25-Hydroxyvitamin D supplementation and health-service utilization for upper respiratory tract infection in young children

Objective: Upper respiratory tract infections (URTI) are the most common and costly condition of childhood. Low vitamin D levels have been hypothesized as a risk factor for URTI. The primary objective was to determine if serum vitamin D levels were associated with health-service utilization (HSU) for URTI including hospital admission, emergency department visits and outpatient sick visits. The secondary objectives were to determine whether oral vitamin D supplementation in pregnancy or childhood was associated with HSU for URTI. Design: Cohort study. HSU was determined by linking each child's provincial health insurance number to health administrative databases. Multivariable quasi Poisson regression was used to evaluate the association between 25-hydroxyvitamin D, vitamin D supplementation and HSU for URTI. Setting: Toronto, Canada. Subjects: Children participating in the TARGet Kids! network between 2008 and 2013. Results: Healthy children aged 0-5 years (n 4962) were included; 52 % were male and mean 25-hydroxyvitamin D was 84 nmol/l (range 11-355 nmol/l). There were 105 (2 %), 721 (15 %) and 3218 (65 %) children with at least one hospital admission, emergency department visit or outpatient sick visit for URTI, respectively. There were no statistically significant associations between 25-hydroxyvitamin D or vitamin D supplementation and HSU for URTI. Conclusions: A clinically meaningful association between vitamin D (continuously and dichotomized at <50 and <75 nmol/l) and HSU for URTI was not identified. While vitamin D may have other benefits for health, reducing HSU for URTI does not appear to be one of them.</p

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

Non-Western immigrant children have lower 25-hydroxyvitamin D than children from Western families

Objective: To determine if children aged 1-6 years from non-Western immigrant families have lower serum 25-hydroxyvitamin D (25(OH)D) levels than children from Western-born families and examine which factors influence this relationship. Design: Cross-sectional study. Setting: Toronto, Canada. Subjects: Healthy children (n 1540) recruited through the TARGet Kids! practice-based research network. Serum 25(OH)D concentrations of non-Western immigrants were compared with those of children from Western-born families. Children from non-Western immigrant families were defined as those born, or their parents were born, outside a Western country. Univariate and multiple linear regression analyses were used to identify factors which might influence this relationship. Results: Median age was 36 months, 51 % were male, 86 % had 'light' skin pigmentation, 55 % took vitamin D supplements, mean cow's milk intake was 1·8 cups/d and 27 % were non-Western immigrants. Median serum 25(OH)D concentration was 83 nmol/l, with 5 % having 25(OH)D Conclusions: There is an association between non-Western immigration and lower 25(OH)D in early childhood. This difference appears related to known vitamin D determinants, primarily vitamin D supplementation, representing opportunities for intervention.</p

DOC-Apnea scores to impairment on the polysomnogram.

<p>DOC-Apnea scores to impairment on the polysomnogram.</p

The “DOC” screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA) and cognitive impairment in stroke prevention clinics

<div><p>Background</p><p>Post-stroke Depression, Obstructive sleep apnea (OSA) and Cognitive impairment (“DOC”) are associated with greater mortality, worse recovery and poorer quality of life. Best practice recommendations endorse routine screening for each condition; yet, all are under-assessed, diagnosed and treated. We seek to determine the feasibility and validity of an integrated tool (“DOC” screen) to identify stroke clinic patients at high-risk of depression, OSA, and cognitive impairment.</p><p>Methods</p><p>All consecutive new referrals to a regional Stroke Prevention Clinic who were English-speaking and non-aphasic were eligible to be screened. Time for screen completion was logged. DOC screen results were compared to the neuropsychological battery and polysomnogram assessments using a modified receiver operator characteristic and area under the curve analysis. Data is reported to conform to STARD guidelines.</p><p>Findings</p><p>1503 people were screened over 2 years. 89% of eligible patients completed the screen in 5 minutes or less (mean 4.2 minutes), less than half the time it takes to complete the Montreal Cognitive Assessment (MoCA). 437 people consented to detailed testing. Of those, 421 completed the Structured Clinical Interview for Depression within 3 months of screening, 387 completed detailed neuropsychological testing within 3 months, and 88 had overnight polysomnograms. Screening scores combined with demographic variables (age, sex, education, body mass index), had excellent validity compared to gold standard diagnoses: DOC-Mood AUC 0.90; DOC-Apnea AUC 0.80; DOC-Cog AUC 0.81. DOC screen scores can reliably categorize patients in to low-, intermediate- or high-risk groups for further action and can do so with comparable accuracy to more time-consuming screens.</p><p>Conclusions</p><p>Systematic screening of depression, obstructive sleep apnea, and cognitive impairment in 5 minutes or less is feasible and valid in a high volume stroke clinic using the DOC screen. The DOC screen may facilitate improved identification and treatment of these comorbidities to improve function in patients after stroke and in those with other neurological diseases that share these comorbid conditions (e.g. Alzheimer’s disease/mild cognitive impairment, Parkinson’s disease, Traumatic Brain Injury, multiple sclerosis).</p></div

Feasibility and validity patient characteristics.

<p>Feasibility and validity patient characteristics.</p

DOC screen.

<p>DOC screen.</p

DOC study patient flow.

<p>Impairment on the reference standard was determined using the two cut-point regression method.</p

DOC-Cog scores to impairment on the neuropsychological test battery.

<p>DOC-Cog scores to impairment on the neuropsychological test battery.</p