Paediatric elbow fractures and public play spaces: adherence to standards for children's playground equipment and surfacing.

Background: Supracondylar humerus fractures (SCHF) are the most common fractures sustained following a fall onto an outstretched hand among healthy children, and one of the leading causes of hospital admission and surgical intervention. The aim of this study was to examine SCHF occurring at public play spaces-particularly to determine whether or not the playground equipment implicated in injurious falls aligned with Canadian playground safety standards. Methods: Cases of children who attended the provincial paediatric orthopaedic clinic following SCHF at a public playground between April 2017 and October 2019 were included in the study. A research assistant visited each playground to measure the play structure type and dimensions, height of the equipment at the point from which the child fell and the type and depth of the surface material, and compare measurements to the 2016 safety standards. Child demographics and injury classification were also noted. Descriptive statistics were calculated and a scatterplot of fall height and surface depth was generated. Results: Forty-three sites, representing 47 SCHF cases (18 female, 29 male), were included in the final analysis. Fourteen children sustained type 1 fracture, 23 had type 2 fracture and the remaining 10 had type 3 fracture. Five children with type 2 fracture and all 10 children with type 3 fracture required surgery. The majority of sites had engineered wood fibre surfacing, with surfacing at 35 sites being less than 300 mm deep. Twenty-six play structures were upper body equipment (ie, monkey bars or similar), seven were track rides, five were rotating structures and the rest comprised a variety of classified and unclassified structures. Twenty-seven children fell from a height exceeding 2 m. Conclusions: The majority of SCHF cases occurred at playgrounds with insufficient surface depth and/or non-compliant equipment. Upper body equipment, track rides and rotating play structures were of particular concern, as the children fell from heights exceeding the recommended standard, likely reflecting the degradation and compaction of the surfacing material over time.

The English Knee Self-Efficacy Scale is a valid and reliable measure for knee-specific self-efficacy in individuals with a sport-related knee injury in the past 5 years.

PURPOSE: To translate and cross-culturally adapt the Swedish Knee Self-Efficacy Scale (K-SES) into English and evaluate the measurement properties in a sample of individuals with previous knee injury. METHODS: Translation, cross-cultural adaptation, and evaluation followed the Beaton multi-step process and COSMIN guidelines. Participants (n = 125) aged 16-60 years with a sport-related intra-articular tibiofemoral or patellofemoral injury within the last 5 years completed the K-SES, Knee Injury and Osteoarthritis Outcome Score, Anterior Cruciate Ligament-Return to Sport After Injury Scale, Tegner Activity Level Scale, and Multi-dimensional Health Locus of Control. Confirmatory factor analysis (CFA) tested a-priori two-factor structure and model fit. Cronbach-alpha, intra-class correlation coefficient (ICC), and absolute reliability (Bland-Altman plots) were calculated. Construct validity was assessed by eight pre-defined hypotheses. A sub-group of participants (n = 42) completed the K-SES twice to assess intra-rater reliability. RESULTS: The cross-cultural adaptation generated an English K-SES with face and content validity. The original two-factor structure was rejected based on CFA and a revised solution informed by Exploratory Factor analysis resulted in an adequate fit. All construct validity hypotheses were confirmed. The K-SES showed good internal consistency [Factor (F1: α = 0.96; F2: α = 0.73)], intra-rater reliability (ICC = 0.92), and no systematic bias between repeated measurements. CONCLUSION: The English K-SES is a valid and reliable measure for knee-specific self-efficacy in individuals who have sustained a sport-related intra-articular knee injury in the previous 5 years. LEVEL OF EVIDENCE: IV.

Moderating effects of family environment on overweight/obese adolescents' dietary behaviours.

BACKGROUND: The familial environment can influence adolescents' risk for obesity. However, we do not fully understand the mechanisms through which parents can influence overweight/obese adolescents' dietary behaviours, specifically whether parenting practices (e.g., rules or routines) and/or their own dietary behaviours are associated with their overweight/obese adolescent's dietary quality. OBJECTIVES: This study examined whether parenting practices and/or parental modeling of dietary quality are associated with overweight/obese adolescents' dietary quality while considering the moderating effects of parenting styles and family functioning. METHODS: Baseline data from 172 overweight/obese adolescents and one of their parents who enrolled in a lifestyle modification intervention were analyzed [mean age = 13.1 (1.8); mean BMI z-score = 2.70 (0.83)]. Parent-adolescent dyads completed three 24-hr dietary recalls online. An index of dietary quality was computed by summing the scores for different food categories assessed in the dietary recall over 3 days. Parents completed questionnaires about their family functioning, dietary parenting practices (i.e., whether child eats breakfast everyday), and styles (authoritative and permissive). Path analysis was used to model interrelationships among the variables using the Stata software version 13. RESULTS: Parental modeling of dietary quality was significantly associated with adolescent dietary quality. Additionally, parenting styles significantly moderated parental modeling, such that an authoritative parenting style in conjunction with modeling healthy eating habits was associated with better adolescent dietary quality. CONCLUSIONS: This work suggests that parental modeling of health behaviours is important; however, it is necessary to consider the broader emotional/relational context into which modeling is expressed since parenting styles moderated these effects. This study provides insight into how parenting styles may alter the effectiveness of parental modeling and highlights the need to account for parenting styles to improve the efficacy of current family-based interventions.