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Background Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport’s safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females. Objective The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby. Methods To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex. Results Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9–66.5) in males and 69.0/1000 match hours (95% CI 46.8–91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0–7.4) for males and 33.9/1000 player-hours (95% CI: 24.1–43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2). Conclusion A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby.

Although high rates of injury occur in youth ice hockey, disagreements exist about the risks and benefits of permitting bodychecking. We sought to evaluate associations between experience with bodychecking and rates of injury and concussion among ice hockey players aged 15-17 years.We obtained data from a prospective cohort study of ice hockey players aged 15-17 years in Alberta who played in leagues that permitted bodychecking. We collected data over 3 seasons of play (2015/16-2017/18). We compared players based on experience with bodychecking (≤ 2 v. ≥ 3 yr), estimated using local and national bodychecking policy and region of play. We used validated methodology of ice hockey injury surveillance to identify all injuries related to ice hockey games and defined concussions according to the Consensus Statement on Concussion in Sport.We included 941 players who contributed to 1168 player-seasons, with 205 players participating in more than 1 season. Compared with players with 2 years or less of bodychecking experience, those with 3 or more years of experience had higher rates of all injury (adjusted incidence rate ratio [IRR] 2.55, 95% confidence interval [CI] 1.57-4.14), injury with more than 7 days of time loss (adjusted IRR 2.65, 95% CI 1.50-4.68) and concussion (adjusted IRR 2.69, 95% CI 1.34-5.42).Among ice hockey players aged 15-17 years who participated in leagues permitting bodychecking, more experience with bodychecking did not protect against injury. This provides further support for removing bodychecking from youth ice hockey.

IntroductionTraffic injury is a leading and preventable cause of child death and disability, with child pedestrians and cyclists particularly vulnerable. Examining built environment correlates of child pedestrian and cyclist motor vehicle collisions (PCMVC) in different settings is needed to promote an evidence-based approach to road safety.MethodsWe conducted a cross-sectional study across multiple urban/suburban environments in Canada (Calgary, Toronto, Montreal, Laval, Peel Region). All public elementary schools were included (n=1030). We examined the role of land use/social environments, road environments and traffic safety interventions on the rates of child PCMVC within 1000 m of schools. Multivariable negative binomial regression was conducted for all cities and by individual city. In a subset of schools (n=389), we examined associations when controlling for active school transportation (AST).ResultsMean PCMVC rate per school ranged from 0.13 collisions/year in Peel to 0.35 in Montreal. Child PCMVC were correlated with land use, social and road environments and traffic safety interventions. In fully adjusted models, social and land use features remained the most important correlates. New immigrant population had the largest positive association with child PCMVC (incidence rate ratio (IRR): 1.26, 95% CI 1.06 to 1.50), while old housing (pre-1960) density was most protective (IRR: 0.83, 95% CI 0.77 to 0.90). AST was associated with PCMVC, but it had no effect on the relationships between PCMVC and other social/environmental correlates.ConclusionThe built environment and social factors influence rates of child PCMVC. Opportunities to reduce child PCMVC exist through modifications to city design and road environments and implementing traffic safety interventions.

BackgroundConcussion is a common injury in children and adolescents. Current best practice guidelines indicate that recovery should be supervised through recurrent follow-up visits. A more detailed understanding of the system-level and individual factors that are associated with follow-up care is a critical step towards increasing evidence-based practice. The objective of this study was to identify predisposing, enabling, and need-based factors associated with follow-up care after pediatric concussion.Materials and methodsA retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients Results194,081 EOCs occurred during the study period but only 13% involved follow-up care (n = 25,461). Males and adolescents were more likely to receive follow-up care. Follow-up was less likely among patients who lived in remote communities or in areas of lower SES, while EOCs beginning in 2011 or later were more likely to involve follow-up care. Patients whose EOC began in outpatient settings, had more than one EOC, or a diagnosis of concussion were more likely to receive follow-up care.ConclusionFollow-up care for pediatric concussion has increased over time and is associated with patient age and sex, history of concussion-related EOC, where a patient lives (community type and area-based SES), and when and where the index visit occurs. A better understanding of which children are more likely to receive follow-up care, as well as how and when they do, is an important step in aligning practice with follow-up guidelines.

