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Nakhla M, Simard M, Dube M, et al. Clin Epidemiol. 2019;11:833–843. The authors have advised there is an error in the diagnostic codes used to validate the cases of diabetes. The code “251.X” was never included in the validation algorithm and was erroneously included in the list of ICD-9 codes in the final revision phase of the manuscript. The authors apologize for this error. Page 835, Diagnostic accuracy section, second sentence, the text “We determined the diagnostic accuracy (sensitivity, specificity, PPV, NPV) of a variety of algorithms, using combinations of physician billings and hospital admissions over 1 or 2 years bearing a diagnosis code of diabetes mellitus (ICD-9 250.X, 251.X; ICD-10 E10.X-14. X)” should read “We determined the diagnostic accuracy (sensitivity, specificity, PPV, NPV) of a variety of algorithms, using combinations of physician billings and hospital admissions over 1 or 2 years bearing a diagnosis code of diabetes mellitus (ICD-9 250.X; ICD-10 E10.X-14. X)”. Read the original article

Meranda Nakhla,1,2 Marc Simard,3 Marjolaine Dube,3 Isabelle Larocque,3 Céline Plante,3 Laurent Legault,1,2 Celine Huot,4 Nancy Gagné,5 Julie Gagné,6 Sarah Wafa,2 Eric I Benchimol,7–9 Elham Rahme10 1Department of Pediatrics, Division of Endocrinology, Montreal Children’s Hospital, Montreal, QC, Canada; 2Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; 3Institut National de Santé Publique du Québec, Québec, QC, Canada; 4Department of Pediatrics, Division of Endocrinology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; 5Department of Pediatrics, Division of Endocrinology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada; 6Department of Pediatrics, Division of Endocrinology, Centre Hospitalier de l’Université Laval, Quebec City, QC, Canada; 7Children’s Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, Canada; 8Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada; 9Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; 10Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, CanadaCorrespondence: Meranda NakhlaCenter of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd, W, 3rd floor, office E3.08, Montreal H4A 3S5, QC, CanadaEmail meranda.nakhla@mcgill.caBackground: Type 1 diabetes is one of the most common chronic diseases in childhood with a worldwide incidence that is increasing by 3–5% per year. The incidence of type 2 diabetes, traditionally viewed as an adult disease, is increasing at alarming rates in children, paralleling the rise in childhood obesity. As the rates of diabetes increase in children, accurate population-based assessment of disease burden is important for those implementing strategies for health services delivery. Health administrative data are a powerful tool that can be used to track disease burden, health services use, and health outcomes. Case validation is essential in ensuring accurate disease identification using administrative databases.Aim: The aim of our study was to define and validate a pediatric diabetes case ascertainment algorithm (including any form of childhood-onset diabetes) using health administrative data.Research design and methods: We conducted a two-stage method using linked health administrative data and data extracted from charts. In stage 1, we linked chart data from a large urban region to health administrative data and compared the diagnostic accuracy of various algorithms. We selected those that performed the best to be validated in stage 2. In stage 2, the most accurate algorithms were validated with chart data within two other geographic areas in the province of Quebec.Results: Accurate identification of diabetes in children (ages ≤15 years) required four physician claims or one hospitalization (with International Classification of Disease codes within 1 year (sensitivity 91.2%, 95% confidence interval [CI] 89.2–92.9]; positive predictive value [PPV] 93.5%, 95% CI 91.7–95.0) or using only four physician claims in 2 years (sensitivity 90.4%, 95% CI 88.3–92.2; PPV 93.2%, 95% CI 91.7–95.0). Separating the physician claims by 30 days increased the PPV of all algorithms tested.Conclusion: Patients with child-onset diabetes can be accurately identified within health administrative databases providing a valid source of information for health care resource planning and evaluation.Keywords: pediatric, validation, health administrative data, diabetes

