Motor vehicle collision (MVC) emergency department (ED) visits and hospitalisations in Ontario during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic policy response dramatically changed local transportation patterns. This project investigated the impact of COVID-19 policies on motor vehicle collision (MVC)-related emergency department (ED) visits and hospitalisations in Ontario. METHODS: Data were collected on MVC-related ED visits and hospitalisations in Ontario between March 2016 and December 2022. Using an interrupted time series design, negative binomial regression models were fitted to the pre-pandemic data, including monthly indicator variables for seasonality and accounting for autocorrelation. Extrapolations simulated expected outcome trajectories during the pandemic, which were compared with actual observed outcome counts using the overall per cent change and mean monthly difference. Data were modelled separately for vehicle occupants, pedestrians and cyclists (MVC and non-MVC injuries). RESULTS: There was a 31.5% decrease in observed ED visits (95% CI -35.4 to -27.3) and a 6.0% decrease in hospitalisations (95% CI -13.2 to 1.6) among vehicle occupants, relative to expected counts during the pandemic. Results were similar for pedestrians. Among cyclist MVCs, there was an increase in ED visits (12.8%, 95% CI -8.2 to 39.4) and hospitalisations (46.0%, 95% CI 11.6 to 93.6). Among non-MVC cyclists, there was also an increase in ED visits (47.0%, 95% CI 12.5 to 86.8) and hospitalisations (50.1%, 95% CI 8.2 to 101.2). CONCLUSIONS: We observed fewer vehicle occupant and pedestrian collision injuries than expected during the pandemic. By contrast, we observed more cycling injuries than expected, especially in cycling injuries not involving motor vehicles. These observations may be attributable to changes in transportation patterns during the pandemic and increased uptake of recreational cycling.

Trends in falls among older adults before and during the COVID-19 pandemic in Ontario, Canada: A retrospective observational study.

BACKGROUND: The public health measures associated with the COVID-19 pandemic may have indirectly impacted other health outcomes, such as falls among older adults. The purpose of this study was to examine trends in fall-related hospitalizations and emergency department visits among older adults before and during the COVID-19 pandemic in Ontario, Canada. METHODS: We obtained fall-related hospitalizations (N = 301,945) and emergency department visit (N = 1,150,829) data from the Canadian Institute for Health Information databases from 2015 to 2022 for adults ages 65 and older in Ontario. Fall-related injuries were obtained using International Classification of Diseases, 10th edition, Canada codes. An interrupted time series analysis was used to model the change in weekly fall-related hospitalizations and emergency department visits before (January 6, 2015-March 16, 2020) and during (March 17, 2020-December 26, 2022) the pandemic. RESULTS: After adjusting for seasonality and population changes, an 8% decrease in fall-related hospitalizations [Relative Rate (RR) = 0.92, 95% Confidence Interval (CI): 0.85, 1.00] and a 23% decrease in fall-related emergency department visits (RR = 0.77, 95%CI: 0.59, 1.00) were observed immediately following the onset of the pandemic, followed by increasing trends during the pandemic for both outcomes. CONCLUSIONS: Following an abrupt decrease in hospitalizations and emergency department visits immediately following the onset of the pandemic, fall-related hospitalizations and emergency department visits have been increasing steadily and are approaching pre-pandemic levels. Further research exploring the factors contributing to these trends may inform future policies for public health emergencies that balance limiting the spread of disease among this population while supporting the physical, psychological, and social needs of this vulnerable group.

Identifying latent classes of physical activity profiles over time among adolescents in Ontario, Canada.

