Objectives:The incidence of pediatric-onset inflammatory bowel disease (IBD) is increasing worldwide. We used population-based health administrative data to determine national Canadian IBD incidence, prevalence, and trends over time of childhood-onset IBD.Methods:We identified children <16 years (y) diagnosed with IBD 1999–2010 from health administrative data in five provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec), comprising 79.2% of the Canadian population. Standardized incidence and prevalence were calculated per 100,000 children. Annual percentage change (APC) in incidence and prevalence were determined using Poisson regression analysis. Provincial estimates were meta-analyzed using random-effects models to produce national estimates.Results:5,214 incident cases were diagnosed during the study period (3,462 Crohn’s disease, 1,382 ulcerative colitis, 279 type unclassifiable). The incidence in Canada was 9.68 (95% CI 9.11 to 10.25) per 100,000 children. Incidence was similar amongst most provinces, but higher in Nova Scotia. APC in incidence did not significantly change over the study period in the overall cohort (+2.06%, 95% CI −0.64% to +4.76%). However, incidence significantly increased in children aged 0–5y (+7.19%, 95% +2.82% to +11.56%). Prevalence at the end of the study period in Canada was 38.25 (95% CI 35.78 to 40.73) per 100,000 children. Prevalence increased significantly over time, APC +4.56% (95% CI +3.71% to +5.42%).Conclusions:Canada has amongst the highest incidence of childhood-onset IBD in the world. Prevalence significantly increased over time. Incidence was not statistically changed with the exception of a rapid increase in incidence in the youngest group of children.

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ICS use in asthma patients appears to be associated with an increased risk of pneumonia and is present for both budesonide and fluticasone.

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We address estimation of the marginal effect of a time‐varying binary treatment on a continuous longitudinal outcome in the context of observational studies using electronic health records, when the relationship of interest is confounded, mediated, and further distorted by an informative visit process. We allow the longitudinal outcome to be recorded only sporadically and assume that its monitoring timing is informed by patients' characteristics. We propose two novel estimators based on linear models for the mean outcome that incorporate an adjustment for confounding and informative monitoring process through generalized inverse probability of treatment weights and a proportional intensity model, respectively. We allow for a flexible modeling of the intercept function as a function of time. Our estimators have closed‐form solutions, and their asymptotic distributions can be derived. Extensive simulation studies show that both estimators outperform standard methods such as the ordinary least squares estimator or estimators that only account for informative monitoring or confounders. We illustrate our methods using data from the Add Health study, assessing the effect of depressive mood on weight in adolescents.

Behavioral sleep problems are highly prevalent among young and school-aged children. Despite strong evidence for effective interventions, few children receive evidence-based care. In this study, 124 Canadian health professionals answered open-ended questions regarding barriers and facilitators of their provision of evidence-based behavioral sleep-related care, and responses were analyzed for content. Responses represented issues at an individual practice level, as well as broader systemic issues. The most frequently reported barrier and facilitator related to knowledge, training, and education. Other barriers included lack of time and institutional support, and facilitators included supportive sleep attitudes and beliefs. This study may inform the design of education programs for health professionals, and provides support for broader systems-level initiatives targeted at increasing evidence-based practice.

Studies examining sleep and psychopathology should control for psychological co-morbidity.