Succession after fire has mainly been studied by chronosequence, which does not allow study of pre- and post-fire communities at the samesite. By using palynology and anthracology, we recovered vegetation communities and fire histories through time on islands of Duparquet Lake, Canada. We show that succession after fire is dependent on interval between two fires (evaluated with depth of humus between subsequent fires). Sites with high fire occurrence show a cyclic succession (same species reappearing after fire), while sites with low fire occurrence show a directional succession. Different fire intervals lead todifferent pre- and post-fire pollen assemblages. During longer fire intervals, pollen assemblages change from Pinus banksiana Lamb. domination to Pinus strobus L. and Picea mariana (Mill.) BSP domination. When fire intervals are short, Pinus banksiana dominates both pre- andpost-fire assemblages. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is one of the most common pediatric chronic illnesses. Although a rising incidence of childhood type 1 diabetes (T1D) has frequently been documented, an almost 400-fold variation in incidence has been seen worldwide. We aimed to describe the trends in incidence of diabetes (type 1, type 2, all types) among children and adolescents living in the Greater Montréal area of Québec, Canada., Methods: Using health administrative data (Québec Integrated Chronic Disease Surveillance System) and medical records from the 3 major pediatric diabetes centres in the Greater Montréal area, we conducted serial cross-sectional studies of children aged 1 to 15 years during the period from 2002 to 2010. We conducted a trend analysis of diabetes incidence over time using multivariate Poisson regression models., Results: We identified 696 new cases of diabetes between 2002 and 2010. The age-standardized incidence of diabetes (all types) increased from 16.3 (95% confidence interval [CI], 12.4 to 21.2) to 27.8 (95% CI, 22.5 to 34.0) per 100,000, with annual incidence increasing, on average, by 5.2% per year (adjusted rate ratio [aRR], 1.052; 95% CI, 1.022 to 1.083). This was driven predominantly by the T1D annual increase of 5.4% (aRR, 1.054; 95% CI, 1.023 to 1.086). A low number of incident cases of type 2 diabetes limited trend analysis in this group. There were no significant interactions between year and sex or age., Conclusions: The annual incidence of T1D is increasing in Québec children and does not vary by sex or age. Further research into etiologic factors is indicated., (Copyright © 2021 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Aims: During transition from paediatric to adult diabetes care, adolescents with diabetes are at increased risk of psychiatric disorders compared with those without diabetes. Prolonged gaps between the last paediatric and first adult diabetes care visit are associated with higher perceived stress and lower life satisfaction. We assessed the effect of a gap (>180 days) in establishing adult diabetes care on the risk of psychiatric disorders and determined other risk factors associated with psychiatric disorders during the transfer to adult care., Methods: Using provincial health administrative databases, we conducted a retrospective cohort study of individuals from Québec, Canada, diagnosed with diabetes between ages 1 and 15 years in 1997-2015. These individuals were followed from 6 months after their last paediatric visit until age 25 years. We used multivariable Cox proportional hazard models to determine the association of gap in care with psychiatric disorders risk., Results: Among 1772 youth with diabetes, 740 (42%) had a gap in care. There was a non-statistically significant association between gap in care and mood disorders diagnosed in the emergency department or hospital (hazard ratio [HR] 1.38, 95% confidence interval [CI]: [0.92, 2.07]). Older age at transfer, recent birth year and higher number of all-cause emergency department visits in the year before transfer increased the risks of psychiatric disorders., Conclusions: Prolonged gaps in care during transfer to adult care are common and may be associated with increased psychiatric disorder risk. Developmental factors associated with adolescence and emerging adulthood may further amplify this risk., (© 2021 Diabetes UK.)

Objective: To determine the longitudinal risks of psychiatric disorders in adolescents and emerging adults with versus without diabetes., Research Design and Methods: We conducted a retrospective cohort study in Quebec, Canada, using linked health administrative databases of adolescents (age 15 years) with and without diabetes and without prior psychiatric disorders between 1997 and 2015, followed to age 25 years., Results: Our cohort included 3,544 individuals with diabetes and 1,388,397 without diabetes. Individuals with diabetes were more likely to suffer from a mood disorder (diagnosed in the emergency department or hospital) (adjusted hazard ratio 1.33 [95% CI 1.19-1.50]), attempt suicide (3.25 [1.79-5.88]), visit a psychiatrist (1.82 [1.67-1.98]), and experience any type of psychiatric disorder (1.29 [1.21-1.37]) compared with their peers without diabetes., Conclusions: Between the ages of 15 and 25 years, the risks of psychiatric disorders and suicide attempts were substantially higher in adolescents and emerging adults with versus without diabetes., (© 2019 by the American Diabetes Association.)