BACKGROUND: Physical activity behaviours are known to be highly correlated. Adolescents who participate in one type of physical activity (e.g., physical education) have a greater likelihood of participating in other physical activities (e.g., organized sports); however, little research has examined participation rates in various physical activity behaviours concurrently. This study identified longitudinal physical activity profiles among secondary school aged youth in Ontario, Canada. METHODS: We used data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada. Using a repeated measures latent class analysis, Ontario students who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917). Latent classes were defined by: PE participation, guideline adherence (≥ 60 min/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics. RESULTS: Three distinct latent classes were identified for females and four were identified for males. These classes were: (1) Guidelines (high probability of guideline adherence; females: 44%; males: 16%), (2) PE & Sports (high probability of PE and sport participation; females: 33%; males: 43%), (3) Guidelines & Sports (high probability of guideline adherence and sport participation; females: 23%; males: 23%;), and (4) Inactive (low probability of all physical activity indicators; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethno-racial identity, weekly spending money, strength training, and English and math grades were associated with class membership among males. CONCLUSIONS: Findings suggest that latent physical activity profiles differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sport participation was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these activities alone may not be providing sufficient levels of physical activity that align with current recommendations for Canadian youth.

Road safety, health equity, and the built environment: perspectives of transport and injury prevention professionals in five Canadian municipalities.

BACKGROUND: Concerns regarding health equity (HE) and the built environment (BE) are well established in the Canadian urban context. Transport and injury prevention professionals across sectors, such as transportation and public health, are involved in designing and implementing BE interventions that enhance the safety of vulnerable road users (VRUs). Results from a larger study examining barriers and facilitators to BE change are used to illustrate how transport and injury prevention professionals perceive HE concerns in their work in five Canadian municipalities. Broadening our understanding of how HE influences the professional BE change context is crucial when advocating for modifications that enhance the safety of equity-deserving VRUs and groups who experience marginalization. METHODS: Interview and focus group data were gathered from transport and injury prevention professionals working in policy/decision-making, transport, police services, public health, non-profit organizations, schools/school boards, community associations, and private sectors across five Canadian urban municipalities: Vancouver, Calgary, Peel Region, Toronto, and Montréal. Data were analyzed using thematic analysis (TA) to illustrate how equity considerations were perceived and applied in participants' BE change work. RESULTS: The results of this study illustrate transport and injury prevention professionals' awareness of the varying needs of VRUs, as well as the inadequacies of current BEs in the Canadian urban context and consultation processes utilized to guide change. Participants emphasized the importance of equitable community consultation strategies, as well as specific BE changes that would support the health and safety of VRUs. Overall, the results highlight how HE concerns inform transport and injury prevention professionals' BE change work in the Canadian urban context. CONCLUSION: For professionals working in urban Canadian transport and injury prevention sectors HE concerns influenced their perspectives of the BE and BE change. These results illustrate a growing need for HE to guide BE change work and consultation processes. Further, these results contribute to ongoing efforts in the Canadian urban context to ensure that HE is at the forefront of BE policy change and decision-making, while promoting existing strategies to ensure that the BE, and related decision-making processes, are accessible and informed by a HE lens.

Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review.

OBJECTIVE: To determine whether high or low adiposity is associated with youth sport-related injury. DATA SOURCES: Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury. MAIN RESULTS: Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation. CONCLUSIONS: Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.

Acute injury or illness related to the inhalation of vaping aerosols among children and adolescents across Canada: A cross-sectional survey of Canadian paediatricians.

Background: Vaping prevalence rates have increased among Canadian youth. Evidence suggests that vaping poses significant health risks to children and adolescents. Objectives: The objectives of the study were to investigate epidemiological characteristics of acute injury/illness cases due to the inhalation of vaping aerosols among children and adolescents across Canada and to explore factors contributing to severe cases. Methods: Data from the 2019 Canadian Paediatric Surveillance Program cross-sectional survey on vaping-related injury/illness were used. Analyses focused on injury/illness cases (n=71) among children and adolescents aged 0 to 17 years who presented to participating paediatricians for a harm related to the inhalation of vaping aerosols. We conducted descriptive analyses and performed logistic regression to explore associations between severe presentations requiring hospitalization or intensive care unit (ICU) admission and selected case characteristics. Results: Of the 71 reported injury/illness cases related to inhalation of vaping aerosols, 56% of patients were male, and 68% were aged 15 to 17 years. Nicotine vaping was reported in 42% of cases, and cannabis vaping in 24%. Fifty-four per cent presented with respiratory distress, 18% with symptoms of nicotine toxicity, and 41% required hospitalization and/or admission to the ICU. Cases presenting with respiratory distress were more likely to be hospitalized/admitted to the ICU (odds ratio [OR]=5.37, 95% confidence interval [CI]:1.76 to 16.39). Conclusions: The inhalation of vaping aerosols among children and adolescents may contribute to acute injury/illness. Clear associations between study variables and severe cases could not be established due to a small sample size. Additional research is needed to determine predictors and preventable risk factors of severe vaping-related injuries.

