Trends in child pedestrian motor vehicle collision injury rates by neighborhood deprivation score in Toronto, Canada.

We examined trends from 2000 to 2019 in child pedestrian motor vehicle collision (PMVC) injury rates in Toronto, Canada, to see if injury trends varied by neighbourhood deprivation. This 20-year period was associated with major road safety policy changes in the City. A Poisson regression analysis examined police-reported data on children (age 1-19 years), killed or seriously injured (KSI) PMVC rates, by deprivation status (using the Ontario Marginalization Index), over the period 2000-2019. Models controlled for location (urban core v. inner suburbs) and evaluated potential interactions. There were 523 child pedestrian KSI collisions from 2000 to 2019. Over this period, KSI rates decreased by more than 50 % across all neighbourhood deprivation levels. Steep declines from 2000 to 2010 were followed by level or increasing child PMVC rates from 2010 to 2019. Higher deprivation was associated with slightly elevated KSI rates; although not statistically significant. It is important to learn from road safety policy "successes" and ensure that future road safety interventions are applied equitably across areas, accounting for deprivation and location.

Once bitten, twice shy? Medically-attended injuries can sensitise parents to children's risk of injuries on playgrounds.

OBJECTIVE: To compare risk perceptions of parents whose child sustained a medically attended playground injury (cases) with those of parents whose child had not (controls) to address two questions. Does having a child experience a medically attended injury: (1) sensitise parents to children's injury vulnerability and severity; (2) influence parents' appraisal of the injury mechanism (child's behaviour), attributions for injuries or beliefs about strategies for prevention? METHOD: Each case-control parent dyad was assigned to one of two conditions: (1) being presented with 10 common injury-risk playground behaviours specific to the equipment on which their child had been hurt, and asked to appraise injury vulnerability and severity; or (2) being presented with scenarios about playground injuries that varied in severity but were all based on the same child behaviour, and asked questions about this behaviour, attributions for injury and strategies for prevention. RESULTS: The results support the occurrence of a sensitisation process. Compared with control parents, case parents showed higher ratings of injury severity and children's vulnerability to injury, made fewer attributions for injuries to bad luck, and endorsed a greater diversity of prevention strategies, including parent (closer supervision), child (teaching rules about safe play on playgrounds) and environmental (modifications to playgrounds). CONCLUSIONS: A child's medically attended injury can create a "teachable moment" for the parent. Linking injury-prevention programming to this teachable moment may increase the likelihood of evoking changes in parental supervisory behaviour and their setting of rules limiting their child's risk behaviours to reduce the occurrence of childhood injury.

Booster seat laws and child fatalities: a case-control study.

A case-control study examined, primarily, the association between booster seat laws and fatalities among children in frontal collisions and, secondarily, the association between booster seat laws and reported restraint use, and restraint use and child fatalities. Children who died in a crash in the US were cases, and children who survived a fatal crash were controls. Subjects were child passengers (4-8 years old) in the Fatality Analysis Reporting System Database, 1995-2005. In states with a booster seat law, children were less likely to die than in states without a law (OR 0.80; 95% CI 0.66 to 0.98). They were also more likely to be restrained (adjusted OR 1.59; 95% CI 1.21 to 2.09) and were more likely to be correctly restrained (adjusted OR 4.44; 95% CI 3.18 to 6.20). It is concluded that booster seat laws are associated with a decrease in child deaths and an increase in correct restraint use among children involved in a fatal crash in the USA.

Are school zones effective? An examination of motor vehicle versus child pedestrian crashes near schools.

OBJECTIVE: To analyse the relationships between factors related to school location and motor vehicle versus child pedestrian collisions. METHODS: Data on all police-reported motor vehicle collisions involving pedestrians less than 18 years of age that occurred in Toronto, Canada, between 2000 and 2005 were analysed. Geographic information systems (GIS) software was used to assess the distance of each collision relative to school location. The relationships between distance from school and collision-related factors such as temporal patterns of school travel times and crossing locations were analysed. RESULTS: Study data showed a total of 2717 motor vehicle versus child (<18) pedestrian collisions. The area density of collisions (collisions/area), particularly fatal collisions, was highest in school zones and decreased as distance from schools increased. The highest proportion of collisions (37.3%) occurred among 10-14-year-olds. Within school zones, collisions were more likely to occur among 5-9-year-old children as they travelled to and from school during months when school was in session. Most collisions within school zones occurred at midblock locations versus intersections. CONCLUSIONS: Focusing interventions around schools with attention to age, travel times, and crossing location will reduce the burden of injury in children. Future studies that take into account traffic and pedestrian volume surrounding schools would be useful for prevention efforts as well as for promotion of walking. These results will help identify priorities and emphasise the importance of considering spatial and temporal patterns in child pedestrian research.