OBJECTIVES To describe injury and concussion rates and mechanisms in female high school rugby players. DESIGN Two-year prospective cohort study. SETTING High school rugby. PARTICIPANTS Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition. INTERVENTION None. MAIN OUTCOME MEASURES Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates. RESULTS A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6). CONCLUSIONS Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.

It is believed youth snow-sports injuries are preventable through adequate safety education. This study evaluated the effectiveness of a ski and snowboard injury prevention video on youth safety knowledge. A cluster randomized controlled trial was conducted among grade 2-9 students participating in a ski-snowboard school program. The intervention group watched a new injury prevention video. The control group watched the general ski-area orientation video. Students completed a 15-question ski-snowboard safety test before, immediately after, and one month after viewing. Within-subject difference between the pre- and post-questionnaire scores was calculated. Linear mixed-effects model assessed difference in knowledge change scores. 1034 students (seven intervention; 10 control schools) were enrolled. Pre- to-post-test knowledge increased by an average of 1.91 in the intervention (n = 388) and 0.10 points in the control (n = 646). The difference between the immediate and one-month post-test was 0.17 for the intervention (n = 122) and 0.60 for the control (n = 130). The mean change score for the immediate post-test was greater in the intervention (1.77; 95% CI: 1.52-2.03). The mean change score between the immediate and one-month post-test was lower (−0.55; 95% CI: −1.07 to 0.02) for the intervention compared with the control. The findings showed a ski-snowboard safety video can increase knowledge immediately after viewing within a school-aged population.

Novice adolescent drivers have a higher propensity to engage in risky driving and are at higher odds of being involved in collisions. Graduated driver licensing programs have been instituted to help novice drivers gain experience while avoiding higher risk driving circumstances. This study examines modifiable risk factors contributing to novice adolescent driver fault in collisions.Police traffic collision report data from municipalities in Alberta for the years 2010-2016, inclusive, were used. Fault in collision was assigned using an automated and previously validated tool for assigning culpability. Factors contributing to novice adolescent (16-19 years of age) fault in collision were examined using multivariable logistic regression.Novice adolescent drivers had higher adjusted odds ratios (aOR) of being at-fault in collision when driving from 01:00-05:00 (aOR = 1.38; 95% Confidence Interval [CI]: 1.26-1.50). Novice adolescent drivers had lower odds of fault when driving with an adult (aOR= 0.62; 95% CI: 0.57-0.68) or a single peer (aOR= 0.87; 95% CI: 0.80-0.94), but higher odds of causing a severe collision with a single peer present (aOR= 2.23; 95% CI: 1.21-4.11). Impairment of the teen driver was reported in 25% of all fatal collisions, and 40% of late-night fatal collisions.The findings support policies that allow driving with a single adult or peer passenger during daytime hours. Driving during late-night hours should be restricted for novice adolescent drivers.

Objectives The primary objective of this paper is to examine terrain park (TP) feature compliance with recommendations from a ski area industry guide (are TP features compliant with the guide?) and determine factors that could be associated with TP feature compliance in Québec ski areas (do factors influence TP feature compliance?), Canada. These recommendations on the design, construction and maintenance are provided by the Québec Ski Areas Association Guide. Methods A group of two to four trained research assistants visited seven ski areas. They used an evaluation tool to assess the compliance of 59 TP features. The evaluation tool, originally developed to assess the quality of TP features based on the guide, was validated in a previous study. Compliance was calculated by the percentage of compliant measures within a given feature. The potential influence of four factors on compliance (size of the TP, size of the feature, snow conditions and type of feature) were examined using a mixed-effects logistic regression model. Results The average TP feature compliance percentage was 93% (95% CI 88% to 99%) for boxes, 91% (95% CI 89% to 94%) for rails and 89% (95% CI 86% to 92%) for jumps. The logistic regression showed that none of the four factors examined were associated with TP feature compliance with the guide. Conclusion Our results suggest that TP features are highly compliant with the guide in Québec ski areas.

