma.  Results: A total of 2926 healthy children aged 0-6 years had 25-hydroxyvitamin D data available and were included in the primary analysis. Mean (IQR) 25-hydroxyvitmain D level was 84 nmol/L (65-98 nmol/L), 218 and 1267 children had 25-hydroxyvitamin D concentrations Conclusions: Vitamin D blood values do not appear to be associated with HSU for asthma in this population of healthy urban children.</p

Agreement between a health claims algorithm and parent-reported asthma in young children

Introduction: Asthma prevalence is commonly measured in national surveys by questionnaire. The Ontario Asthma Surveillance Information System (OASIS) developed a validated health claims diagnosis algorithm to estimate asthma prevalence. The primary objective was to assess the agreement between two approaches of measuring asthma in young children. Secondary objectives were to identify concordant and discordant pairs, and to identify factors associated with disagreement.  Study design and setting: A measurement study to evaluate the agreement between the OASIS algorithm and parent‐reported asthma (criterion standard). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Multivariable logistic regression was used to determine factors associated with disagreement.  Results: Healthy children aged 1 to 5 years (n =3642) participating in the TARGet Kids! practice based research network 2008‐2013 in Toronto, Canada were included. Prevalence of asthma was 14% and 6% by the OASIS algorithm and parent‐reported asthma, respectively. The Kappa statistic was 0.43, sensitivity 81%, specificity 90%, PPV 34%, and NPV 99%. There were 3249 concordant and 393 discordant pairs. Statistically significant factors associated with asthma identified by OASIS but not parent report included: male sex, higher zBMI, and parent history of asthma. Males were less likely to have asthma identified by parent report but not OASIS.  Conclusion: The OASIS algorithm identified more asthma cases in young children than parent‐reported asthma. The OASIS algorithm had high sensitivity, specificity, and NPV but low PPV relative to parent‐reported asthma. These findings need replication in other populations.</p

Unadjusted and Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-Fasting Serum Lipids (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.

<p>^aAdjusted for age, sex, season, vitamin D supplementation, daily volume of cow’s milk intake, daily minutes of outdoor play, daily minutes of screen time, zBMI, and skin pigmentation.</p><p>^bP-values for secondary objectives adjusted for multiple testing using a false discovery rate controlling procedure correction. Statistical significance is defined as an adjusted P-value <0.05.</p><p>^cTriglyceride values were log transformed for analysis and back transformed results are presented.</p><p>Unadjusted and Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-Fasting Serum Lipids (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.</p

Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-HDL (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.

<p>^aTo convert from mg/dL to SI units divide the results for non-HDL, Total Cholesterol, LDL and HDL by 38.6, and divide by 88.6 for triglycerides.</p><p>Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-HDL (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.</p

Automated Self-Administered 24-H Dietary Assessment Tool (ASA24) recalls for parent proxy-reporting of children's intake (> 4 years of age): a feasibility study

Background: Robust measurement of dietary intake in population studies of children is critical to better understand the diet-health nexus. It is unknown whether parent proxy-report of children's dietary intake through online 24-h recalls is feasible in large cohort studies. Objectives: The primary objective of this study was to describe the feasibility of the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24) to measure parent proxy-reported child dietary intake. A secondary objective was to compare intake estimates with those from national surveillance. Methods: Parents of children aged 4-15 years participating in the TARGet Kids! research network in Toronto, Canada were invited by email to complete an online ASA24-Canada-2016 recall for their child, with a subsample prompted to complete a second recall about 2 weeks later. Descriptive statistics were reported for ASA24 completion characteristics and intake of several nutrients. Comparisons were made to the 2015 Canadian Community Health Survey (CCHS) 24-h recall data. Results: A total of 163 parents completed the first recall, and 46 completed the second, reflecting response rates of 35% and 59%, respectively. Seven (4%) first recalls and one (2%) second recall were excluded for ineligibility, missing data, or inadvertent parental self-report. The median number of foods reported on the first recall was 18.0 (interquartile range (IQR) 6.0) and median time to complete was 29.5 min (IQR 17.0). Nutrient intakes for energy, total fat, protein, carbohydrates, fiber, sodium, total sugars, and added sugars were similar across the two recalls and the CCHS. Conclusions: The ASA24 was found to be feasible for parent proxy-reporting of children's intake and to yield intake estimates comparable to those from national surveillance, but strategies are needed to increase response rate and support completion to enhance generalizability.</p

Composite analysis of wind patterns for months with high and low Kawasaki disease (KD) occurrences.

<p>Time series of standardized monthly number of KD cases, with months (May-October in grey) and anomalously high and low occurrences of new KD cases highlighted in red and blue, respectively (A). Wind speed (color, units [m/s]) and direction (arrows) during months with high KD occurrences (B), low KD occurrences (D) and difference between months with high and low KD occurrences (C) centered over the Pacific Ocean.</p

Habitual environmental exposures in children with Kawasaki disease (KD).

<p>Habitual environmental exposures in children with Kawasaki disease (KD).</p

Distribution of ethnicity/origin across controls and patients with Kawasaki disease (KD).

<p>Distribution of ethnicity/origin across controls and patients with Kawasaki disease (KD).</p

Conceptual framework for individual risk of developing Kawasaki disease (KD) linking disease etiology, pathogenesis and global distribution.

<p>Conceptual framework for individual risk of developing Kawasaki disease (KD) linking disease etiology, pathogenesis and global distribution.</p

Composite analysis of wind patterns for months with high and low Kawasaki disease (KD) occurrences.

<p>Time series of standardized monthly number of KD cases, with months (May-October in grey) and anomalously high and low occurrences of new KD cases highlighted in red and blue, respectively (A). Wind speed (color, units [m/s]) and direction (arrows) during months with high KD occurrences (B), low KD occurrences (D) and difference between months with high and low KD occurrences (C) centered over the Pacific Ocean.</p