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Antimicrobial use in Canadian acute-care hospitals: Findings from three national point-prevalence surveys between 2002 and 2017
- Jennifer J. Liang, Wallis Rudnick, Robyn Mitchell, James Brooks, Kathryn Bush, John Conly, Jennifer Ellison, Charles Frenette, Lynn Johnston, Christian Lavallée, Allison McGeer, Dominik Mertz, Linda Pelude, Michelle Science, Andrew Simor, Stephanie Smith, Paula Stagg, Kathryn N. Suh, Nisha Thampi, Daniel J.G. Thirion, Joseph Vayalumkal, Alice Wong, Geoffrey Taylor, for the Canadian Nosocomial Infection Surveillance Program
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 43 / Issue 11 / November 2022
- Published online by Cambridge University Press:
- 07 March 2022, pp. 1558-1564
- Print publication:
- November 2022
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Objectives:
The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Methods:Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
Results:In each survey, 28−47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%−37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%−41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%−40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60).
Conclusions:The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
LO86: Lack of association between four biomarkers and the presence of persistent post-concussion symptoms after a mild traumatic brain injury
- N. Le Sage, N. Le Sage, J. Frenette, J. Chauny, S. Berthelot, P. Archambault, J. Perry, J. Lee, E. Lang, A. McRae, X. Neveu, P. Tardif, V. Boucher, É. Mercier, M. Émond
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, pp. S38-S39
- Print publication:
- May 2020
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Introduction: Mild Traumatic Brain Injury (mTBI) is a common problem: each year in Canada, its incidence is estimated at 500-600 cases per 100 000. Between 10 and 56% of mTBI patients develop persistent post-concussion symptoms (PPCS) that can last for more than 90 days. It is therefore important for clinicians to identify patients who are at risk of developing PPCS. We hypothesized that blood biomarkers drawn upon patient arrival to the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and the incidence of PPCS 90 days post mTBI. Methods: Patients were recruited in seven Canadian ED. Non-hospitalized patients, aged ≥14 years old with a documented mTBI that occurred ≤24 hrs of ED consultation, with a GCS ≥13 at arrival were included. Sociodemographic and clinical data as well as blood samples were collected in the ED. A standardized telephone questionnaire was administered at 90 days post ED visit. The following biomarkers were analyzed using enzyme-linked immunosorbent assay (ELISA): S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial fibrillary acidic protein (GFAP). The primary outcome measure was the presence of persistent symptoms at 90 days after mTBI, as assessed using the Rivermead Post-Concussion symptoms Questionnaire (RPQ). A ROC curve was constructed for each biomarker. Results: 1276 patients were included in the study. The median age for this cohort was 39 (IQR 23-57) years old, 61% were male and 15% suffered PPCS. The median values (IQR) for patients with PPCS compared to those without were: 43 pg/mL (26-67) versus 42 pg/mL (24-70) for S100B protein, 50 pg/mL (50-223) versus 50 pg/mL (50-199) for NSE, 2929 pg/mL (1733-4744) versus 3180 pg/mL (1835-4761) for c-Tau and 1644 pg/mL (650-3215) versus 1894 pg/mL (700-3498) for GFAP. For each of these biomarkers, Areas Under the Curve (AUC) were 0.495, 0.495, 0.51 and 0.54, respectively. Conclusion: Among mTBI patients, S100B protein, NSE, c-Tau or GFAP during the first 24 hours after trauma do not seem to be able to predict PPCS. Future research testing of other biomarkers is needed in order to determine their usefulness in predicting PPCS when combined with relevant clinical data.
