Background:Lipoprotein(a) [Lp(a)] level is a well established, independent risk factor for premature atherosclerotic cardiovascular disease. The 2021 Canadian Cardiovascular Society dyslipidemia recommendations advise that Lp(a) measurement be performed as part of cardiovascular risk stratification. However, little is known about the clinical adoption of this recommendation, particularly as undertaken for young patients presenting with acute coronary syndromes. Methods:This study assessed the prevalence and predictors of Lp(a) measurement in a contemporary cohort of patients aged ≤ 65 years presenting with ST-elevation myocardial infarction (STEMI) in Vancouver, Canada between January 2016 and January 2023. The primary outcome was the proportion of such patients who had a measurement of Lp(a) prior to or within 1 year of index STEMI hospitalization. Secondary analyses explored predictors of Lp(a) measurement at any point in the lifetime, as well as measurement trends through years. Results:A total of 1106 patients were studied (mean age 55.9 years; 88.1% male). Only 240 patients (21.7%) had Lp(a) level assessed within 1 year of STEMI. The rate of Lp(a) measurement increased from 15% to 39% during the interval from 2016-2023 (P < 0.01 for trend). Older age (OR 0.67; 95% confidence interval [CI] [0.60, 0.75], P < 0.01), prior history of smoking (OR 0.65; 95% CI [0.46, 0.91], P = 0.01), and earlier year of STEMI in the study period (OR 0.83; 95% CI [0.77, 0.90], P < 0.01) were independently associated with a lower likelihood of Lp(a) measurement. Conclusions:Although rates of measurement have increased from 2016 to 2023, Lp(a) testing remains underutilized among younger STEMI patients. Strategies are needed to increase the testing of Lp(a) level among younger patients with STEMI, especially with the development of novel targeted therapeutics.

Background:Rates of obesity worldwide continue to increase and are associated with myriad health risks and socioeconomic burdens. Exercise is a traditional treatment for adults with obesity to increase physical activity levels, improve cardiorespiratory fitness, and reduce cardiometabolic risk. However, many people living with obesity do not engage in enough physical activity to achieve health benefits and often cite a perceived lack of time, lack of access to equipment, and stigma as barriers. "Exercise snacks" are short (~1 min) isolated bouts of vigorous exercise performed sporadically throughout the day that may be a viable strategy to improve fitness and cardiometabolic health. It is unknown whether exercise snacks are a feasible option in the real world for people living with obesity. Objective:This study aims to conduct a pilot randomized clinical trial (RCT) to determine the feasibility and preliminary efficacy of a 12-week smartphone app-supported exercise snacks intervention with behavior change counseling for improving cardiorespiratory fitness and other indices of cardiometabolic health in previously inactive adults living with obesity. Methods:A 2-site, parallel arm, RCT will be conducted in Kelowna and Hamilton, Canada. Eighty inactive adults living with obesity will be randomized to an exercise snacks or stretching/mobility exercise comparator group for 12 weeks. The former will complete 4 × 1-minute bouts of vigorous exercise at least 5 days per week, and the latter will perform mobility or stretching exercises using the same schedule. Interventions will be delivered through a customized smartphone mobile app and will be tailored to the participants' schedules via onboarding counseling sessions, with ongoing telephone check-in call support at weeks 1, 2, 4, and 8. This pilot RCT will focus on feasibility as reflected by rates of recruitment, adherence, and dropout. We will also assess cardiorespiratory fitness, anthropometric markers, and routine blood health markers (eg, glucose, insulin) at baseline and postintervention. Results:This study is funded through the Heart & Stroke Foundation of Canada Grants-in-Aid program (2024/2025). Recruitment began on July 18, 2025 (Kelowna) and in November 2025 (Hamilton). As of March 31, 2026, we have enrolled 65 participants (University of British Columbia Okanagan, n=51; McMaster University, n=14). Data analysis will begin once all enrolled participants have completed the trial, and we expect to publish the results of the trial in winter 2027. Conclusions:This study will test an RCT protocol, provide evidence on the feasibility of exercise snacks in inactive adults living with obesity, and report preliminary effect size estimates for their ability to improve cardiometabolic health.