Childhood unintentional injury: The impact of family income, education level, occupation status, and other measures of socioeconomic status. A systematic review.

INTRODUCTION: Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES. METHODS: A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017-representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance. RESULTS: Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures. CONCLUSION: Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.

Strengthening public health nutrition: findings from a situational assessment to inform system-wide capacity building in Ontario, Canada.

OBJECTIVE: To assess public health nutrition practice within the public health system in Ontario, Canada to identify provincial-wide needs for scientific and technical support. DESIGN: A qualitative descriptive study was conducted to identify activities, strengths, challenges and opportunities in public health nutrition practice using semi-structured key informant interviews (n 21) and focus groups (n 10). Recorded notes were analysed concurrently with data generation using content analysis. System needs were prioritised through a survey. SETTING: Public health units. PARTICIPANTS: Eighty-nine practitioners, managers, directors, medical officers of health, researchers and other stakeholders were purposively recruited through snowball and extreme case sampling. RESULTS: Five themes were generated: (i) current public health nutrition practice was broad, complex, in transition and collaborative; (ii) data/evidence/research relevant to public health needs were insufficiently available and accessible; (iii) the amount and specificity of guidance/leadership was perceived to be mismatched with strong evidence that diet is a risk factor for poor health; (iv) resources/capacity were varied but insufficient and (v) understanding of nutrition expertise in public health among colleagues, leadership and other organisations can be improved. Top ranked needs were increased understanding, visibility and prioritisation of healthy eating and food environments; improved access to data and evidence; improved collaboration and coordination; and increased alignment of activities and goals. CONCLUSIONS: Collective capacity in the public health nutrition can be improved through strategic system-wide capacity-building interventions. Research is needed to explore how improvements in data, evidence and local contexts can bridge research and practice to effectively and efficiently improve population diets and health.

How can we support best practice? A situational assessment of injury prevention practice in public health.

BACKGROUND: To effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health. METHODS: A descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n = 20) and focus groups (n = 19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support. RESULTS: Major themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice. CONCLUSIONS: The results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury.

Defining sustainability in practice: views from implementing real-world innovations in health care.

BACKGROUND: One of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability actually means. Several reviews have helped synthesize and clarify how researchers conceptualize and operationalize sustainability. In this study, we sought to identify how individuals who implement and/or sustain evidence-informed innovations in health care define sustainability. METHODS: We conducted in-depth, semi-structured interviews with implementation leaders and relevant staff involved in the implementation of evidence-based innovations relevant to cancer survivorship care (n = 27). An inductive approach, using constant comparative analysis, was used for analysis of interview transcripts and field notes. RESULTS: Participants described sustainability as an ongoing and dynamic process that incorporates three key concepts and four important conditions. The key concepts were: (1) continued capacity to deliver the innovation, (2) continued delivery of the innovation, and (3) continued receipt of benefits. The key conditions related to (2) and (3), and included: (2a) innovations must continue in the absence of the champion or person/team who introduced it and (3a) adaptation is critical to ensuring relevancy and fit, and thus to delivering the intended benefits. CONCLUSIONS: Participants provided a nuanced view of sustainability, with both continued delivery and continued benefits only relevant under certain conditions. The findings reveal the interconnected elements of what sustainability means in practice, providing a unique and important perspective to the academic literature.

Facilitators and Barriers to the Implementation of iSPRINT: A Sport Injury Prevention Program in Junior High Schools.

