Influence of genetic variation in the vitamin D pathway on plasma 25-hydroxyvitamin D3 levels and survival among patients with metastatic colorectal cancer.

PURPOSE: The relationships of genetic variation in the vitamin D pathway with circulating 25-hydroxyvitamin D3 [25(OH)D] levels and survival remain largely unknown for patients with metastatic colorectal cancer (mCRC). METHODS: Among 535 patients participating in a randomized trial of chemotherapy for mCRC, we prospectively measured baseline plasma 25(OH)D and examined 124 tagging single-nucleotide polymorphisms (SNPs) within seven genes in the vitamin D pathway, including five SNPs associated with circulating 25(OH)D levels in previous genome-wide association studies (GWAS). We evaluated whether these SNPs were associated with plasma 25(OH)D levels and patient outcome (overall survival, time to progression, and tumor response), using linear, logistic, and Cox proportional hazards regression. RESULTS: We observed a significant association between 25(OH)D levels and an additive genetic risk score determined by the five GWAS-identified SNPs (p = 0.0009). We did not observe any direct association between 25(OH)D-associated SNPs, individually or as a genetic risk score, and patient outcome. However, we found a significant interaction between 25(OH)D levels and rs12785878 genotype in DHCR7 on overall survival (pinteraction = 0.02). CONCLUSION: Germline genetic variation in the vitamin D pathway informs baseline 25(OH)D levels among patients with mCRC. The association between 25(OH)D levels and overall survival may vary by DHCR7 genotype. ClinicalTrials.gov Identifier: NCT00003594 ( https://clinicaltrials.gov/ct2/show/NCT00003594 ).

Emergency Care of Children with Ambulatory Care Sensitive Conditions in the United States.

BACKGROUND: Ambulatory care sensitive (ACS) conditions are health problems that could be prevented or ameliorated with adequate access to primary care services. OBJECTIVES: To determine the extent to which ACS conditions account for care received by children in U.S. emergency departments (EDs) and the patient charges for this care. METHODS: A retrospective, cross-sectional analysis of the 2010 Nationwide Emergency Department Sample was performed. Patients 0-19 years of age were included and visits for ACS conditions were identified. Main outcome measures were the percentage of visits for ACS conditions, regression models predicting presentation for ACS conditions based on patient demographic characteristics, and ED charges for ACS ED visits. RESULTS: Of almost 30 million pediatric ED visits in the United States in 2010, 13.2% were for exclusively ACS conditions. Patients with public or no insurance were 1.2 times more likely than privately insured patients to present for an ACS condition. Lower household income (adjusted odds ratio [aOR] 1.49; 95% confidence interval [CI] 1.33-1.66) and younger patient age (aOR = 2.55; 95% CI 2.41-2.69) were also predictive of an ACS ED visit. The total of charges for ACS visits was almost $3 billion, of which publicly insured patients accounted for $1.5 billion. CONCLUSIONS: Almost one in seven U.S. pediatric ED visits may be preventable by quality primary care. Patients with public insurance and lower income are more likely than other groups to present with ACS conditions. Better access to and use of primary care services could reduce health care costs and relieve ED overcrowding.

Trends in hospitalization rates and severity of injuries from abuse in young children, 1997-2009.

OBJECTIVES: To examine trends in incidence of hospitalizations for injury from abuse in young children from 1997 through 2009 and to examine injury severity trends. METHODS: Cases were identified in the National Inpatient Sample database of the Healthcare Cost and Utilization Project by using International Classification of Diseases, Ninth Revision, Clinical Modification codes for child maltreatment and external cause of injury for assault in children aged 0 through 3 years. Incidence was calculated by age, gender, and region. Trends in incidence of hospitalization and injury severity were calculated over time. RESULTS: Hospitalization rates for injury from abuse showed no significant change over the study period, ranging from a low of 2.10 per 10, 000 children in 1998 to a high of 3.01 per 10, 000 children in 2005 (P = .755). Children aged <1 had significantly higher hospitalization rates for injury from abuse (6.01 vs 1.12, P <.001) and higher mean injury severity scores compared with children aged 1 to 3 years (12.50, SD = 0.14 vs 8.56, SD = 0.21, P <.001). Injury severity scores increased significantly over the study period. CONCLUSIONS: No significant change in hospitalization rates for injury from abuse among young children was observed from 1997 to 2009. These results coincide with other reports of stable or modestly increasing rates of serious physical abuse or death in young children but not with reports from child welfare data showing declines in physical abuse during the same period. Diverse sources of data may provide important complementary methods to track child abuse.