Objectives: To assess maternal and neonatal risk factors for intraventricular hemorrhage (IVH). To examine the association of patent ductus arteriosus (PDA) and its treatment, with IVH and its severity. Study design: In this retrospective cohort study, we included preterm neonates born at <29 weeks, admitted to a tertiary level III Neonatal Intensive Care Unit in Calgary, Canada, between 2013 and 2016, who had a head ultrasound in the first 7 days of life. A subset analysis included neonates who also had cardiac ultrasound in the first 3 days of life. Results: Of the 495 neonates, 121 (24.4%) had IVH of any grade and 48 (9.7%) had severe IVH. Identified risk factors were small birth gestation and weight, lack of antenatal corticosteroids, maternal chorioamnionitis, Apgar score <5 at 5 min, umbilical cord pH < 7, respiratory distress syndrome, early onset sepsis, hypercapnia, pCO 2 fluctuations, prolonged intubation, inhaled nitric oxide, inotropes or normal saline boluses, metabolic derangements, opioids infusions, and bicarbonate/THAM therapy. In a primary analysis of the total cohort, when the decision to treat a PDA was used as a surrogate marker of its clinical significance, a PDA requiring treatment was associated with a higher risk of IVH. There was no significant difference in the incidence of IVH between neonates with early treatment of a clinically significant PDA compared to late, however early indomethacin treatment was associated with reduced severity of IVH. In the subset analysis, the presence of a hemodynamically significant PDA (hs-PDA) was not associated with a higher probability of IVH. Of those with severe IVH, 18 (55%) had a hs-PDA; this is clinically but not statistically significant. Conclusions: Identified risk factors should be the target of IVH reduction bundles. Early indomethacin treatment for a clinically significant PDA may reduce IVH severity., (Copyright © 2019 Khanafer-Larocque, Soraisham, Stritzke, Al Awad, Thomas, Murthy, Kamaluddeen, Scott and Mohammad.)

Background: Diabetic ketoacidosis at type 1 diabetes diagnosis is a preventable life-threatening complication. Canadian data on the temporal trends of the prevalence of diabetic ketoacidosis at the onset of type 1 diabetes in children are unknown. We aimed to determine the temporal changes in diabetic ketoacidosis prevalence at diabetes diagnosis in Quebec., Methods: We conducted a population-based cohort study of children (aged 1-17 yr) living in Quebec who were diagnosed with diabetes between 2001 and 2014, using multiple health administrative linked databases available at the Institut national de santé publique du Québec through the Quebec Integrated Chronic Surveillance System. We used multivariate Poisson regression analysis with robust error variance to determine trends in the prevalence of diabetic ketoacidosis., Results: We found that 25.6% (1471/5741) of children presented with diabetic ketoacidosis at diabetes diagnosis. The incidence of diabetes was stable at 30 cases per 100 000 children per year during the study period. The age- and sex-standardized rates of diabetic ketoacidosis increased from 22% (95% confidence interval [CI] 17%-26%) in 2001 to 30% (95% CI 24%-36%) in 2014. The relative increase of diabetic ketoacidosis prevalence at diabetes diagnosis over the study period was 2.0% per year (rate ratio 1.02; 95% CI 1.01-1.03)., Interpretation: Despite a stable incidence of type 1 diabetes, we found that the prevalence of diabetic ketoacidosis at diabetes onset increased between 2001 and 2014. Our findings are concerning and demonstrate a need to continue to campaign to recognize type 1 diabetes before diabetic ketoacidosis supervenes., Competing Interests: Competing interests: Meranda Nakhla received a lecture fee from the Quebec Association of Endocrinologists. No other competing interests were declared., (Copyright 2019, Joule Inc. or its licensors.)