A comparison of booster seat use in Canadian provinces with and without legislation.

BACKGROUND: The use of booster seats continues to be low, despite their effectiveness in reducing injury in motor vehicle collisions. Many jurisdictions have introduced legislation requiring the use of booster seats. To date, there have been no Canadian studies evaluating the effectiveness of legislation on booster seat use. OBJECTIVES: To describe restraint use among Canadian children aged 4-8 years, and compare booster seat use between provinces/territories with and without legislation. METHODS: The data were obtained from a National Survey of Child Restraint Use/Misuse conducted between June and August 2006. A roadside observation survey was conducted at 182 sites across Canada. Weighted statistical analyses of differences in proportions were conducted, accounting for sampling stratification and clustering by car effects. RESULTS: The roadside survey estimated that 24.6% of children aged 4-8 were restrained in booster seats in provinces with legislation, compared with 16.6% in provinces without (p<0.001). CONCLUSION: This is the first Canadian national study using direct observation to determine the effect of legislation on booster seat use. Provinces with legislation had higher booster seat use, but overall rates were still disappointingly low. Ongoing surveillance of child safety seat use and evaluation of effective adjuncts to legislation is required in order to see collision-related child deaths and injuries drop in the future.

Pedestrian injuries in school-attending children: a comparison of injury data sources in a low-income setting.

OBJECTIVE: To estimate and compare the rate of pedestrian injuries in primary school-attending children of urban Uganda using different data sources. DESIGN: Data collection from a hospital-based trauma registry, police data, teacher reports, and a cross-sectional community-based survey. SETTING: Kawempe, the largest urban district in the capital Kampala, Uganda. Patients or SUBJECTS: Primary school-attending children aged 4-12 from 39 randomly selected schools were included in the trauma registry, police data, and teacher reports. 1828 households randomly selected from the 39 schools were interviewed for the community survey. MAIN OUTCOME MEASURE: A pedestrian injury. For the trauma registry-defined as a pedestrian injury resulting in a visit to the hospital. For the police data-defined as a pedestrian injury reported to the police. For the teacher reports and survey-defined as a pedestrian injury resulting in at least a day off school. RESULTS: The estimated pedestrian injury rates per 100 000 person-years were 54.0 (95% CI 25.3 to 117.4), <53.97 (95% CI 23.8 to 125.9), 1878.8 (95% CI 1513.1 to 2322.4), and 764.0 (95% CI 523.3 to 1117.2) from the trauma registry, police data, teacher reports, and community survey, respectively. CONCLUSIONS: Pedestrian injury rates differed significantly between different data sources. Users must be aware of the different target populations, definitions, and limitations of the data sources before direct comparisons are made. Injury reports by volunteer teachers may be a feasible source of injury data in other low/middle-income countries.

Introduction of Water-Vapor Broadening Parameters and Their Temperature-Dependent Exponents Into the HITRAN Database: Part I-CO2, N2O, CO, CH4, O2, NH3, and H2S.

The amount of water vapor in the terrestrial atmosphere is highly variable both spatially and temporally. In the tropics it sometimes constitutes 4-5% of the atmosphere. At the same time collisional broadening of spectral lines by water vapor is much larger than that by nitrogen and oxygen. Therefore, in order to accurately characterize and model spectra of the atmospheres with significant amounts of water vapor, the line-shape parameters for spectral lines broadened by water vapor are required. In this work, the pressure-broadening parameters (and their temperature-dependent exponents) due to the pressure of water vapor for spectral lines of CO2, N2O, CO, CH4, O2, NH3, and H2S from both experimental and theoretical studies were collected and carefully reviewed. A set of semiempirical models based on these collected data was proposed and then used to estimate water broadening and its temperature dependence for all transitions of selected molecules in the HITRAN2016 database.

The spectrum of growing skull fracture in children.

The genesis and complications of the growing skull fracture in children is discussed. Four patients are presented to illustrate the common and uncommon features of growing skull fractures. The need for complete radiological evaluation as well as the timing of follow-up examinations is stressed.

Determining suitability for home versus community-based ambulatory therapy services for adults with arthritis.

OBJECTIVE: A survey of clients seen by a community-based arthritis therapy service was conducted to investigate how characteristics of clients might provide information to assist in the development of guidelines for services delivered in the home versus in a community-based ambulatory setting. METHODS: Clients completed a self-administered questionnaire, which included the Health Assessment Questionnaire, and a mobility handicap measure. Two indicator variables selected as criteria for suitability for ambulatory therapy were the therapists' rating of client suitability and the clients' report of going out more than once weekly. RESULTS: Based on these indicator variables, 60-76% of clients currently receiving home therapy by this service could potentially receive services in a community-based ambulatory setting. CONCLUSION: The results demonstrate the usefulness of considering client characteristics when deciding whether clients need to be seen at home. This study emphasizes the need to determine the most efficient and effective methods of providing services to people in the community with chronic conditions.