LO88: S100B serum protein level for the detection of clinically significant intracranial hemorrhage in patients with mild traumatic brain injury: a prospective cohort study
- J. Blais-L'Écuyer, J. Blais-L'Écuyer, É. Mercier, P. Tardif, P. Archambault, J. Chauny, S. Berthelot, J. Frenette, J. Perry, I. Stiell, M. Émond, J. Lee, E. Lang, A. McRae, V. Boucher, N. Le Sage
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S39
- Print publication:
- May 2020
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Introduction: Clinical assessment of patients with mTBI is challenging and overuse of head CT in the emergency department (ED) is a major problem. During the last decades, studies have attempted to reduce unnecessary head CTs following a mTBI by identifying new tools aiming to predict intracranial bleeding. S100B serum protein level might be helpful reducing those imaging since a higher level of S-100B protein has been associated with intracranial hemorrhage following a mTBI in previous literature. The main objective of this study was to assess whether the S100B serum protein level is associated with clinically important brain injury and could be used to reduce the number of head CT following a mTBI. Methods: This prospective multicenter cohort study was conducted in five Canadian ED. MTBI patients with a Glasgow Coma Scale (GCS) score of 13-15 in the ED and a blood sample drawn within 24-hours after the injury were included. S-100B protein was analyzed using enzyme-linked immunosorbent assay (ELISA). All types of intracranial bleedings were reviewed by a radiologist who was blinded to the biomarker results. The main outcome was the presence of clinically important brain injury. Results: A total of 476 patients were included. Mean age was 41 ± 18 years old and 150 (31.5%) were female. Twenty-four (5.0%) patients had a clinically significant intracranial hemorrhage while 37 (7.8%) had any type of intracranial bleeding. S100B median value (Q1-Q3) of was: 0.043 ug/L (0.008-0.080) for patients with clinically important brain injury versus 0.039 μg/L (0.023-0.059) for patients without clinically important brain injury. Sensitivity and specificity of the S100B protein level, if used alone to detect clinically important brain injury, were 16.7% (95% CI 4.7-37.4) and 88.5% (95% CI 85.2-91.3), respectively. Conclusion: S100B serum protein level was not associated with clinically significant intracranial hemorrhage in mTBI patients. This protein did not appear to be useful to reduce the number of CT prescribed in the ED and would have missed many clinically important brain injuries. Future research should focus on different ways to assess mTBI patient and ultimately reduce unnecessary head CT.
LO87: Influence of co-injuries on post-concussion symptoms after a mild traumatic brain injury
- V. Ouellet, V. Boucher, F. Beauchamp, X. Neveu, P. Archambault, S. Berthelot, J. Chauny, E. de Guise, M. Émond, J. Frenette, E. Lang, J. Lee, É. Mercier, L. Moore, M. Ouellet, J. Perry, N. Le Sage
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S39
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- May 2020
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Introduction: Each year, 3/1000 Canadians sustain a mild traumatic brain injury (mTBI). Many of those mTBI are accompanied by various co-injuries such as dislocations, sprains, fractures or internal injuries. A number of those patients, with or without co-injuries will suffer from persistent post-concussive symptoms (PPCS) more than 90 days post injury. However, little is known about the impact of co-injuries on mTBI outcome. This study aims to describe the impact of co-injuries on PPCS and on patient return to normal activities. Methods: This multicenter prospective cohort study took place in seven large Canadian Emergency Departments (ED). Inclusion criteria: patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of ED visit, with a Glasgow Coma Scale score of 13-15. Patients who were admitted following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. A research nurse then conducted three follow-up phone interviews at 7, 30 and 90 days post-injury, in which they assessed symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to estimate the influence of co-injuries. Results: A total of 1674 patients were included, of which 1023 (61.1%) had at least one co-injury. At 90 days, patients with co-injuries seemed to be at higher risk of having 3 symptoms ≥2 points according to the RPQ (RR: 1.28 95% CI 1.02-1.61) and of experiencing the following symptoms: dizziness (RR: 1.50 95% CI 1.03-2.20), fatigue (RR: 1.35 95% CI 1.05-1.74), headaches (RR: 1.53 95% CI 1.10-2.13), taking longer to think (RR: 1.50 95% CI 1.07-2.11) and feeling frustrated (RR: 1.45 95% CI 1.01-2.07). We also observed that patients with co-injuries were at higher risk of non-return to their normal activities (RR: 2.31 95% CI 1.37-3.90). Conclusion: Patients with co-injuries could be at higher risk of suffering from specific symptoms at 90 days post-injury and to be unable to return to normal activities 90 days post-injury. A better understanding of the impact of co-injuries on mTBI could improve patient management. However, further research is needed to determine if the differences shown in this study are due to the impact of co-injuries on mTBI recovery or to the co-injuries themselves.