Background: Diabetic ketoacidosis is the leading cause of death among children with type 1 diabetes mellitus, and is an avoidable complication at first-time diagnosis of diabetes. Because having a usual provider of primary care is important in improving health outcomes for children, we tested the association between having a usual provider of care and risk of diabetic ketoacidosis at onset of diabetes., Methods: Using linked health administrative data for the province of Quebec, we conducted a population-based retrospective cohort study of children aged 1-17 years in whom diabetes was diagnosed from 2006 to 2015. We estimated adjusted risk ratios (RRs) for an episode of diabetic ketoacidosis at the time of diabetes diagnosis in relation to usual provider of care (family physician, pediatrician or none) using Poisson regression models with robust error variance., Results: We identified 3704 new cases of diabetes in Quebec children from 2006 to 2015. Of these, 996 (26.9%) presented with diabetic ketoacidosis. A decreased risk of this complication was associated with having a usual provider of care; the association was stronger with increasing age, reaching statistical significance among those aged 12-17 years. Within this age group, those who had a family physician or a pediatrician were 31% less likely (adjusted RR 0.69, 95% confidence interval [CI] 0.56-0.85) or 38% less likely (adjusted RR 0.62, 95% CI 0.45-0.86), respectively, to present with diabetic ketoacidosis, relative to those without a usual provider of care., Interpretation: For children with newly diagnosed diabetes, having a usual provider of care appears to be important in decreasing the risk of diabetic ketoacidosis at the time of diabetes diagnosis. Our results provide further evidence concerning the need for initiatives that promote access to primary care for children., Competing Interests: Competing interests: Laurent Legault has served on advisory boards for Medtronic and Lilly; has received grants for unrelated research from Merck, Sanofi and AstraZeneca; and holds a share of intellectual property not related to this work. No other competing interests were declared., (© 2018 Joule Inc. or its licensors.)

Purpose: The study sought to examine the association between clinical image quality of mammograms and screening sensitivity., Methods: Four radiologists evaluated the clinical image quality of 374 invasive screen-detected cancers and 356 invasive interval breast cancers for which quality evaluation of screening mammograms could be assessed from cancers diagnosed among participants in the Quebec Breast Cancer Screening Program in 2007. Quality evaluation was based on the Canadian Association of Radiologists accreditation criteria, which are similar to those of the American College of Radiology. The association between clinical quality and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and adjusted sensitivity ratios were obtained through marginal standardization. No institutional review board approval was required., Results: A proportion of 28% (206 of 730) of screening mammograms had lower overall quality for the majority of assessments. Positioning was the quality attribute that was the most frequently deficient. The 2-year screening sensitivity reached 68%. Sensitivity of screening was not statistically associated with the overall quality (ratio of 2-year sensitivity = 1.03; 95% confidence interval: 0.93-1.15) or with any quality attributes (positioning, exposure, compression, sharpness, artifacts, contrast). Results were similar for the 1-year sensitivity., Conclusions: Although not all mammograms in the Quebec screening program met the optimum quality required by the Canadian Association of Radiologists or American College of Radiology accreditation, the screening mammograms produced in this population-based organized screening program reached a high enough level of quality so that the remaining variation in quality is too little to impair screening sensitivity., (Copyright © 2017 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.)

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

Background: Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings., Methods: This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18-64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was "return to work in good health" at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest., Results: The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%- 94%)., Interpretation: A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome.

The habit of sucking is the first coordinated muscular activity of the infant. There are essentially two forms of sucking: the nutritive form which provides essential nutrients, while non-nutritive sucking insures a feeling of warmth and a sense of security. This review gives a description of the anatomy and physiology of sucking together with the influence of breastfeeding and bottle-feeding (conventional or orthodontic nipples) on the dentofacial structures of the infant. Factors involved in the choice of feeding are also discussed. Children who do not have access to unrestricted breastfeeding or bottle-fed children may satisfy their instinctive sucking urge with a pacifier. This paper presents the different types of pacifiers (conventional or orthodontic) along with the beneficial effects provided by pacifiers. Detrimental effects caused by incorrect use of pacifiers or digit-sucking habits are also summarized. Health professionals should inform expectant mothers about the dentofacial advantages of breastfeeding.