Laminitis: risk factors and outcome in a group of Danish horses

Reasons for performing study: Recent systematic reviews have highlighted the lack of quality information with respect to the epidemiology of equine laminitis. Objectives: To identify in Denmark the risk factors for new (i.e. not believed to have suffered from laminitis previously) cases of laminitis (NL) and to look at the outcome and incidence of repeated episodes of laminitis in these animals as well as those which had previously suffered an episode of laminitis (i.e. chronic cases) over the following 12 months. Methods: Information was obtained from 110 veterinary diagnosed cases of laminitis (69 new and 41 chronic) and 80 control animals (the next non-laminitic horse/pony seen by that participating practice). All animals were followed for up to one year. Univariable and multivariable conditional logistic regression was conducted for the NL case control pairs. Variables were retained within the final multivariable models if the likelihood ratio p-value was < 0.05. Results: There was no association between sex or gender and laminitis. A recent change of grass, being on what was considered high quality grass and being a cold-blooded type, <149cm ( i.e. Shetland, Fell, Welsh, or Dartmoor pony, Icelandic horse, Norwegian fjords, or a mix of these breeds) were all significant risk factors for laminitis. Although cresty neck score (CNS), and body condition Score (BCS), were significantly associated with NL at the univariable screening stage, they were found to be confounders of breed and each other during the multivariable model building process. Other factors such as weight, and estimated starch intake were not found to be significant .Thirty three percent of all the laminitis cases had been humanely destroyed within 12 months of diagnosis, mainly for laminitis associated reasons, compared with only 7.5% of the controls (none for laminitis associated reasons). Conclusions: and potential Relevance: This study confirms the importance of grass turn out and breed on laminitis risk. Horses in work at the time of diagnosis as well as those diagnosed in the winter and spring were more likely to be humanely destroyed within the next 12 months than those not in work or diagnosed in the autumn and summer

Parents\u27 perception of stroller use in young children: A qualitative study

Background: Despite their wide usage, it has recently been suggested that stroller use may reduce physical activity levels of young children. However, there have been no studies on stroller use as it relates to physical activity outcomes. The objectives of this study were to understand the context of stroller use for young children and parents\u27 perceptions of the relationship between stroller use and their children\u27s physical activity. Methods: Parents of children 1 to 5 years of age were recruited through two sites of TARGet Kids!, a primary-care, practice-based research network in Toronto, Canada. Fourteen semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim and two independent reviewers conducted thematic analysis. A number of strategies were employed to ensure the trustworthiness of the data. Results: Parents discussed reasons for stroller use (i.e., transportation; storage; leisure; supervision/confinement; parent physical activity; and sleep), factors that influence the decision to use a stroller (i.e., caregiver choice; convenience, timing, distance; family lifestyle; and child preference), and perceived impact of stroller use on physical activity (i.e., most parents did not recognize a connection between stroller use and physical activity). Conclusion: This study provides a context for researchers and policy makers to consider when developing stroller related physical activity guidelines for young children

DO IT Trial: vitamin D Outcomes and Interventions in Toddlers - a TARGet Kids! randomized controlled trial.

BackgroundVitamin D levels are alarmingly low (<75 nmol/L) in 65-70% of North American children older than 1 year. An increased risk of viral upper respiratory tract infections (URTI), asthma-related hospitalizations and use of anti-inflammatory medication have all been linked with low vitamin D. No study has determined whether wintertime vitamin D supplementation can reduce the risk of URTI and asthma exacerbations, two of the most common and costly illnesses of early childhood. The objectives of this study are: 1) to compare the effect of 'high dose' (2000 IU/day) vs. 'standard dose' (400 IU/day) vitamin D supplementation in achieving reductions in laboratory confirmed URTI and asthma exacerbations during the winter in preschool-aged Canadian children; and 2) to assess the effect of 'high dose' vitamin D supplementation on vitamin D serum levels and specific viruses that cause URTI.Methods/designThis study is a pragmatic randomized controlled trial. Over 4 successive winters we will recruit 750 healthy children 1-5 years of age. Participating physicians are part of a primary healthcare research network called TARGet Kids!. Children will be randomized to the 'standard dose' or 'high dose' oral supplemental vitamin D for a minimum of 4 months (200 children per group). Parents will obtain a nasal swab from their child with each URTI, report the number of asthma exacerbations and complete symptom checklists. Unscheduled physician visits for URTIs and asthma exacerbations will be recorded. By May, a blood sample will be drawn to determine vitamin D serum levels. The primary analysis will be a comparison of URTI rate between study groups using a Poisson regression model. Secondary analyses will compare vitamin D serum levels, asthma exacerbations and the frequency of specific viral agents between groups.DiscussionIdentifying whether vitamin D supplementation of preschoolers can reduce wintertime viral URTIs and asthma exacerbations and what dose is optimal may reduce population wide morbidity and associated health care and societal costs. This information will assist in determining practice and health policy recommendations related to vitamin D supplementation in healthy Canadian preschoolers