BackgroundPedestrians are commonly involved in vehicle collisions that result in injuries and fatalities. Pedestrian distraction has become an emerging safety issue as more pedestrians use their mobile phones while walking and crossing the street.ObjectivesThe purpose of this research synthesis and meta-analysis is to determine the extent to which cell phone conversation, text messaging or browsing, and listening to music affect a number of common pedestrian behavioural measures.MethodsA keyword search was developed with a subject librarian that used MeSH terms from selected databases including PsycINFO, SPORTDiscus, Medline and TRID. Supplemental searches were also conducted with Google Scholar and Mendeley.Effect size codingThirty-three studies met inclusion criteria and were subjected to data extraction. Statistical information (ie, M, SD, SE, 95% CI, OR, F, t) was extracted to generate standardised mean difference effect sizes (ie, Cohen’s d) and r effect sizes.ResultsFourteen experimental studies were ultimately included in an N-weighted meta-analysis (k=81 effect sizes), and eight observational studies were included in a qualitative overview. Both mobile phone conversation and text messaging increased rates of hits and close calls. Texting decreased rates of looking left and right prior to and/or during street crossing. As might be expected, text messaging was generally found to have the most detrimental effect on multiple behavioural measures.LimitationsA variety of study quality issues limit the interpretation and generalisation of the results, which are described, as are future study measurement and methods improvements.

ObjectivesTo compare rates of injury and concussion among U-15 (ages 13–14 years) ice hockey players playing in leagues allowing body checking, but who have a varying number of years of body checking experience.MethodsThis 5-year longitudinal cohort included U-15 ice hockey players playing in leagues where policy allowed body checking. Years of body checking experience were classified based on national/local body checking policy. All ice hockey game-related injuries were identified using a validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician. Multiple multilevel Poisson regression analysis was performed, adjusting for important covariates and a random effect at a team level (offset by game exposure hours), to estimate injury and concussion incidence rate ratios (IRRs).ResultsIn total, 1647 players participated, contributing 1842 player-seasons (195 players participating in two seasons). Relative to no body checking experience, no significant differences were found in the adjusted IRRs for game-related injury for players with 1 year (IRR=1.06; 95% CI: 0.77 to 1.45) or 2+ years (IRR=1.16; 95% CI: 0.74 to 1.84) body checking experience. Similarly, no differences were found in the rates of concussion for players with 1 year (IRR=0.92; 95% CI: 0.59 to 1.42) or 2+ years (IRR=0.69; 95% CI: 0.38 to 1.25) body checking experience.ConclusionsAmong ice hockey players aged 13–14 years participating in leagues permitting body checking, the adjusted rates of all injury and concussion were not significantly different between those that had body checking experience and those that did not. Based on these findings, no association was found between body checking experience and rates of injury or concussion specifically in adolescent ice hockey.

ObjectiveTo evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT).MethodsThis was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014–2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses.Results1067 students (aged 11–16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively).ConclusionThe iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students.Trial registration numberNCT03312504

BackgroundProper helmet fit is an important consideration for preventing head injuries, including concussions, in helmeted sports like youth ice hockey and ringette. Helmet fit assessments are typically completed in-person;however, this was not possible given COVID-19 restrictions. Thus, alternative considerations for virtual assessments were required.ObjectiveTo examine the feasibility and inter-rater reliability of virtual ice hockey and ringette helmet fit assessments.DesignCross-sectional.SettingCalgary, Canada.ParticipantsElite/upper division youth (ages 13–18) ice hockey (n=31 males) and ringette (n=30 females) players.Assessment of Risk FactorsStandardized ice hockey/ringette helmet fit criteria were developed and reliable for in-person assessments. Criteria were adapted for virtual delivery to participants over ZOOM video platform individually by two trained assessors per sport.Main Outcome MeasurementsTwelve helmet fit criteria scored as yes/proper fit or no/poor fit were used to assess helmet shell fit (e.g., helmet fits snug, doesn’t cover eyes), positioning (e.g., helmet is 1–2 finger widths above eyebrows, covers base of skull), facemask fit (e.g., chin piece fits, facemask does not move left/right), and others. Percent agreement (PA) between raters was used to describe inter-rater reliability, and each rater documented barriers for completing the assessments virtually.ResultsAcceptable PA (>80%) was demonstrated for 8/12 criterion for ice hockey and 9/12 for ringette. Below acceptable agreement was found for all four criterion assessing the helmet facemask fit (PA range: 48%-74%) in ice hockey players and criteria for the chin straps fit (PA=66%), helmet positioning (PA=73%), and facemask fit (PA=63%) in ringette players. Common barriers were related to technology (e.g., audio/video quality) and environment (e.g., noisy, lighting).ConclusionsVirtual helmet fit assessments are feasible and reliable for most criteria, with more training required for criteria below acceptable agreement. Virtual assessments provides another option for assessing helmet fit for concussion prevention in helmeted sports.

