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Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.

https://arctichealth.org/en/permalink/ahliterature122113
Source
CMAJ. 2012 Sep 18;184(13):E709-18
Publication Type
Article
Date
Sep-18-2012
Author
Anne G Matlow
G Ross Baker
Virginia Flintoft
Douglas Cochrane
Maitreya Coffey
Eyal Cohen
Catherine M G Cronin
Rita Damignani
Robert Dubé
Roger Galbraith
Dawn Hartfield
Leigh Anne Newhook
Cheri Nijssen-Jordan
Author Affiliation
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. anne.matlow@wchospital.ca
Source
CMAJ. 2012 Sep 18;184(13):E709-18
Date
Sep-18-2012
Language
English
Publication Type
Article
Keywords
Academic Medical Centers - statistics & numerical data
Adolescent
Age Factors
Canada
Child
Child, Preschool
Hospitals - statistics & numerical data
Hospitals, Community - statistics & numerical data
Hospitals, Pediatric - statistics & numerical data
Humans
Incidence
Infant
Infant, Newborn
Logistic Models
Medical Errors - statistics & numerical data
Retrospective Studies
Abstract
Limited data are available on adverse events among children admitted to hospital. The Canadian Paediatric Adverse Events Study was done to describe the epidemiology of adverse events among children in hospital in Canada.
We performed a 2-stage medical record review at 8 academic pediatric centres and 14 community hospitals in Canada. We reviewed charts from patients admitted from April 2008 through March 2009, evenly distributed across 4 age groups (0 to 28 d; 29 to 365 d; > 1 to 5 yr and > 5 to 18 yr). In stage 1, nurses and health records personnel who had received training in the use of the Canadian Paediatric Trigger Tool reviewed medical records to detect triggers for possible adverse events. In stage 2, physicians reviewed the charts identified as having triggers and described the adverse events.
A total of 3669 children were admitted to hospital during the study period. The weighted rate of adverse events was 9.2%. Adverse events were more frequent in academic pediatric centres than in community hospitals (adjusted odds ratio [OR] 2.98, 95% confidence interval [CI] 1.65-5.39). The incidence of preventable adverse events was not significantly different between types of hospital, but nonpreventable adverse events were more common in academic pediatric centres (adjusted OR 4.39, 95% CI 2.08-9.27). Surgical events predominated overall and occurred more frequently in academic pediatric centres than in community hospitals (37.2% v. 21.5%, relative risk [RR] 1.7, 95% CI 1.0-3.1), whereas events associated with diagnostic errors were significantly less frequent (11.1% v. 23.1%, RR 0.5, 95% CI 0.2-0.9).
More children have adverse events in academic pediatric centres than in community hospitals; however, adverse events in the former are less likely to be preventable. There are many opportunities to reduce harm affecting children in hospital in Canada, particularly related to surgery, intensive care and diagnostic error.
Notes
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PubMed ID
22847964 View in PubMed
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Assessing Infant Feeding Attitudes of Expectant Women in a Provincial Population in Canada: Validation of the Iowa Infant Feeding Attitude Scale.

https://arctichealth.org/en/permalink/ahliterature281423
Source
J Hum Lact. 2016 Aug;32(3):NP9-NP18
Publication Type
Article
Date
Aug-2016
Author
Laurie K Twells
William K Midodzi
Valerie Ludlow
Janet Murphy-Goodridge
Lorraine Burrage
Nicole Gill
Beth Halfyard
Rebecca Schiff
Leigh Anne Newhook
Source
J Hum Lact. 2016 Aug;32(3):NP9-NP18
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Bottle Feeding - psychology
Breast Feeding - psychology
Cross-Sectional Studies
Female
Humans
Intention
Mothers - psychology
Newfoundland and Labrador
Pregnancy - psychology
ROC Curve
Reproducibility of Results
Rural Population
Surveys and Questionnaires
Urban Population
Abstract
Maternal attitudes to infant feeding are predictive of intent and initiation of breastfeeding.
The Iowa Infant Feeding Attitude Scale (IIFAS) has not been validated in the Canadian population. This study was conducted in Newfoundland and Labrador, a Canadian province with low breastfeeding rates. Objectives were to assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed.
The IIFAS assessment tool was administered to 793 pregnant women. Differences in the total IIFAS scores were compared between urban and rural areas. Reliability and validity analysis was conducted on the IIFAS. The receiver operating characteristic (ROC) of the IIFAS was assessed against mother's intent to breastfeed.
The mean ? SD of the total IIFAS score of the overall sample was 64.0 ? 10.4. There were no significant differences in attitudes between urban (63.9 ? 10.5) and rural (64.4 ? 9.9) populations. There were significant differences in total IIFAS scores between women who intend to breastfeed (67.3 ? 8.3) and those who do not (51.6 ? 7.7), regardless of population region. The high value of the area under the curve (AUC) of the ROC (AUC = 0.92) demonstrates excellent ability of the IIFAS to predict intent to breastfeed. The internal consistency of the IIFAS was strong, with a Cronbach's alpha greater than .80 in the overall sample.
The IIFAS examined in this provincial population provides a valid and reliable assessment of maternal attitudes toward infant feeding. This tool could be used to identify mothers less likely to breastfeed and to inform health promotion programs.
PubMed ID
25425631 View in PubMed
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Can exclusive breastfeeding reduce the likelihood of childhood obesity in some regions of Canada?