Using a randomised, crossover design, we investigated whether exercise snacks could improve indices of glucose regulation assessed by continuous glucose monitoring, compared with an equivalent no-exercise control period in people living with non-insulin-treated type 2 diabetes. Previously inactive participants with well-controlled type 2 diabetes (n=31; 21 female participants, ten male participants; approximately 58 years old, BMI approximately 31 kg/m2, HbA1c approximately 48 mmol/mol [6.6

OBJECTIVE:To test the hypothesis that home- and community-based exercise, prescribed according to the spinal cord injury (SCI) exercise guidelines, reduces chronic pain. DESIGN:Single-blinded, pragmatic randomized controlled trial with 2 arms (exercise intervention, waitlist control) and assessments at baseline, 3 months, and 6 months. SETTING:Testing at 2 university-based laboratories located on separate campuses within the same institution. Exercise in participants' preferred locations. PARTICIPANTS:Forty-six adults with SCI (76% men/male; 59% paraplegic; Mage=50.6±14.1; Myears since injury=16.5±12.8) and chronic neuropathic or musculoskeletal pain, who did not routinely achieve the SCI exercise guidelines. INTERVENTION:Intervention participants (n=25) received an individualized exercise prescription for aerobic and strength training. Fitness trainers and exercise counselors supported implementation. Control participants (n=21) continued their usual activities. MAIN OUTCOME MEASURES:The primary outcome was the SF-36 Pain score at 6 months. Secondary outcomes were International SCI Pain Basic Dataset version 2.0 (ISCIPBDS) pain-intensity and interference scores, and standardized measures of pain coping, well-being, conditioned pain modulation, and proinflammatory cytokines. RESULTS:In intent-to-treat analyses, the estimated treatment effect (95% CI) on SF-36 Pain was 7.9 (-1.9 to 17.7; P=.11) at 6 months. Tipping-point analyses suggested that these effects may have been significant if the target sample size had been achieved. Treatment effects for ISCIPBDS pain intensity were -1.8 (-3.4, -0.1; P=.04) at 6 months. Relative to controls, participants in the intervention condition reported significant reductions in pain interference at 3 months and reduced use of pain-coping strategies at 6 months (Ps<0.05). No other effects were significant. CONCLUSIONS:Intervention effects on SF-36 Pain were inconclusive. Analyses of secondary outcomes (ISCIPBDS) suggest exercise prescribed according to the SCI exercise guidelines, and implemented in real-world settings, can reduce pain intensity. Meeting the aerobic-exercise guideline may be especially important. Further replication in pragmatic trials is required.

Background:For women with chronic or gestational hypertension who remain well, early term birth (at 37-38 weeks' gestation) may reduce maternal complications, caesareans and stillbirths, but it may increase neonatal morbidity compared with expectant care. Expectant care may increase costs. There are no high-quality data to guide care, which currently involves maternal-fetal surveillance and intervention for maternal or fetal compromise, which may be rapid or unexpected. Objective:To investigate optimal timing of birth for women with chronic or gestational hypertension who reach term and remain well. Design:Pragmatic, unmasked, multicentre randomised trial with a health economic analysis. Setting:Fifty United Kingdom hospitals. Participants:Inclusion: maternal age ≥ 16 years, chronic or gestational hypertension, singleton pregnancy, live fetus, 36+0-37+6 weeks' gestation and able to give documented informed consent. Exclusion: contraindication to either trial arm (e.g. pre-eclampsia), blood pressure ≥ 160/110 mmHg until controlled, major fetal anomaly anticipated to require neonatal care unit admission or participation in another timed birth trial. Interventions:Planned early term birth at 38+0-3 weeks' (intervention) or 'usual care at term' (control, revised from 'expectant care until at least 40+0 weeks', August 2022). Main outcome measures:Maternal coprimary: composite of 'poor maternal outcome' (severe hypertension, maternal death or maternal morbidity and superiority hypothesis). Neonatal coprimary: neonatal care unit admission ≥ 4 hours (non-inferiority hypothesis). Each coprimary is measured until primary hospital discharge or 28 days post birth (whichever is earlier). Key secondary: caesarean birth. Randomisation:1 : 1 ratio, minimised for key prognostic variables: site, hypertension type and prior caesarean. Blinding:It was not possible to mask care providers or participants to the intervention. For the coprimary maternal outcome, there was local site principal investigator/delegate sign-off based on review, masked to allocated group, of primary case notes. Results:From 2019 to 2022, 403 participants were randomised (37% of target 1080) to intervention (n = 201) or control (n = 202). The funder stopped the trial during the coronavirus disease discovered in 2019 pandemic for delayed recruitment. In the intervention (vs. control) group, birth was a median of 0.9 weeks earlier (38.4, interquartile range 38.3-38.6 vs. 39.3, interquartile range 38.7-39.9 weeks). There was no evidence of a difference in 'poor maternal outcome' (13% vs. 12%, respectively; adjusted risk ratio 1.16, 95% confidence interval 0.72 to 1.87). For 'neonatal care unit admission ≥ 4 hours', the intervention was considered to be non-inferior to control, as the adjusted risk difference, 95% confidence interval upper bound did not cross the 8% pre-specified non-inferiority margin (7% vs. 7%, respectively; adjusted risk difference 0.003, 95% confidence interval -0.05 to +0.06), although event rates were lower than estimated. There was no evidence of a difference in caesarean (29% vs. 36%, respectively; adjusted risk ratio 0.81, 95% confidence interval 0.61 to 1.08). Limitations:Recruitment was 37% of the anticipated sample size (as above). Conclusions:Despite being unable to recruit to target in this study, we observed that most women with chronic or gestational hypertension required labour induction and planned birth at 380-3 weeks (vs. usual care), which resulted in birth an average of 6 days earlier and there were no differences in poor maternal outcome or neonatal morbidity. Our findings provide reassurance about planned birth at 380-3 weeks as a clinical option for these women. Future work:An individual participant data meta-analysis is planned to address whether the intervention (vs. control) reduces caesarean; low adverse event rates would make unfeasible mounting another randomised trial. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/167/123.