Injuries and deaths from motor vehicle collisions are a significant public health issue. As public health researchers and practitioners, we must support the work of municipalities by advocating for effective interventions to reduce this burden. This requires an evidence-based approach; however, many interventions embedded in existing road safety policies in Canada are not supported by evidence. The objective of this work was to review the built environment (BE) interventions in road safety policies in five, urban municipalities in Canada and summarize the peer-reviewed literature to support them. A low proportion of included studies specific to the existing road safety policies in urban areas in Canada demonstrated a reduction in collisions. Further, significant variability in the level of effectiveness across interventions exists. Information specific to the effectiveness of interventions should be an integral part of the decision making process for BE change; however, more work is needed to better understand critical decision making factors.

To compare physical contacts (PCs) and head contacts (HCs) in nonelite U15 (ages 13-14) and U18 (ages 15-17) ice hockey players in body checking (BC) and non-BC leagues.Cohort video analysis study.Ice hockey arenas in Calgary, Canada.Players from 13 BC and 13 non-BC games at the nonelite U15 and U18 levels (n = 52 total games).Games were videotaped and analyzed to compare PC variables between leagues allowing and prohibiting BC.Validated methodology for PC type (trunk PC and other types of PC with limb/stick/head), intensity (low and high intensity), and HC. Incidence rate ratios (IRRs) were estimated using Poisson regression (controlling for cluster by team game and offset by player minutes) to compare the incidence of PCs in BC and non-BC games.The rate of trunk PCs was lower in the non-BC leagues for both U15 (IRR = 0.50, 99% confidence interval [CI]: 0.43-0.58) and U18 (IRR = 0.56, 99% CI: 0.46-0.67) players. This was most significant for BC contacts (U15: IRR = 0.18, 99% CI: 0.11-0.29; U18: IRR = 0.16, 99% CI: 0.08-0.34), although also significant for body contacts (U15: IRR = 0.54, 99% CI: 0.46-0.64; U18: IRR = 0.58, 99% CI: 0.48-0.70), other PCs, (U15: IRR = 0.60, 99% CI: 0.45-0.78; U18: IRR = 0.71, 99% CI: 0.58-0.88), and HCs (U15: IRR = 0.40, 99% CI: 0.22-0.71; U18: IRR = 0.37, 99% CI: 0.25-0.57).The incidence of BC was 82% lower in the U15 and 84% lower in U18 levels not allowing BC, with lower HC and other PC rates also in non-BC leagues. These findings demonstrate high adherence with BC policy change in youth ice hockey.