https://arctichealth.org/en/permalink/ahliterature144475
Source
Can J Public Health. 2010 Jan-Feb;101(1):36-9
Publication Type
Article
Author
Laurie Twells
Leigh Anne Newhook
Author Affiliation
Memorial University, School of Pharmacy, 300 Prince Philip Drive, St. Johns, NL A1B 3V6. ltwells@mun.ca
Source
Can J Public Health. 2010 Jan-Feb;101(1):36-9
Language
English
Publication Type
Article
Keywords
Body mass index
Breast Feeding
Canada - epidemiology
Child Welfare
Child, Preschool
Confidence Intervals
Cross-Sectional Studies
Female
Humans
Male
Newfoundland and Labrador - epidemiology
Nutrition Surveys
Obesity - epidemiology - prevention & control
Odds Ratio
Overweight - epidemiology
Prevalence
Questionnaires
Risk factors
Abstract
The prevalence of childhood obesity in Canada is a major concern. Studies report a small but significant inverse relationship between exclusive breastfeeding and childhood obesity. The study objectives were to determine the prevalence of overweight and obesity in a preschool population living in Newfoundland and Labrador (NL) and to examine the relationship between exclusive breastfeeding and preschool obesity.
This was a cross-sectional analysis of 1,026 children born in 2001 who participated in the Pre Kindergarten Health Fairs in 2005. Heights and weights were collected and body mass index (BMI) calculated. The BMI-for-age references used by the Centers for Disease Control (CDC) in the United States were used to classify the weight status of children. Infant feeding information was collected through a survey. The relationship between breastfeeding and childhood obesity was examined using logistic regression models controlling for child's age and gender, mother's education and smoking status, and whether the baby was preterm or full-term.
In 2005, 65%, 19% and 16% of preschool children were normal, overweight and obese, respectively. 74% of women initiated breastfeeding and 43% exclusively breastfed to 3 months. Exclusive breastfeeding to 3 months was protective of preschool obesity (adjusted odds ratio (AOR) 0.65, 95% CI 0.45-0.96).
Obesity is prevalent in preschool children in NL. Exclusive breastfeeding appeared to be a protective factor for obesity in preschoolers. Given the known benefits of breastfeeding and the adverse health consequences of obesity, efforts should be made to increase exclusive breastfeeding which may help to prevent the development of obesity in young children.
PubMed ID
20364536 View in PubMed
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Childhood type 1 diabetes mellitus in Newfoundland and Labrador, Canada.

https://arctichealth.org/en/permalink/ahliterature169724
Source
Diabetes Res Clin Pract. 2006 Oct;74(1):82-9
Publication Type
Article
Date
Oct-2006
Author
Reza Alaghehbandan
Kayla D Collins
Leigh Anne Newhook
Don MacDonald
Author Affiliation
Research and Development Division, Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada. rezaa@nlchi.nl.ca
Source
Diabetes Res Clin Pract. 2006 Oct;74(1):82-9
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Child, Preschool
Diabetes Mellitus, Type 1 - epidemiology
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Infant
Male
Newfoundland and Labrador - epidemiology
Abstract
The aim of this study was to calculate incidence and hospitalization rates of childhood type 1 diabetes mellitus (T1DM) in Newfoundland and Labrador, and to assess hospitalization trends and associated factors. Data for all patients aged 0-19 years with a diagnosis of T1DM was obtained from the clinical database management system (CDMS) for a 7-year period between April 1, 1995 and March 31, 2002. Incidence was calculated for the 0-7 years age group. A total of 894 T1DM hospital separations among children aged 0-19 years were identified, representing a hospitalization rate of 88.6 per 100,000 person-years (P-Y). The CDMS identified 518 incidences of hospitalization (51.2 per 100,000 P-Y). The overall hospitalization rate increased over the study period (P((2))=0.065). Hospitalization rates for males and females were 77.3 and 100.2 per 100,000 P-Y, respectively (P((2))=0.00011). Of the 894 hospitalization separations, 216 hospitalizations were for diabetic ketoacidosis (DKA) (21.4 per 100,000 P-Y). Female gender and older age were found to be predictive factors of DKA. The incidence rate of T1DM among children aged 0-7 years was 19.0 per 100,000 P-Y. Newfoundland and Labrador has one of the highest incidence rates of T1DM in the world. Hospitalization rates for DKA and non-DKA increased slightly over the study period. Age and sex patterns suggest that DKA is a particular challenge among adolescent girls. Preventive strategies are needed, particularly in areas of the province with the highest rates.
Notes
Erratum In: Diabetes Res Clin Pract. 2007 Feb;75(2):252
PubMed ID
16621109 View in PubMed
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Delayed diagnosis and issues with pump usage are the leading causes of diabetic ketoacidosis in children with diabetes living in Newfoundland and Labrador, Canada.