LO89: Describing the evolution of post-concussion symptoms after sports-related mTBI
- F. Beauchamp, V. Boucher, X. Neveu, V. Ouellet, P. Archambault, S. Berthelot, J. Chauny, E. de Guise, M. Émond, J. Frenette, E. Lang, J. Lee, É. Mercier, L. Moore, M. Ouellet, J. Perry, N. Le Sage
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S40
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- May 2020
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Introduction: Mild traumatic brain injury (mTBI) is a serious public health issue and as much as one third of mTBI patients could be affected by persistent post-concussion symptoms (PPCS) three months after their injury. Even though a significant proportion of all mTBIs are sports-related (SR), little is known on the recovery process of SR mTBI patients and the potential differences between SR mTBI and patients who suffered non-sports-related mTBI. The objective of this study was to describe the evolution of PPCS among patients who sustained a SR mTBI compared to those who sustained non sport-related mTBI. Methods: This Canadian multicenter prospective cohort study included patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of Emergency Department (ED) visit, with a Glasgow Coma Scale score of 13-15. Patients who were hospitalized following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. Three follow-up phone interviews were conducted by a research nurse at 7, 30 and 90 days post-injury to assess symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to demonstrate the impact of the mechanism of injury (sports vs non-sports) on the presence and severity of PPCS. Results: A total of 1676 mTBI patients were included, 358 (21.4%) of which sustained a SR mTBI. At 90 days post-injury, patients who suffered a SR mTBI seemed to be significantly less affected by fatigue (RR: 0.70 (95% CI: 0.50-0.97)) and irritability (RR: 0.60 (95% CI: 0.38-0.94)). However, no difference was observed between the two groups regarding each other symptom evaluated in the RPQ. Moreover, the proportion of patients with three symptoms or more, a score ≥21 on the RPQ and those who did return to their normal activities were also comparable. Conclusion: Although persistent post-concussion symptoms are slightly different depending on the mechanism of trauma, our results show that patients who sustained SR-mTBI could be at lower risk of experiencing some types of symptoms 90 days post-injury, in particular, fatigue and irritability.
LO93: Prognostic value of S-100B protein for prediction of post-concussion symptoms following a mild traumatic brain injury: systematic review and meta-analysis
- E. Mercier, P. Tardif, P. Cameron, B. Batomen Kuimi, M. Émond, L. Moore, B. Mitra, J. Frenette, É. De Guise, M. Ouellet, M. Bordeleau, N. Le Sage
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S60
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- May 2017
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Introduction: Mild traumatic brain injury (mTBI) is a major cause of morbidity but there are no validated tools to help clinicians predict post-concussion symptoms. This systematic review and meta-analysis aimed to determine the prognostic value of S-100B protein to predict post-concussion symptoms following a mTBI in adults. Methods: The protocol of this systematic review was registered with the PROSPERO database (CRD42016032578). A search strategy was performed on seven databases (CINAHL, Cochrane CENTRAL, EMBASE, MEDLINE, Web of Knowledge, PyscBITE, PsycINFO) from their inception to October 2016. Studies evaluating the association between S-100B protein level and post-concussion symptoms assessed at least seven days after the mTBI were eligible. Individual patient data were requested. Studies eligibility assessment, data extraction and risk of bias assessment were performed independently by two researchers. Analyses were done following the meta-analysis using individual participant data or summary aggregate data guidelines from the Cochrane Methodology Review Group. Results: Outcomes were dichotomised as persistent (≥3 months) or early (≥7 days <3 months). Our search strategy yielded 23,298 citations of which 29 studies presenting between seven and 223 patients (n=2505) were included. Post-concussion syndrome (PCS) (16 studies), neuropsychological symptoms (9 studies) and health-related quality of life (4 studies) were the most frequently presented outcomes. The S-100B protein serum level of patients with no PCS was similar to that of patients experiencing persistent PCS (mean difference 0.00 [-0.05, 0.04]) or early PCS (mean difference 0.03 [-0.02, 0.08]). The odds of having persistent PCS (OR 0.56 (95% CI: 0.29-1.10) or early PCS (OR 1.67 (95% CI: 0.98-2.85) in patients with an elevated S-100B protein serum level was not significantly different from that of patients with normal values. No meta-analysis was performed for other outcomes than PCS due to heterogeneity and small samples. Studies’ overall risk of bias was considered moderate. Conclusion: Results suggest that the prognostic value of S-100B protein serum level to predict persistent and early post-concussion symptoms is limited. Variability in injury to S-100B protein sample time and outcomes assessed could potentially explain the lack of association and needs further evaluation.