Modeling physical dependence in arthritis: the relative contribution of specific disabilities and environmental factors.

OBJECTIVES: To explore the relationship between disability and physical dependence handicap, and the mediating effect of personal (demographic) and environmental factors as modeled by the International Classification of Impairments, Disability, and Handicaps. METHODS: Data on people with arthritis-associated disabilities were abstracted from a national population survey (n = 16,017). A hierarchical physical dependence variable was formulated. Nominal logistical regression was used to determine predictors of physical dependence related to specific disability, personal characteristics, and environmental adaptation variables. RESULTS: The risk of physical dependence only increased substantially at age > or = 75 years. Specific types of physical disability differentially predicted different levels of physical dependence. The major predictor of physical dependence was disability alone and in conjunction with environmental factors. CONCLUSIONS: There appears to be a specific and ordered relationship between the level of physical dependence and various types of physical disabilities. The findings could have implications for therapeutic intervention and health status measures.

Computed tomography and angiography in the diagnosis of suprasellar mass lesions.

We studied four cases in which the differentiation between a noncalcified suprasellar aneurysm and tuberculum meningioma, and a calcified suprasellar aneurysm and craniopharyngioma, could not be established by computed tomography scan alone. Cerebral angiography clearly showed both aneurysms.

Intracranial ectopic pituitary adenoma. Case report.

The authors report a unique case of ectopic intracranial pituitary adenoma, associated clinically with generalized seizures and aggressive behavior. The lesion presumably arose from cells in the pars tuberalis and did not involve the sella turcica.

Jugular venography for evaluation of abnormalities of the skull base.

Jugular venography done to evaluate abnormalities at the base of the skull demonstrated three distinctly different patterns depending on whether there is occlusion, invasion, or growth with in the internal jugular vein. Improper technique results in a lack of intracranial dural sinus filling which may masquerade as venous occlusion. This problem is avoided by adequate neck compression along with proper volume and rate of delivery of contrast. Radiographically, an abnormal jugular vein at the base of the skull will show a concave defect in true occlusion, constriction or invasion of the vein by tumor, or tumor growth within the vein.

Relative singularity/mixedness judgements for selected taste stimuli.

Quinine hydrochloride, fructose, citric acid, NaCl, monosodium glutamate, KCl, and mixtures of two, three and four solutes were rated and ranked along a continuum from "single" to "mixed" tasting. Quinine was judged most singular, with fructose and citric acid forming a second most singular group. Other stimuli were intermediate while the mixtures were judged most mixed, the mixedness increasing with mixture complexity. When NaCl and fructose were judged with their binary mixtures in the same manner, the degree of mixedness of the mixtures varied with the proportions of the components.

School contact tracing following a cluster of tuberculosis cases in two Scarborough schools.

Ten refugee children from an extended family were diagnosed with active tuberculosis. The family had recently arrived in Scarborough from Somalia. Mantoux skin testing was organized by the local health department for students in the two schools the children attended. An eleventh active case was found on screening. The reactivity rate for children tested once was 1.2% for Canadian-born students, and 14.6% for foreign-born students. Reactivity rates of students tested once were not significantly higher than those in comparison schools. Repeat skin testing of non-reactors revealed a conversion rate of 4.4%. This rate may be an overestimate as a result of the booster phenomenon. Increased risk of testing positive was associated with a history of BCG and being foreign-born in all schools. As rates of tuberculin reactivity have greatly increased in Scarborough schools since the early 1980s, it is recommended that health departments screen foreign-born students for tuberculosis upon entrance to school.

The nature of increased hospital use in poor neighbourhoods: findings from a Canadian inner city.

The relationship between socioeconomic factors and hospital use is not well understood in the Canadian context. We used the 1991 Canada census and 1990-92 Ontario hospital discharge abstracts for residents of southeast Toronto to calculate crude and age-sex adjusted rates of hospital admission, bed days, and costs by quintile of low-income households. Population-based rates of admission to hospital, bed days and costs were all significantly related to census tract income (p < 0.01 for males and females). The number of admissions per person admitted was significantly associated with census tract income (p < 0.01 for males and females), but length of stay and resource intensity weight were not. Hospital costs were 50.0% higher for the poorest quintile of neighbourhoods than for the wealthiest and 35.8% higher than for the middle-income quintile. Poor urban neighbourhoods may require more resources than previously anticipated, related to higher hospital admission and readmission rates.