https://arctichealth.org/en/permalink/ahliterature269264
Source
BMC Res Notes. 2015;8:158
Publication Type
Article
Date
2015
Author
Jessica Jackman
Roger Chafe
Daniel Albrechtsons
Robert Porter
Colleen Nugent
Shahzad Waheed
Leigh Anne Newhook
Source
BMC Res Notes. 2015;8:158
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Diabetes Mellitus, Type 1 - complications - drug therapy
Diabetic Ketoacidosis - diagnosis
Humans
Infant
Infant, Newborn
Infusion Pumps
Insulin - administration & dosage - therapeutic use
Length of Stay
Newfoundland and Labrador
Patient Admission
Abstract
Newfoundland and Labrador (NL) has a very high incidence of type 1 diabetes (T1DM) and admission rate for diabetic ketoacidosis (DKA). The purpose of this study was to identify characteristics and precipitating factors associated with pediatric DKA in this population.
This was a retrospective study on children diagnosed with DKA from 2007-2011 admitted to the province's only tertiary care pediatric hospital. Demographics, biochemical characteristics, and reasons for DKA diagnosis were analyzed. Chi-square and Fisher Exact tests were performed for categorical variables; t- and non-parametric Kruskal-Wallis tests were performed for continuous variables.
A total of 90 children were admitted with DKA (39.5% newly diagnosed; 60.5% were previously diagnosed). The rate of DKA on presentation for incident cases was 22.1%. More severe cases of DKA occurred in younger, newly diagnosed patients. Almost half of preexisting diabetes cases were recurrent DKA (49.1%). The most common presenting characteristics of newly diagnosed patients were weight loss, bedwetting, polyuria, polydipsia, and neurologic symptoms. Pre-existing diabetes patients most often presented with abdominal pain and vomiting. Diagnosis of diabetes in new patients and issues related to interrupted insulin delivery in pre-existing patients using insulin pump therapy were the most common factors associated with DKA. Of the newly diagnosed patients presenting in DKA, 64% had seen a physician in the weeks leading up to diagnosis.
Pediatric patients have predictable patterns associated with a diagnosis of DKA. Most cases of DKA could be prevented with earlier diagnosis and improved education and problem-solving by families and health care providers. DKA preventative strategies are recommended and should be aimed at patients, their families, and health care professionals especially those outside of pediatric centers.
Notes
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PubMed ID
25889476 View in PubMed
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Determinants of Nonmedically Indicated In-Hospital Supplementation of Infants Whose Birthing Parents Intended to Exclusively Breastfeed.