OBJECTIVES: Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years). METHODS: Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach. RESULTS: Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization. CONCLUSIONS: Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required.

Supporting public health practice in healthy growth and development in the Province of Ontario, Canada.

BACKGROUND: As public health services are modernized in Ontario, Canada, there is a need to inform the system-level roles and responsibilities of government agencies. The aim of this study was to identify how Public Health Ontario (PHO) can optimally support evidence-based planning and programming in Healthy Growth and Development (HGD) across Ontario. METHODS AND DESIGN: A situational assessment was conducted with key informants from public health and other HGD fields. SAMPLE: Key informants were identified using purposeful snowball sampling and included public health nurses, health promoters, and medical officers of health. Analytic strategy: Twenty telephone interviews and seven focus groups were used to collect data. A thematic analysis was conducted concurrently with data collection. RESULTS: Five themes were identified: (a) Transition to the new Ontario Public Health Standards (OPHS) included experiences of adopting the new OPHS within local public health units (PHUs). (b) Collaborating and networking referred to the ability to work with community partners. (c) Data, evidence, and research described the presence of data, evidence, and research to support practice. (d) Decision making, planning, and priority setting described resources available that influenced decision making. (e) Current and emerging issues in HGD included high-priority topics. CONCLUSION: Public health practice in HGD is complex with many challenges in data and evidence, and making programming decisions without adequate or measurable indicators. A specialized position at PHO is an opportunity to support some of these system-wide needs.

E-cigarettes: A new hazard for children and adolescents.

OBJECTIVES: Electronic cigarettes and fluid (e-cigarettes, e-fluid) are hazardous materials that when inhaled or ingested may pose significant health risks to children and adolescents. The objective of this work was to explore the spectrum of injury related to e-cigarette exposure among Canadian children and adolescents. METHODS: A one-time survey was sent to all paediatricians in Canada. Information was collected on children and adolescents who presented with e-cigarette exposure (inhalation and ingestion cases) in the previous 12 months. Questions included the number of injuries and symptoms, in addition to age, sex, treatment setting, intentional e-cigarette use, and how the products were accessed. RESULTS: A total of 520 surveys were completed and returned, identifying 35 cases. Symptoms related to inhalation were present in 30 cases and in 5 ingestion cases (5 unintentional, 0 intentional). For inhalation cases, most were male, ages 15 to 19 years, who sought treatment for nausea/vomiting, cough, throat irritation, or acute nicotine toxicity in an outpatient clinic/office. Most inhalation cases reported e-cigarette use 2 to 3 days/week, and e-cigarettes purchases from a mall kiosk/store. For ingestion cases, most were male, ages 1 to 4 years presenting to an emergency department with nausea/vomiting, cough, or respiratory irritation. Younger cases accessed e-fluid at home, older cases purchased in a mall kiosk/store. E-fluid flavours reported consumed were fruit, candy, and tobacco. CONCLUSIONS: E-cigarettes, recently introduced into the North American market are hazardous to children and adolescents. Given the low response rate to the survey, further investigation into the true burden of injury, as well as the risks that e-cigarettes pose, together with ways to reduce exposure, is needed.

Spatial distribution of pedestrian-motor vehicle collisions before and after pedestrian countdown signal installation in Toronto, Canada.