Tongue paralysis following head trauma.

Paralysis of the tongue due to isolated bilateral hypoglossal nerve palsy is a rare occurrence. Due to a trauma the cause in our case may have been a traction injury to both hypoglossal nerves at the base of skull. In some cases a contributing factor may be malformation of the skull base. Most cases have a good prognosis for recovery.

Stage managing change: supporting new patient care models.

The scope and accelerated pace of change is providing high drama in health care organizations today. The Central DuPage Hospital experience of transitioning to patient-focused care was driven by aggressive targets and tight timelines. Providing practical, adaptable change management strategies to key players ensured a well-staged transition to the new models of patient care.

Effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes in China / 中华流行病学杂志

Objective To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China.Methods In this cluster randomized controlled trial,a total of 799 T2DM patients with most recent hemoglobin Alc (HbAlc) ≥ 7.5％ (or fasting plasma glucose level ≥ 10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai,and randomized into a health literacy intervention group,an exercise intervention group,a comprehensive intervention group and a control group.After baseline survey and examination,a one-year intervention and 3 times (at 3rd,6th,and 12th month) follow-up surveys were conducted.Results The follow-up rates for all the subjects were 99.4％,98.4％ and 95.2％,respectively,at 3rd,6th and 12th month.Patients in intervention groups were more likely to achieve a goal HbAlc level (HbA1c ＜ 7.0％) than those in control group,with the highest glycemic control rate (25.3％) observed in comprehensive intervention group at 3rd month and then in exercise intervention group (25.3％ and 34.6％) respectively,at 6th month and 12th month.The average levels of HbAlc in three intervention groups were lower at each follow-up time point than those at baseline survey.However,the decreases in HbA1c were obvious only at 6th month (P＜0.001),with ls-mean (95％CI) of-0.48％ (-0.71％,-0.25％),-0.33％ (-0.55％,-0.11％) and-0.70％ (-0.92％,-0.48％),respectively,in comprehensive,health literacy and exercise intervention groups,but it increased slightly by 0.03％ (-0.19％,0.25％) in control group.Compared with control group,the interventions were significantly associated with the decrease of HbA1c level,with the most improvement observed in comprehensive group (3 =-0.47,95％ CI:-0.73,-0.20) at 3rd month,and in exercise intervention group at 6th month (3=-0.73,95％CI:-0.98,-0.47) and at 12th month (β=-0.75,95％CI:-1.05,-0.45) of follow-up.Stratified analyses showed that patients with lower health literacy level could benefit from any intervention,while those with higher numeracy skill benefited more from exercise intervention.Conclusion Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM,which would be helpful in reducing the risks of complications and deaths in diabetes patients.

Effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes in China / 中华流行病学杂志

Objective: To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China. Methods: In this cluster randomized controlled trial, a total of 799 T2DM patients with most recent hemoglobin A1c (HbA1c) ≥ 7.5% (or fasting plasma glucose level ≥10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai, and randomized into a health literacy intervention group, an exercise intervention group, a comprehensive intervention group and a control group. After baseline survey and examination, a one-year intervention and 3 times (at 3(rd), 6(th), and 12(th) month) follow-up surveys were conducted. Results: The follow-up rates for all the subjects were 99.4%, 98.4% and 95.2%, respectively, at 3(rd), 6(th) and 12(th) month. Patients in intervention groups were more likely to achieve a goal HbA1c level (HbA1c <7.0%) than those in control group, with the highest glycemic control rate (25.3%) observed in comprehensive intervention group at 3(rd) month and then in exercise intervention group (25.3% and 34.6%) respectively, at 6(th) month and 12(th) month. The average levels of HbA1c in three intervention groups were lower at each follow-up time point than those at baseline survey. However, the decreases in HbA1c were obvious only at 6(th) month (P<0.001), with ls-mean (95%CI) of -0.48% (-0.71%, -0.25%), -0.33% (-0.55%, -0.11%) and -0.70% (-0.92%, -0.48%), respectively, in comprehensive, health literacy and exercise intervention groups, but it increased slightly by 0.03% (-0.19%, 0.25%) in control group. Compared with control group, the interventions were significantly associated with the decrease of HbA1c level, with the most improvement observed in comprehensive group (β=-0.47, 95% CI: -0.73, -0.20) at 3(rd) month, and in exercise intervention group at 6(th) month (β=-0.73, 95%CI: -0.98, -0.47) and at 12(th) month (β=-0.75, 95%CI: -1.05, -0.45) of follow-up. Stratified analyses showed that patients with lower health literacy level could benefit from any intervention, while those with higher numeracy skill benefited more from exercise intervention. Conclusion: Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM, which would be helpful in reducing the risks of complications and deaths in diabetes patients.