168: Failure of Free, Public Vitamin D Supplementation Program for Quebec Infants – Temporal Trends and Significant Predictors
Bibliographic record
Abstract
To prevent deficiency several agencies including the CPS recommend 400 IU/d of vitamin D in infancy. For nearly 20 years, Quebec has offered a program of free supplements through its public medication insurance plan (RAMQ). Other jurisdictions have implemented programs to enhance vitamin D supplementation. Our study sought to evaluate the uptake of vitamin D via this prescription program in both term and preterm infants and determine the incidence of nutritional rickets over this time. This was a retrospective cohort study of infant; the data are derived from the province of Quebec, Canada. All healthy infants born between 1998 and 2008 and covered by RAMQ drug plan were included. Data were extracted from the Quebec Pregnancy Cohort built by the linkage of three databases: RAMQ medical and prescription databases (diagnoses, medications, SES), MedEcho (hospitalizations), and ISQ (birthweight, SES). Predictors of program participation were identified through logistic regression (GEE). A total of 123,018 term infants were eligible for RAMQ and the mean annual prevalence of supplemental vitamin D exposure was 17.9±5.6%. The median age for obtaining the first bottle was 36 days (range 1 to 370). The majority (51.0%) obtained only one bottle of fifty doses (median 1, range 1 to 20). 8812 preterm infants were similarly eligible; vitamin D exposure was 34% in early (23 to 33 weeks) and 17% in late preterm infants. The median age was 49 days and the median number of bottles was two (range one to 15). For all infants, mothers of higher SES, those who lived as a couple, older mothers, or a prescription by a pediatrician significantly increased the odds of obtaining vitamin (P<0.05). Additionally, there was a statistically significant decline in program participation over time (OR 0.89 per year, 95% CI 0.88 to 0.90). The overall incidence of nutritional rickets was 23.9 cases per 100,000 live births with an annual increase of 1.12 cases per year (Poisson regression, 95% CI 1.01 to 1.24). Without specific educational measures, a free prescription program for vitamin D failed to encourage participation or long-term adherence. Moreover, participation decreased with time and coincided with an increase in the incidence of rickets. Higher SES and care by a pediatrician increased odds for participation. New strategies targeting these variables and providing educational support for healthcare workers and the general community may need to be developed to increase vitamin D supplementation rates.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".