INTRODUCTION:Integrase strand transfer inhibitors (INSTIs) are first-line antiretroviral medications used in pregnancy. Pre-clinical research suggests adverse effects in human stem cells associated with second- versus first-generation INSTIs. We compared perinatal and early infant outcomes after exposure to first- versus second-generation INSTIs. METHODS:Data were taken from the Canadian Perinatal HIV Surveillance Program. Infants born between January 1, 2010, and December 31, 2023, with in utero INSTI exposure were included. Univariate analysis compared perinatal and early infant outcomes between first- and second-generation INSTI exposures. Multivariable logistic regression was completed to identify independent associations between INSTI class and perinatal outcomes. RESULTS:A total of 1160 infants were included: 433 exposed to first-generation INSTIs and 727 to second-generation. There was a non-significant finding of fewer small-for-gestational-age (SGA) infants with exposure to second-generation INSTIs (odds ratio [OR] = 0.75; 95% confidence interval [CI] = 0.55-1.01, p = 0.058), which remained non-significant in multivariable analysis (OR = 0.72, 95% CI = 0.49-1.07, p = 0.105). There was a non-significant finding of increased preterm births with exposure to second-generation INSTIs (OR = 1.40, 95% CI = 0.97-2.00, p = 0.070), which remained non-significant in multivariable analyses (OR = 1.01, 95% CI = 0.62-1.66, p = 0.962). There was a non-significant increase in infant deaths in the second-generation INSTI group compared to the first-generation group (6 vs. 0, p = 0.089). No differences were observed in HIV transmission (p = 0.208). CONCLUSIONS:There were no significant associations between second-generation INSTIs and adverse perinatal outcomes compared to first-generation INSTIs. These findings support the ongoing use of second-generation INSTIs in pregnancy with continued careful surveillance of perinatal outcomes.

AIMS:To investigate the feasibility and preliminary efficacy of a 12-week remotely-delivered exercise snacks (ES) intervention in adults with type 2 diabetes. MATERIAL AND METHODS:Insufficiently active adults with type 2 diabetes (N = 69; 46 females; mean age ± SD: 58 ± 11 years) were randomised to an ES or mobility/stretching comparator group (CON), which involved 4 × 1-min bouts of either vigorous or low intensity exercise, respectively, on ≥ 5 days/week. The primary outcome was feasibility based on adherence. Secondary outcomes included exercise enjoyment (1-7 scale), rating of perceived exertion (RPE; 0-10 scale), heart rate (HR), haemoglobin A1c (HbA1c), blood biomarkers of cardiometabolic health, 30-s sit-to-stand capacity, grip strength, estimated maximal oxygen uptake, and anthropometrics. RESULTS:Weekly adherence (estimated marginal mean [95% confidence interval]: 18 bouts [16-21] for both groups; p = 0.99) and total enjoyment (ES: 4.5 [4.1-4.8] vs. CON: 4.3 [4.0-4.7]; p = 0.64) were high and not different between groups. Despite higher RPE (5.7 [5.4-6.1]) and peak HR (73 [70-77] % of age-predicted HR maximum) in ES versus CON (2.0 [1.7-2.4] and 61 [58-64] % of age-predicted HR maximum, respectively) (all p < 0.001), there were no between-group differences in the change in any secondary outcome (all p > 0.05) except for greater sit-to-stand capacity in ES after training (between-group effect estimate [95% confidence interval]: 1.9 repetitions [0.3-3.4]; p = 0.02). CONCLUSIONS:Exercise snacks were feasible to perform in the real world and improved sit-to-stand capacity to a greater extent than CON in adults living with type 2 diabetes. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT06407245.

