on behalf of the TARGet Kids! Collaboration abstract OBJECTIVES: To determine the agreement between weight-for-length and BMI-for-age in children 0 to <2 years by using research-collected data, examine factors that may affect agreement, and determine if agreement differs between research-and routinely collected data. METHODS:Cross-sectional data on healthy, term-born children (n = 1632) aged 0 to <2 years attending the TARGet Kids! practice-based research network in Toronto, Canada (December 2008-October 2014 were collected. Multiple visits for each child were included. Length (cm) and weight (kg) measurements were obtained by trained research assistants during research visits, and by nonresearch staff during all other visits. BMI-for-age z-scores were compared with weight-for-length z-scores (the criterion measure). RESULTS:The correlation between weight-for-length and BMI-for-age was strong (r = 0.986, P < .0001) and Bland-Altman plots revealed good agreement (difference = −0.08, SD = 0.20, P = .91). A small proportion (6.3%) of observations were misclassified and most misclassifications occurred near the percentile cutoffs. There were no differences by age and sex. Agreement was similar between research-and routinely collected data (r = 0.99, P < .001; mean difference −0.84, SD = 0.20, P = .67). CONCLUSIONS:Weight-for-length and BMI-for-age demonstrated high agreement with low misclassification. BMI-for-age may be an appropriate indicator of growth in the first 2 years of life and has the potential to be used from birth to adulthood. Additional investigation is needed to determine if BMI-for-age in children <2 years is associated with future health outcomes. St. Michael's Hospital, Toronto, Ontario, Canada Ms Furlong and Dr Anderson conceptualized and designed the study, contributed to the analysis and interpretation of the data, and drafted the manuscript; Ms Kang contributed to the analysis and interpretation of the data; Drs Lebovic and Birken conceptualized and designed the study and contributed to the analysis and interpretation of the data; Drs Parkin, Maguire, and O'Connor assisted in refi ning the study design and contributed to the analysis and interpretation of the data; and all authors contributed to the revision of the manuscript, approved the fi nal version submitted for publication, and agreed to act as guarantors of the work. Growth monitoring continues to be the most valuable clinical and public health tool to monitor growth and assess the health and nutritional status of children. 1, 2 Growth monitoring of children 0 to 18 years old in primary care is recommended by numerous expert bodies worldwide. [3][4][5][6] In 2006, the World Health Organization (WHO) endorsed new growth reference charts that were constructed from the monitoring of growth, in a longitudinal manner, of healthy, singleton, term-born children in 6 ethnically diverse countries. 7,8 These charts represent ideal growth in children under optimal environmental conditions for growth and have percentile cutoffs that can be u...
Creatine (Cr) is an important high-energy phosphate buffer in tissues with a high energy demand such as muscle and brain and is consequently a highly consumed nutritional supplement. Creatine is synthesized via the S-adenosylmethionine (SAM) dependent methylation of guanidinoacetate (GAA) which is not regulated by a feedback mechanism. The first objective of this study was to determine the effectiveness of GAA at increasing tissue Cr stores. Because SAM is required for other methylation reactions, we also wanted to determine whether an increased creatine synthesis would lead to a lower availability of methyl groups for other methylated products. Three month-old pigs (n = 18) were fed control, GAA- or Cr-supplemented diets twice daily. On day 18 or 19, anesthesia was induced 1–3 hours post feeding and a bolus of [methyl-3H]methionine was intravenously infused. After 30 minutes, the liver was analyzed for methyl-3H incorporation into protein, Cr, phosphatidylcholine (PC) and DNA. Although both Cr and GAA led to higher hepatic Cr concentration, only supplementation with GAA led to higher levels of muscle Cr (P < 0.05). Only GAA supplementation resulted in lower methyl-3H incorporation into PC and protein as well as lower hepatic SAM concentration compared to the controls, suggesting that Cr synthesis resulted in a limited methyl supply for PC and protein synthesis (P < 0.05). Although GAA is more effective than Cr at supporting muscle Cr accretion, further research should be conducted into the long term consequences of a limited methyl supply and its effects on protein and PC homeostasis.
Background Older adults have a higher visit rate and poorer health outcomes in the emergency department (ED) compared to their younger counterparts. Older adults are more likely to require additional resources and hospital admission. The nonspecific, atypical, and complex nature of disease presentation in older adults challenges current ED triage systems. Acute illness in older adults is often missed or commonly disguised in the ED as a social or functional issue. If diagnostic clarity is lacking or safe discharge from the ED is not feasible, then older adults may be labelled a “social admission” (or another synonymous term), often leading to negative health consequences. Objective This scoping review aims to describe and synthesize the available evidence on patient characteristics, adverse events, and health outcomes for older adults labelled as “social admission” (and other synonymously used terms), as well as those with nonacute or nonspecific complaints in the ED or hospital setting. Methods A literature search of MEDLINE, Embase, Scopus, PsycINFO, and CINAHL was completed. Relevant reference lists were screened. Data have been managed using EndNote software and the Covidence web application. Original data have been included if patients are aged ≥65 years and are considered a “social admission” (or other synonymously used term) or if they present to the ED with a nonacute or nonspecific complaint. Two review team members have reviewed titles and abstracts and will review full-text articles. Disagreements are resolved by consensus or in discussion with a third reviewer. This review does not require research ethics approval. Results As of January 2023, we have completed the title and abstract screening and have started the full-text screening. Some remaining full-text articles are being retrieved and/or translated. We are extracting data from included studies. Data will be presented in a narrative and descriptive manner, summarizing key concepts, patient characteristics, and health outcomes of patients labelled as a “social admission” (and other synonymously used terms) and of those with nonacute and nonspecific complaints. We expect the first results for publication in Spring 2023. Conclusions Acute illness in the older adult is not always easily identified. We hope to better understand patient characteristics, adverse events, and health outcomes of older adults labelled as a “social admission,” as well as those with nonacute or nonspecific complaints. We aim to identify priorities for future research and identify knowledge gaps that may inform health care providers caring for these vulnerable patients. International Registered Report Identifier (IRRID) DERR1-10.2196/38246
BackgroundVitamin D is postulated to have antimicrobial properties, reduce inflammation, and has been implicated in respiratory health. Serum 25‐hydroxyvitamin D (25[OH]D) has been associated with risk and severity of respiratory tract infections (RTIs) in some, but not all, observational studies.MethodsWe searched MEDLINE, EMBASE, CCTR, AMED, and LILACS (through August 1, 2014) to identify observational studies (with the exception of case reports). Odds ratios, dichotomizing serum 25(OH)D at 50 and 75 nmol/L, were pooled using generic inverse variance methods with random‐effects models. Heterogeneity was assessed using Cochrane's Q and quantified by the I2 statistic. Subgroups included age, location of infection, and study design.ResultsWe included 19 studies (n = 44, 301) in one or more meta‐analyses. Serum 25(OH)D levels < 50 nmol/L were associated with an increased odds of RTIs (OR = 2.63, 95% CI: 1.45‐4.76). Subgroup analyses revealed that the effect remained significant in children (OR = 2.80, 95% CI: 1.31‐5.96), lower RTIs (OR = 2.06, 95% CI: 1.16‐3.55), and in case‐control studies (OR = 2.25, 95% CI: 1.14‐4.45). Similar results were obtained when serum 25(OH)D was dichotomized at 75 nmol/L. Moderate heterogeneity was observed in all analyses (I2 蠅 42%).ConclusionsLow serum 25(OH)D was associated with an increased risk of RTIs and remained significant in various subgroup analyses. Future studies are required to elucidate these subgroup effects.
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