LO94: Prognostic value of neuron-specific enolase (NSE) for prediction of post-concussion symptoms following a mild traumatic brain injury: a systematic review
- E. Mercier, P. Tardif, P. Cameron, M. Émond, L. Moore, B. Mitra, M. Ouellet, J. Frenette, É. De Guise, N. Le Sage
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S60
- Print publication:
- May 2017
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Introduction: Mild traumatic brain injury (mTBI) is an understudied worldwide health problem and a socio-economic burden that remains a major cause of morbidity. However, there is no prognostication tool to help clinicians predict the occurrence of post-concussion symptoms. This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following a mTBI in adults. Methods: The protocol of this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number CRD42016033683). Seven databases (CINAHL, Cochrane CENTRAL, EMBASE, MEDLINE, PsycBITE, PsycINFO, Web of Knowledge/Biosis) were searched for cohort studies evaluating the association between NSE levels and post-concussion symptoms assessed at least seven days after the mild TBI. Grey literature was also screened using databases on dissertations and theses as well as abstracts from relevant congresses. Two researchers independently screened studies for inclusion, extracted data, and appraised their quality using the Quality in Prognostic Studies (QUIPS) tool from the Cochrane Collaboration Group. Results: Our search strategy yielded a total of 23,298 citations from which eight cohorts presented in 10 studies were included. Studies included between 45 and 141 patients (total=608 patients). The most frequently assessed outcomes were post-concussion syndrome (PCS) (13 assessments), neuropsychological disorders (10 assessments), return to work or sick leave (2 assessments) and Glasgow Outcome Scale (GOS) (2 assessments). No association was found between an elevated NSE serum level and the occurrence of PCS. Of the 33 outcomes assessments performed, only three showed an association between a higher level of serum NSE and a post-concussion symptom (alteration of at least three cognitive domains at 2 weeks, standardised physician assessment at 6 weeks and headache at 6 months following a mild TBI). Included studies’ overall risk of bias was considered moderate. Conclusion: Results of this systematic review conclude that based on current levels of evidence, serum NSE levels alone do not provide prognostic information on persistent or early post-concussion symptoms after a mTBI.
Impact of an Infection Control and Antimicrobial Stewardship Program on Solid Organ Transplantation and Hepatobiliary Surgical Site Infections
- Charles Frenette, David Sperlea, Yveta Leharova, Daniel J. G. Thirion
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 37 / Issue 12 / December 2016
- Published online by Cambridge University Press:
- 03 October 2016, pp. 1468-1474
- Print publication:
- December 2016
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OBJECTIVE
The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs).
METHODSThis study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas–kidney transplantation were included. Outcomes were compared between a preintervention group (2010–2011) and a postintervention group (2012–2014).
RESULTSA total of 1,424 procedures averaged an overall SSI rate of 11.2%. After implementation of the interventions, a decrease of 52.8% in SSI rates from 17.4% to 8.2% was observed (P<.001; odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5–2.9). An overall significant decrease >50% (relative rate; P<.001) was observed in superficial incisional and organ-space infections between pre- and postintervention groups. In addition, a 54.9% decrease from 19.7% to 8.9% (P<.001; OR, 2.2; 95% CI, 1.4–3.5) and a 51.6% decrease from 15.5% to 7.5% (P=.001; OR, 2.2; 95% CI, 1.4–3.5) were observed for SSI rates in hepatobiliary surgery and solid organ transplantation, respectively. The antimicrobial stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 15.2% (absolute rate) from 45.1% to 60.3% (P<.003; 95% CI, 5.4–24.9).
CONCLUSIONSA long-term serial infection control and antimicrobial stewardship intervention decreased SSIs among patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas–kidney transplantation.