Peer support and digital technology are two promising strategies to address psychosocial needs in type 1 diabetes (T1D). REACHOUT is a mobile app designed to deliver peer-led mental health support to adults with T1D living in British Columbia. This report describes the methodological design and recruitment for the REACHOUT randomized wait-list controlled (WLC) trial. The primary goal was to examine whether participation in the REACHOUT intervention was associated with reductions in diabetes distress compared to a WLC condition (eligible to receive the intervention after six months). Two-hundred twenty-five adults with T1D (age 19-81 years) completed a baseline survey;113 participants were randomized to the six-month REACHOUT intervention and 112 to the WLC condition. REACHOUT offers support that is choice-based, customizable, and just-in-time. Support delivery modalities include one-on-one support from a participant-selected peer supporter, group-based text support using a 24/7 chat room and topic-specific discussion boards, and small group virtual face-to-face support. The primary outcome of this trial was diabetes distress; secondary outcomes included depressive symptoms, perceived social support, diabetes-specific quality of life, and resilience; exploratory outcomes were A1c, time in range, health resource utilization, and cost-effectiveness. The goal of this research is to examine whether a mobile app that delivers peer-led and personalized mental health support can improve diabetes distress and other mental health outcomes among adults living with T1D.

BACKGROUND:Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. There are several determinants of individual pregnant women's risk of developing pre-eclampsia, including biomarkers and ultrasound markers. OBJECTIVE:A conceptual framework to collate and summarise the extensive body of literature on biomarkers (including ultrasound markers) associated with pre-eclampsia, through a hierarchical systematic literature review. SEARCH STRATEGY:Medline, Embase, Health Technology Assessments, Database of Abstracts of Reviews of Effects, Cochrane Library were searched until April 2024. SELECTION CRITERIA:Reviews and cohort studies (> 100 participants) reporting biomarkers associated with pre-eclampsia were included. DATA COLLECTION AND ANALYSIS:Studies were screened by title, then abstract and full text. Evidence was prioritised from umbrella reviews, followed by systematic reviews and then observational studies. Associations were assessed for strength of association and quality of evidence using GRADE. MAIN RESULTS:The biomarker domain included 40 individual determinants of pre-eclampsia. Of these, there were 18 biomarkers with definite or probable associations based on moderate-strong quality evidence across markers of angiogenic imbalance, fetal-placental unit function, inflammatory and immune markers, and physiological markers. Vascular endothelial growth factor, human chorionic gonadotropin, inhibin-A, maternal serum placental protein-13, and interferon-gamma had definite associations based on high-quality evidence. CONCLUSION:Biomarkers associated with the development of pre-eclampsia highlight the multi-factorial aetiology of the syndrome. The addition of biomarkers, including ultrasound, will optimise the prediction of pre-eclampsia and enable individualised risk stratification.