https://arctichealth.org/en/permalink/ahliterature285959
Source
J Hum Lact. 2017 May;33(2):278-284
Publication Type
Article
Date
May-2017
Author
Julia Temple Newhook
Leigh Anne Newhook
William K Midodzi
Janet Murphy Goodridge
Lorraine Burrage
Nicole Gill
Beth Halfyard
Laurie Twells
Source
J Hum Lact. 2017 May;33(2):278-284
Date
May-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Breast Feeding - psychology - statistics & numerical data
Cohort Studies
Dietary Supplements - statistics & numerical data
Feeding Behavior
Female
Humans
Infant
Infant Formula - utilization
Infant, Newborn
Intention
Longitudinal Studies
Newfoundland and Labrador
Parents - psychology
Self Report
Surveys and Questionnaires
Abstract
Despite high rates of intention to exclusively breastfeed, rates of exclusive breastfeeding in Canada are low. Supplementation may begin in hospital and is associated with reduced breastfeeding duration. Research aim: The aim of this investigation was to explore determinants of in-hospital nonmedically indicated supplementation of infants whose birthing parents intended to exclusively breastfeed.
This study is a cross-sectional one-group nonexperimental design, focused on participants who intended to exclusively breastfeed for 6 months ( n = 496). Data were collected between October 2011 and October 2015 in Newfoundland and Labrador. Variables measured included age; rural/urban location; education; income; race; marital status; parity; smoking status; having been breastfed as an infant; previous breastfeeding experience; Iowa Infant Feeding Attitude Scale score; delivery mode; infant birth weight; birth satisfaction; skin-to-skin contact; length of participant's hospital stay; breastfeeding advice from a lactation consultant, registered nurse, or physician; and first impression of breastfeeding. We evaluated determinants of in-hospital nonmedically indicated supplementation using bivariate and multivariate logistic regression analyses.
Overall, 16.9% ( n = 84) of infants received nonmedically indicated supplementation in hospital. Multivariate modeling revealed four determinants: low total prenatal Iowa Infant Feeding Attitude Scale score (odds ratio [OR] = 1.96, 95% confidence interval [CI] [1.18, 3.27]), no previous breastfeeding experience (OR = 2.03, 95% CI [1.15, 3.61]), negative first impression of breastfeeding (OR = 2.67, 95% CI [1.61, 4.43]), and receiving breastfeeding advice from a hospital physician (OR = 2.86, 95% CI [1.59, 5.15]).
Elements of the hospital experience, self-efficacy, and attitudes toward infant feeding are determinants of nonmedically indicated supplementation of infants whose birthing parents intended to exclusively breastfeed.
PubMed ID
28418804 View in PubMed
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The geospatial relation between UV solar radiation and type 1 diabetes in Newfoundland.

https://arctichealth.org/en/permalink/ahliterature152451
Source
Acta Diabetol. 2010 Mar;47(1):73-8
Publication Type
Article
Date
Mar-2010
Author
Scott Sloka
Marie Grant
Leigh Anne Newhook
Author Affiliation
Department of Neurology, Memorial University of Newfoundland, 108 Moss Heather Dr, St John's, NL, A1B 4S1, Canada. p97jss@mun.ca
Source
Acta Diabetol. 2010 Mar;47(1):73-8
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Child
Demography
Diabetes Mellitus, Type 1 - epidemiology
Ecosystem
Geography
Humans
Incidence
Newfoundland and Labrador - epidemiology
Ozone - analysis
Population Density
Satellite Communications
Sunlight
Ultraviolet Rays
Abstract
Type 1 diabetes (T1DM) has been previously associated with northern latitude and vitamin D insufficiency. This study investigates the geospatial association between average daily ultraviolet B (UVB) irradiance and T1DM across the province of Newfoundland (NL), Canada. NL has one of the highest documented incidences of T1DM worldwide. A complete list of patients diagnosed (1987-2005) with T1DM in the province of Newfoundland and Labrador (NL) was constructed using multiple sources. All places of habitation at diagnosis were ascertained. Ecological analysis using Bayesian estimation was performed employing both NASA UVB data and latitude. Correlation of T1DM to both UVB irradiation and latitude was measured. A statistically significant correlation of erythemal UVB irradiance was observed (-0.0284: 95% CI -0.0542 to -0.0096). A more significant correlation of T1DM was observed with erythemal UVB irradiance than with latitude. This study suggests that erythemal UVB radiation may be geospatially associated with the incidence of T1DM in NL.
PubMed ID
19238314 View in PubMed
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Infant-feeding among low-income women: the social context that shapes their perspectives and experiences.