BACKGROUND: Pedestrian countdown signals (PCS) have been installed in many cities over the last 15 years. Few studies have evaluated the effectiveness of PCS on pedestrian motor vehicle collisions (PMVC). This exploratory study compared the spatial patterns of collisions pre and post PCS installation at PCS intersections and intersections or roadways without PCS in Toronto, and examined differences by age. METHODS: PCS were installed at the majority of Toronto intersections from 2007 to 2009. Spatial patterns were compared between 4 years of police-reported PMVC prior to PCS installation to 4 years post installation at 1864 intersections. The spatial distribution of PMVC was estimated using kernel density estimates and simple point patterns examined changes in spatial patterns overall and stratified by age. Areas of higher or lower point density pre to post installation were identified. RESULTS: There were 14 911 PMVC included in the analysis. There was an overall reduction in PMVC post PCS installation at both PCS locations and non-PCS locations, with a greater reduction at non-PCS locations (22% vs 1%). There was an increase in PMVC involving adults (5%) and older adults (9%) at PCS locations after installation, with increased adult PMVC concentrated downtown, and older adult increases occurring throughout the city following no spatial pattern. There was a reduction in children's PMVC at both PCS and non-PCS locations, with greater reductions at non-PCS locations (35% vs 48%). CONCLUSIONS: Results suggest that the effects of PCS on PMVC may vary by age and location, illustrating the usefulness of exploratory spatial data analysis approaches in road safety. The age and location effects need to be understood in order to consistently improve pedestrian mobility and safety using PCS.

'Active & Safe Central': development of an online resource for the prevention of injury in sport and recreational activity.

BACKGROUND: Sport and recreation related injuries exert a significant cost on the healthcare system. As prevention researchers and practitioners, we have a responsibility to provide guidance towards prevention to those who participate in sport and recreation, and those that coach, treat and parent children that participate. The objective of this project was to use an integrated knowledge translation approach to develop an end user-driven digital platform that provides injury prevention information and resources across 51 sport and recreational activities. DESIGN: We used an integrated knowledge translation approach to scope and develop an online sport and recreational injury prevention resource. A project team was formed that included end users-coaches, parents and athletes, injury researchers and practitioners, as well as members of a digital design team. All members of the project team informed the development process, including a review of literature and existing resources, the translation of evidence and development of the platform. At all stages of development, members of the project team cocreated knowledge for the tool, including forming the research questions, the approach, feasibility and development of outcomes. CONCLUSION: The 'Active & Safe Central' (https://activesafe.ca/) platform provides web-based sport injury and prevention information. This user-friendly, web and mobile accessible platform can increase the reach, awareness and implementation of prevention programming in sport and recreational activity.

The built environment and active transportation safety in children and youth: a study protocol.

BACKGROUND: Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury. METHODS: First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist's route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries. DISCUSSION: This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team's national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

E-cigarettes: A new hazard for children and adolescents.

OBJECTIVES: Electronic cigarettes and fluid (e-cigarettes, e-fluid) are hazardous materials that when inhaled or ingested may pose significant health risks to children and adolescents. The objective of this work was to explore the spectrum of injury related to e-cigarette exposure among Canadian children and adolescents. METHODS: A one-time survey was sent to all paediatricians in Canada. Information was collected on children and adolescents who presented with e-cigarette exposure (inhalation and ingestion cases) in the previous 12 months. Questions included the number of injuries and symptoms, in addition to age, sex, treatment setting, intentional e-cigarette use and how the products were accessed. RESULTS: A total of 520 surveys were completed and returned, identifying 220 cases. Symptoms related to inhalation were present in 135 cases (43 unintentional, 92 intentional) and in 85 ingestion cases (35 unintentional, 50 intentional). For inhalation cases, most were male, aged 15 to 19 years, who sought treatment for nausea/vomiting, cough, throat irritation or acute nicotine toxicity in an outpatient clinic/office. Most inhalation cases reported e-cigarette use 2 to 3 days/week, and e-cigarettes purchases from a mall kiosk/store. For ingestion cases, most were male, aged 1 to 4 years presenting to an emergency department with nausea/vomiting, cough or respiratory irritation. Younger cases accessed e-fluid at home, older cases purchased in a mall kiosk/store. E-fluid flavours reported consumed were fruit, candy, and tobacco. CONCLUSIONS: E-cigarettes, recently introduced into the North American market are hazardous to children and adolescents. Further investigation into the risks that e-cigarettes pose and ways to reduce exposure is needed to minimize injury.

Temperament and fracture in preschool-aged children.