INTRODUCTION:Presumptive HIV therapy (PHT) is recommended for post-natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in cases of in utero transmission. The objective of this study was to describe the risk of VT and use PHT among newborns in Canada, and specifically, factors associated with the use of PHT. METHODS:Data were analysed for all mother-infant pairs (MIPs) in the Canadian Perinatal HIV Surveillance Program (1997-2020), collected annually from 22 perinatal HIV centres in Canada. Infants were categorized as high risk (delivery viral load [dVL] ≥1000 copies/ml or maternal combined antiretroviral [cART] <4 weeks prior to delivery), moderate risk (dVL detectable and <1000 copies/ml, and maternal cART ≥4 weeks prior to delivery) and low risk (dVL undetectable and maternal cART ≥4 weeks prior to delivery). Neonatal prophylaxis and HIV transmission risk were compared between groups. RESULTS:A total of 4743 MIPs were included in the analysis. Overall, 13.3% of newborns received PHT; the most prescribed PHT regimens included combinations using zidovudine, lamivudine and nelfinavir (48.5%) or nevirapine (41.9%). While the most significant risk factor for transmission on univariate analysis was a detectable dVL ≥1000 copies/ml versus undetectable (odds ratio [OR] 27.91 [11.20-69.54]), the risk remained significantly increased at dVL between 400 and 999 copies/ml (OR 31.71 [8.31-120.98], but not at dVL between 50 and 399 copies/ml (OR 3.03 [0.72-12.81]). At dVL 50-399 copies/ml, 29.8% of infants received PHT, increasing to 46.7% at dVL 400-999 copies/ml, and 64.4% of infants at dVL≥1000 copies/ml. The overall risk of transmission was 6% in the high-risk group, 0.5% in the moderate-risk group and 0.2% in the low-risk group. CONCLUSIONS:PHT has been widely used in Canada in situations at high risk of VT, with 25% of newborns in this risk group receiving PHT as PNP. While PHT may reduce the risk of VT in high-risk situations and may be of benefit in cases of VT, these data also highlight ongoing gaps in perinatal HIV prevention in Canada.

BACKGROUND:Cardiogenic shock (CS) develops in up to 10% of patients with ST-segment-elevation myocardial infarction and is associated with high mortality and morbidity rates. The objective of the current study was to generate a clinical scoring system that can be easily applied in the prehospital setting to predict the development of in-hospital CS among patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction. METHODS:The authors conducted a retrospective cohort study using prospective data from a dual hub-and-spoke health system. Logistic regression was used to assess the relationship between prespecified clinical predictors and the occurrence of in-hospital CS. Internal validation was conducted to assess the C statistic and calibration curve of the prediction model. The prediction model was converted to a risk score by scaling of the regression coefficients. RESULTS:From April 1, 2012, to December 31, 2020, there were 2736 consecutive patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Of these, 415 (15.2%) developed CS. Eight strong predictors were independently associated with CS by multivariable analysis and used to develop a prediction model. The model achieved a C statistic of 0.87. The EARLY SHOCK risk scoring algorithm incorporates Emergency Medical Services Heart Rate and Systolic Blood Pressure, Age, Renal Replacement, Location of Infarction, Sugar (diabetes), Heart Failure, and Cardiac Arrest. CONCLUSIONS:The authors identified 8 clinical variables that strongly predict CS among patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. This has been developed into the EARLY SHOCK score, which can be easily applied in the prehospital setting to rapidly identify CS and enable shock team activation. External validation for the scoring system is pending for broader application.

INTRODUCTION:The Quadrivalent human papillomavirus (HPV) Vaccine Evaluation Study with Addition of the Nonavalent Vaccine Study (QUEST-ADVANCE) aims to provide insight into the long-term immunogenicity and effectiveness of one, two and three HPV vaccine doses. Here, we describe the protocol for QUEST-ADVANCE. METHODS AND ANALYSIS:QUEST-ADVANCE is an observational cohort study including males and females who are unvaccinated or vaccinated with the quadrivalent or nonavalent HPV vaccine in British Columbia, Canada. Female participants who are unvaccinated or vaccinated with 1-3 doses of the quadrivalent or nonavalent HPV vaccine at 9-14 years of age will be recruited approximately 5 or 12 years postvaccination eligibility. Male participants who are unvaccinated or vaccinated with 1 or 2 doses of the nonavalent HPV vaccine at 9-14 years of age will be recruited at approximately 5 years postvaccination eligibility. The study involves a maximum of four visits over a period of 4-5 years for female participants, and two visits over a 12-month period for male participants. At each visit, self-collected swabs (cervico-vaginal or penile) and questionnaire data will be collected. In each study group, a subset of participants will be invited to participate in a substudy evaluating the long-term humoral immunogenicity of the HPV vaccine. Additional blood samples will be collected from participants who are part of the immunogenicity substudy. The total required sample size is 7180 individuals. The primary objectives are (1) to examine vaccine effectiveness in males and females against prevalent genital HPV infections for one, two and three doses of the HPV vaccine compared with unvaccinated participants and (2) to evaluate if there is non-inferior immunogenicity as indicated by type-specific antibody response of one dose of the HPV vaccine in 20-27-year-old females vaccinated at 9-14 years of age compared with historical data of three doses of the HPV vaccine females vaccinated at 16-26 years of age up to 12 years postvaccination. ETHICS AND DISSEMINATION:QUEST-ADVANCE was approved by the Research Ethics Board of the University of British Columbia/Children's and Women's Health Centre of British Columbia (H20-02111). Individual electronic informed consent or assent will be obtained from each participant before any study-specific procedures are undertaken. Results will be published in an international peer-reviewed journal and on the study website.