Paediatric Obesity Research in Early Childhood and the Primary Care Setting: The TARGet Kids! Research Network

Primary paediatric health care is the foundation for preventative child health. In light of the recent obesity epidemic, paediatricians find themselves at the frontline of identification and management of childhood obesity. However, it is well recognized that evidence based approaches to obesity prevention and subsequent translation of this evidence into practice are critically needed. This paper explores the role of primary care in obesity prevention and introduces a novel application and development of a primary care research network in Canada—TARGet Kids!—to develop and translate an evidence-base on effective screening and prevention of childhood obesity

Can an evidence-based guideline reminder card improve asthma management in the emergency department?

SummaryObjectiveAsthma is the most common chronic disease in children. Previous studies described significant variations in acute asthma management in children. This study was conducted to examine whether asthma management in the pediatric emergency department (ED) was improved through the use of an evidence-based acute asthma care guideline reminder card.MethodsThe Pediatric Acute Asthma Management Guideline (PAMG) was introduced to the ED of a pediatric tertiary care hospital in Ontario, Canada. Medical charts of 278 retrospective ED visits (January–December 2002) and 154 prospective visits (July 2003–June 2004) were reviewed to assess changes in acute asthma management such as medication treatment, asthma education, and discharge planning. Logistic and linear regressions were used to determine the effect of PAMG on asthma management in the ED. The propensity score method was used to adjust for confounding.ResultsDuring the implementation of PAMG, patients who visited the ED were more likely to receive oral corticosteroids (Adjusted Odds Ratio [AOR] = 2.26, 95% CI: 1.63–3.14, p < 0.0001) and oxygen saturation reassessment before ED discharge (AOR = 2.02, 95% CI: 1.45–2.82, p < 0.0001). They also received 0.23 (95% CI: 0.03–0.44, p = 0.0283) more doses of bronchodilator in the first hour of ED stay. Improvements in asthma education and discharge planning were noted, but the changes were not statistically significant.ConclusionsAfter the implementation of an evidence-based guideline reminder card, medication treatment for acute asthma in the ED was significantly improved; however, asthma education and discharge planning remained unchanged. Future efforts on promoting guideline-based practice in the ED should focus on these components

Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care

Background: Electronic medical records (EMRs) from primary care may be a feasible source of height and weight data. However the use of EMRs in research has been impeded by lack of standardization of EMRs systems, data access and concerns about the quality of the data.Objectives: The study objectives were to determine the data completeness and accuracy of child heights and weights collected in primary care EMRs, and to identify factors associated with these data quality attributes.Methods: A cross-sectional study examining height and weight data for children <19 years from EMRs through the Electronic Medical Records Administrative data Linked Database (EMRALD), a network of family practices across the province of Ontario. Body mass index z-scores were calculated using the WHO Growth Standards and Reference.Results: A total of 54,964 children were identified from EMRALD. Overall, 93% had at least 1 complete set of growth measurements to calculate a BMI z-score. 66.2% of all primary care visits had complete BMI z-score data. After stratifying by visit type 89.9% of well-child visits and 33.9% of sick visits had complete BMI z-score data; incomplete BMI z-score was mainly due to missing height measurements. Only 2.7% of BMI z-score data were excluded due to implausible values.Conclusions: Data completeness at well-child visits and overall data accuracy were greater than 90%. EMRs may be a valid source of data to provide estimates of obesity in children who attend primary care

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

Introduction 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. Objectives and Approach The primary objective was to determine if vitamin D serum levels in early childhood were associated with HSU for asthma including: a) total HSU, b) hospital admissions, c) emergency department visits and d) outpatient sick visits. Secondary objectives were to determine whether vitamin D supplementation in pregnancy or childhood were associated with HSU for asthma. Prospective cohort study of children participating in the TARGet Kids! practice based research network. HSU was determined by linking each child's provincial health insurance number to health administrative databases. Multivariable quasi Poisson and logistic regression were used to evaluate the associations. Results 2926 healthy children ages 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 levels <50 nmol/L and <75 nmol/L, respectively. In the adjusted models, there were no associations between 25-hydroxyvitamin D (continuously or dichotomized at 50 and 75 nmol/L), vitamin D supplementation in pregnancy or childhood and HSU for asthma. Conclusion/Implications Higher vitamin D blood values do not appear to be associated with HSU for asthma in this population of healthy urban children