https://arctichealth.org/en/permalink/ahliterature106136
Source
Can J Nurs Res. 2013 Sep;45(3):28-49
Publication Type
Article
Date
Sep-2013
Author
Julia Temple Newhook
Valerie Ludlow
Leigh Anne Newhook
Kimberly Bonia
Janet Murphy Goodridge
Laurie Twells
Author Affiliation
Patient Research Centre, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Source
Can J Nurs Res. 2013 Sep;45(3):28-49
Date
Sep-2013
Language
English
Geographic Location
Canada
Publication Type
Article
Keywords
Breast Feeding
Female
Focus Groups
Humans
Infant
Newfoundland and Labrador
Poverty
Abstract
This article explores the perspectives of low-income women in order to better understand the social context that shapes their infant-feeding perspectives and experiences. The authors used purposive sampling to conduct 3 focus groups with 19 women who were formula-feeding their infants in 1 urban and 2 rural communities in the eastern region of the island of Newfoundland in Canada. Elements of the social context for infant-feeding included the prevalence of myths and misinformation about breastfeeding; cultural expectations about infant behaviour; the postnatal experience, including the medicalization of birth and breastfeeding; partner support and child-care workload; cultural stigma of breastfeeding; and a moralizing ideology that equates breastfeeding with "good mothering. "The authors discuss the implications of the findings from a nursing and public health perspective, offering 7 recommendations for how nurses and health professionals might better support women and their families.
PubMed ID
24236370 View in PubMed
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Reducing episodes of diabetic ketoacidosis within a youth population: a focus group study with patients and families.

https://arctichealth.org/en/permalink/ahliterature273552
Source
BMC Res Notes. 2015;8:395
Publication Type
Article
Date
2015
Author
Roger Chafe
Daniel Albrechtsons
Donna Hagerty
Leigh Anne Newhook
Source
BMC Res Notes. 2015;8:395
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Diabetic Ketoacidosis - physiopathology - prevention & control
Family
Focus Groups
Humans
Newfoundland and Labrador
Rural Population
Urban Population
Abstract
Diabetic ketoacidosis (DKA) is the most common cause of morbidity and mortality for youth with type 1 diabetes mellitus (T1DM). This article reports qualitative data from focus groups with youth and parents of youth with T1DM on the barriers that they identify to DKA prevention and resources that may aid youth better manage their diabetes.
Four focus groups were held in three communities, two rural and one urban, in the Canadian province of Newfoundland and Labrador (NL) with adolescents and parents of youth with diabetes. Open-ended questions focused on knowledge of DKA, diabetes education, personal experiences with DKA, barriers to diabetes self-management, situations which put them at risk for DKA and resources that could be developed to aid youth in preventing DKA.
There were 19 participants (14 parents and 5 youth). Participants identified factors which increased their risk of DKA as difficulty in distinguishing cases of DKA from other illnesses; variations in diabetes education received; information overload about their condition; the long period from initial diagnosis, when most education about the condition was received; and stress regarding situations where youth are not in the direct care of their parents. Participants from rural areas reported geographical isolation and lack of regular access to specialist health care personnel as additional barriers to better diabetes management.
The project identified barriers to DKA prevention for youth which were not previously identified in the medical literature, e.g., the stress associated with temporary guardians, risk of information overload at initial diagnosis and the long period from initial diagnosis when most diabetes education is received. Families from rural areas do report additional burdens, but in some cases these families have developed community supports to help offset some of these problems. Mobile and online resources, educational refreshers about DKA, concise resources for teachers and other temporary guardians, and DKA treatment kits for parents may help improve diabetes management and prevent future episodes of DKA.
Notes
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PubMed ID
26323283 View in PubMed
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Seasonal variation of maternal serum vitamin D in Newfoundland and Labrador.

https://arctichealth.org/en/permalink/ahliterature150545
Source
J Obstet Gynaecol Can. 2009 Apr;31(4):313-21
Publication Type
Article
Date
Apr-2009
Author
Scott Sloka
Jackie Stokes
Edward Randell
Leigh Anne Newhook
Author Affiliation
Department of Clinical Neurosciences, University of Calgary, Calgary AB, Canada.
Source
J Obstet Gynaecol Can. 2009 Apr;31(4):313-21
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Adult
Female
Humans
Newfoundland and Labrador - epidemiology
Pregnancy
Seasons
Vitamin D - analogs & derivatives - blood
Vitamin D Deficiency - epidemiology
Abstract
Research has suggested that vitamin D insufficiency and deficiency is common at northern latitudes, and that vitamin D insufficiency and deficiency may be common during pregnancy. We measured the serum 25-hydroxyvitamin D (25-[OH]D) status of pregnant women across the province of Newfoundland and Labrador in both summer and winter to investigate seasonal differences, age associations, and differences in geospatial distribution across the province.
We uniformly and randomly sampled blood from pregnant women in each of 79 census consolidated subdivisions across Newfoundland and Labrador from January to March 2007 and from July to September 2007.
We obtained 304 samples from the end of winter (March) and 289 samples from the end of summer (September). Mean serum 25-(OH)D concentration was 52.1 nmol/L in winter and 68.6 nmol/L in summer (P
PubMed ID
19497150 View in PubMed
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14 records – page 1 of 2.