Objectives Assess the feasibility of a mobile health (mHealth)-supported home-delivered physical activity (PA) intervention (MOTIVATE-T2D) in people with recently diagnosed type 2 diabetes (T2D).Design Feasibility multicentre, parallel group, randomised controlled trial (RCT).Setting Participants were recruited from England and Canada using a decentralised design.Participants Adults (40–75 years) recently diagnosed with T2D (5–24 months).Interventions Participants were randomised 1:1 to intervention (MOTIVATE-T2D) or active control groups. Participants codesigned 6month- home-delivered, personalised, progressive PA programmes supported by virtual behavioural counselling. MOTIVATE-T2D used biofeedback from wearable technologies to support the programme. The active control group received the same intervention without wearables.Outcomes The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Clinical data on effectiveness were collected as exploratory outcomes at baseline, 6 and 12 months, with HbA1c and systolic blood pressure (BP) proposed as primary outcomes for a future full RCT.Results n=135 eligible participants expressed an interest in the trial, resulting in 125 participants randomised (age 55±9 years, 48% female, 81% white), a recruitment rate of 93%. Retention at 12 months was 82%. MOTIVATE-T2D participants were more likely to start (OR 10.4, CI 3.4 to 32.1) and maintain purposeful exercise at 6 (OR 7.1, CI 3.2 to 15.7) and 12 months (OR 2.9, CI 1.2 to 7.4). Exploratory clinical outcomes showed a potential effect in favour of MOTIVATE-T2D, including proposed primary outcomes HbA1c and systolic BP (between-group mean differences: HbA1c: 6 months: −5% change from baseline, CI −10 to 2: 12 months: −2% change from baseline, CI −8 to −4; systolic BP: 6 months: −1 mm Hg, CI −5 to 3: 12 months: −4 mm Hg, CI −8 to 1).Conclusions Our findings support the feasibility of delivering the MOTIVATE-T2D mHealth-supported PA intervention for people with recently diagnosed T2D and progression to a full RCT to examine its clinical and cost-effectiveness.Trial registration number ISRCTN: 14335124; ClinicalTrials.gov: NCT0465353.

[This corrects the article DOI: 10.1371/journal.pmed.1004481.].

Objectives:While studies have demonstrated increased morbidity and mortality risk in infancy among children who are HIV-exposed and uninfected (CHEU), longitudinal data are limited. The objective of this study was to assess long-term risk of hospitalization among CHEU compared to children who are HIV-unexposed and uninfected (CHUU), and determine risk factors for hospitalization among CHEU.Design:A longitudinal cohort study (1988-2015) linking the Centre maternel et infantile sur le SIDA cohort (Montreal, Quebec) to administrative data from the R & eacute;gie de l'assurance maladie du Qu & eacute;bec (RAMQ), a universal health insurance provider in the province of Quebec.Methods:CHEU from the CMIS cohort were matched 1 : 3 by age, sex, and postal code with CHUU controls from the RAMQ database. Incidence and causes of hospitalization between CHEU and CHUU were compared using Poisson regression.Results:Seven hundred twenty-six CHEU were matched to 2178 CHUU. Risk of first hospitalization was significantly higher among CHEU at 1 year (incidence rate ratio [IRR] 2.22 [1.86-2.66]), 5 years (IRR 1.62 [1.39-1.90]), and over the lifespan (IRR 1.55 [1.33-1.81]). Among CHEU, significant risk factors for hospitalization on univariate regression analysis included birth year before 2005, prematurity, small for gestational age (SGA), detectable maternal viral load (dVL) at delivery, and maternal hepatitis C co-infection. In the adjusted analysis, small for gestational age and dVL remained significant risk factors.Conclusion:CHEU had a higher rate of hospitalization than CHUU controls across their lifespan. Significant risk factors included SGA and detectable maternal dVL, suggesting a need for enhanced pediatric care for these children.

[This corrects the article DOI: 10.1371/journal.pone.0308926.].