OBJECTIVES: Approximately one-half of all children will sustain a fracture before adulthood. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. The purpose of this study was to examine the association between temperament and fracture risk in preschool-aged children. METHODS: Children aged 3 to 6 years who were diagnosed with a fracture were recruited from the Hospital for Sick Children Fracture Clinic. Using a retrospective case-control study design, the 148 cases were frequency-matched by age and sex to 426 controls from the TARGet Kids primary care paediatric cohort. The Childhood Behaviour Questionnaire, a 36-item caregiver response questionnaire was used to assess three of the following temperament factors: surgency (e.g., high activity level), negative affect (e.g., anger, fear, discomfort) and effortful control (e.g., attentional focusing). RESULTS: Unadjusted logistic models demonstrated no association between children with previous fracture and higher scores of surgency (unadjusted odds ratio [OR]=1.06, 95% confidence interval [CI]: 0.84, 1.34), negative affect (unadjusted OR=1.15, 95% CI: 0.93, 1.42) or effortful control (unadjusted OR=0.80, 95% CI: 0.63, 1.03). Further, models adjusted for covariates also demonstrated no significant association with surgency (1.00, 95% CI: 0.78, 1.29), negative affect (1.09, 95% CI: 0.86, 1.37) and effortful control (0.80, 95% CI: 0.61, 1.05). CONCLUSION: None of the three main temperament types identified by the Childhood Behaviour Questionnaire were associated with an increase in fracture risk.

A School-Based Injury Prevention Program to Reduce Sport Injury Risk and Improve Healthy Outcomes in Youth: A Pilot Cluster-Randomized Controlled Trial.

OBJECTIVE: To examine a school-based high-intensity neuromuscular training (NMT) program in reducing sport injury risk and improving fitness in youth. PARTICIPANTS: Students (ages 11-15) (n = 725) in physical education (PE) classes were randomized by school to intervention or control groups. INTERVENTION: A 12-week high-intensity NMT program (including aerobic, strength, balance, and agility components) was designed to reduce sport injury risk and improve measures of fitness. The control program was a standard of practice warm-up (including running and stretching). RESULTS: A Poisson regression model using an intent-to-treat analysis demonstrated a reduced risk of sport injury: incidence rate ratio (IRR)all injury = 0.30 (95% CI, 0.19-0.49), IRRlower extremity injury = 0.31 (95% CI, 0.19-0.51), IRRankle sprain injury = 0.27 (95% CI, 0.15-0.50), and IRRknee sprain injury = 0.36 (95% CI, 0.13-0.98). A change in waist circumference: -0.99 centimeters (95% CI, -1.84 to -0.14) and an increase in indirect measures of aerobic fitness: 1.28 mL·kg·min (95% CI, 0.66-1.90) in the intervention school compared with the control school also occurred. CONCLUSIONS: A NMT program in junior high school PE class was efficacious in reducing sport-related injury and improving measures of adiposity and fitness in the intervention group.

The development of a framework to integrate evidence into a national injury prevention strategy.

BACKGROUND: Injury is the leading cause of death from birth to age 34 in Canada (Statistics Canada, 2008). In 2013, a national injury prevention organization in Canada initiated a research-practitioner collaboration to establish a framework for incorporating evidence in the organization's decision-making. In this study, we outline the development process and provide an overview of the framework. METHODS: The process of development of the evidence-synthesis framework included consultation with national and international injury prevention experts, a review of the research literature to identify existing models for incorporating research evidence into public health practice and extensive interactions with the organization's leadership and staff. RESULTS: A framework emphasizing four types of research evidence was recommended: (i) epidemiologic evidence describing the burden and cause of injury, (ii) evidence concerning the effectiveness of interventions, (iii) evidence on effective methods for implementing promising interventions at a population level, and (iv) evidence and theory from the behavioral sciences. Through the evidence-synthesis process the framework prioritizes highly synthesized evidence-based strategies and draws attention to important research gaps. CONCLUSIONS: This study describes a novel opportunity to operationalize an organization's commitment to integrate evidence into practice. The framework provides guidance on how to use evidence strategically to maximize the potential impact of prevention efforts. Opportunities for further evaluation and dissemination are discussed.