Infect Control Hosp Epidemiol 2016;1468–1474
Use of vitamin D supplements during infancy in an international feeding trial
- Eveliina Lehtonen, Anne Ormisson, Anita Nucci, David Cuthbertson, Susa Sorkio, Mila Hyytinen, Kirsi Alahuhta, Carol Berseth, Marja Salonen, Shayne Taback, Margaret Franciscus, Teba González-Frutos, Tuuli E Korhonen, Margaret L Lawson, Dorothy J Becker, Jeffrey P Krischer, Mikael Knip, Suvi M Virtanen, , Thomas Mandrup-Poulsen, Elias Arjas, Åke Lernmark, Barbara Schmidt, Jeffrey P. Krischer, Hans K. Åkerblom, Mila Hyytinen, Mikael Knip, Katriina Koski, Matti Koski, Eeva Pajakkala, Marja Salonen, David Cuthbertson, Jeffrey P. Krischer, Linda Shanker, Brenda Bradley, Hans-Michael Dosch, John Dupré, William Fraser, Margaret Lawson, Jeffrey L. Mahon, Mathew Sermer, Shayne P. Taback, Dorothy Becker, Margaret Franciscus, Anita Nucci, Jerry Palmer, Minna Pekkala, Suvi M. Virtanen, Jacki Catteau, Neville Howard, Patricia Crock, Maria Craig, Cheril L. Clarson, Lynda Bere, David Thompson, Daniel Metzger, Colleen Marshall, Jennifer Kwan, David K. Stephure, Daniele Pacaud, Wendy Schwarz, Rose Girgis, Marilyn Thompson, Shayne P. Taback, Daniel Catte, Margaret L. Lawson, Brenda Bradley, Denis Daneman, Mathew Sermer, Mary-Jean Martin, Valérie Morin, Lyne Frenette, Suzanne Ferland, Susan Sanderson, Kathy Heath, Céline Huot, Monique Gonthier, Maryse Thibeault, Laurent Legault, Diane Laforte, Elizabeth A. Cummings, Karen Scott, Tracey Bridger, Cheryl Crummell, Robyn Houlden, Adriana Breen, George Carson, Sheila Kelly, Koravangattu Sankaran, Marie Penner, Richard A. White, Nancy King, James Popkin, Laurie Robson, Eva Al Taji, Irena Aldhoon, Pavla Mendlova, Jan Vavrinec, Jan Vosahlo, Ludmila Brazdova, Jitrenka Venhacova, Petra Venhacova, Adam Cipra, Zdenka Tomsikova, Petra Krckova, Pavla Gogelova, Ülle Einberg, Mall-Anne Riikjärv, Anne Ormisson, Vallo Tillmann, Päivi Kleemola, Anna Parkkola, Heli Suomalainen, Anna-Liisa Järvenpää, Anu-Maaria Hämälainen, Hannu Haavisto, Sirpa Tenhola, Pentti Lautala, Pia Salonen, Susanna Aspholm, Heli Siljander, Carita Holm, Samuli Ylitalo, Raisa Lounamaa, Anja Nuuja, Timo Talvitie, Kaija Lindström, Hanna Huopio, Jouni Pesola, Riitta Veijola, Päivi Tapanainen, Abram Alar, Paavo Korpela, Marja-Liisa Käär, Taina Mustila, Ritva Virransalo, Päivi Nykänen, Bärbel Aschemeier, Thomas Danne, Olga Kordonouri, Dóra Krikovszky, László Madácsy, Yeganeh Manon Khazrai, Ernesto Maddaloni, Paolo Pozzilli, Carla Mannu, Marco Songini, Carine de Beaufort, Ulrike Schierloh, Jan Bruining, Margriet Bisschoff, Aleksander Basiak, Renata Wasikowa, Marta Ciechanowska, Grazyna Deja, Przemyslawa Jarosz-Chobot, Agnieszka Szadkowska, Katarzyna Cypryk, Malgorzata Zawodniak-Szalapska, Luis Castano, Teba Gonzalez Frutos, Mirentxu Oyarzabal, Manuel Serrano-Ríos, María Teresa Martínez-Larrad, Federico Gustavo Hawkins, Dolores Rodriguez Arnau, Johnny Ludvigsson, Malgorzata Smolinska Konefal, Ragnar Hanas, Bengt Lindblad, Nils-Osten Nilsson, Hans Fors, Maria Nordwall, Agne Lindh, Hans Edenwall, Jan Aman, Calle Johansson, Margrit Gadient, Eugen Schoenle, Dorothy Becker, Ashi Daftary, Margaret Franciscus, Carol Gilmour, Jerry Palmer, Rachel Taculad, Marilyn Tanner-Blasiar, Neil White, Uday Devaskar, Heather Horowitz, Lisa Rogers, Roxana Colon, Teresa Frazer, Jose Torres, Robin Goland, Ellen Greenberg, Maudene Nelson, Holly Schachner, Barney Softness, Jorma Ilonen, Massimo Trucco, Lynn Nichol, Erkki Savilahti, Taina Härkönen, Mikael Knip, Outi Vaarala, Kristiina Luopajärvi, Hans-Michael Dosch
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- Journal:
- Public Health Nutrition / Volume 17 / Issue 4 / April 2014
- Published online by Cambridge University Press:
- 24 June 2013, pp. 810-822
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Objective
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
DesignLongitudinal study.
SettingInformation about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
SubjectsInfants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
ResultsDaily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
ConclusionsMost of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.