Objective: Linking emergency medical services (EMS) data to hospital outcomes is important for quality assurance and research initiatives. However, non-linkage due to missing or incomplete patient information may increase the risk of bias and distort findings. The purpose of this study was to explore if an optimization strategy, in addition to an existing linkage process, improved the linkage rate and reduced selection and information bias.Methods: 4,150 transported patients in a metropolitan EMS system in Alberta, Canada from 2016/17 were linked to two Emergency Department (ED) databases by a standard strategy using a unique health care number, date/time of ED arrival, and hospital name. An optimized strategy added additional linkage steps incorporating last name, year of birth, and a manual search. The strategies were compared to assess the rate of linkage, and to describe event and patient-level characteristics of unlinked records.Results: The standard strategy resulted in 3,650 out of 4,150 (88.0%) linked records (95% CI 86.9%-88.9%). Of the 500 non-linked records, an additional 381 were linked by the optimized strategy (n = 4,031/4,150 [97.1%; 95% CI: 96.6%-97.6%]). There were no false positive linkages. The highest linkage failure was in 25 to 34 year-old patients (n = 93/478, 19.5%), males (n = 236/1975, 12.0%), Echo level events (n = 15/77, 19.5%), and emergency transport (45/231, 19.5%). The optimized strategy improved linkage in these groups by 68.8% (64/93), 79.2% (187/236), 40.0% (6/15), and 51.1% (23/45) respectively. For dispatch card, the highest linkage failure occurred in Card 24-Pregnancy/Childbirth/Miscarriage (n = 30/44, 68.2%), Card 27-Stab/Gunshot/Penetrating Trauma (n = 6/17, 35.3%), and Card 9-Cardiac/Respiratory Arrest/Death (n = 12/46, 26.1%). The optimized strategy improved linkage by 10.0% (3/30), 83.3% (5/6), and 41.7% (5/12) respectively. For the 119 unlinked records, 71 (59.7%) had sufficient information for linkage, but no appropriately matching records could be found.Conclusion: An optimized sequential deterministic strategy linking EMS data to ED outcomes improved the linkage rate without increasing the number of false positive links, and reduced the potential for bias. Even with adequate information, some records were not linked to their ED visit. This study underscores the importance of understanding how data are linked to hospital outcomes in EMS research and the potential for bias.

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously. Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs. Study Design: Cost-effectiveness analysis alongside cohort study. Level of Evidence: Level 3. Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively. Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

BackgroundSchool safety zones were created in 2017 under the City of Toronto’s Vision Zero Road Safety Plan. This pilot study examined the effect of built environment interventions on driver speeds, active school transportation (AST) and dangerous driving.MethodsInterventions were implemented at 34 schools and 45 matched controls (2017–2019). Drivers travelling over the speed limit of >30 km/hour and 85th percentile speeds were measured using pneumatic speed tubes at school frontages. Observers examined AST and dangerous driving at school arrival times. Repeated measures beta and multiple regression analyses were used to study the intervention effects.ResultsMost schools had posted speed limits of 40 km/hour (58%) or ≥50 km/hour (23%). A decrease in drivers travelling over the speed limit was observed at intervention schools post-intervention (from 44% to 40%; OR 0.79, 95% CI 0.66 to 0.96). Seventy-one per cent of drivers travelled >30 km/hour and the 85th percentile speed was 47 km/hour at intervention schools, with no change in either postintervention. There were no changes in speed metrics in the controls. AST increased by 5% (OR 1.22, 95% CI 0.97 to 1.54) at intervention schools. Reductions in dangerous driving were observed at all schools.ConclusionsPosted speed limits were >30 km/hour at most schools and high proportions of drivers were travelling above the speed limits. There were reductions in drivers exceeding the speed limit and in dangerous driving, and modest increased AST post intervention. Bolder interventions to slow traffic are required to effectively reduce speeding around schools, which may increase safe AST.

To describe injury and concussion rates and mechanisms in female high school rugby players.Two-year prospective cohort study.High school rugby.Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition.None.Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates.A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6).Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.

ObjectivesThe objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15–17) on reducing rates of injury and concussion.MethodsThis is a prospective cohort study. Players 15–17 years-old were recruited from teams in non-elite divisions of play (lower 40%–70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015–18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss).Results44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually.ConclusionsThe rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15–17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players.

Objective: The objective of this study was to identify driver characteristics associated with youth bicycle–motor vehicle collisions in Alberta, Canada.Methods: Edmonton and Calgary police collisio...

Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population.From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features.Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found.Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.En dépit de données canadiennes abondantes sur les associations entre aménagement urbain et comportements liés à la santé, nous savons peu de chose sur les associations entre aménagement urbain et problèmes de santé. Cet examen de la portée est destiné à offrir une synthèse des données tirées d’études quantitatives ayant examiné la relation entre l’environnement bâti et les problèmes de santé chroniques, l’état de santé et la qualité de vie autodéclarés ainsi que les blessures au sein de la population canadienne adulte.De janvier à mars 2017, nous avons effectué des recherches dans 13 bases de données afin de sélectionner, sans égard à la date de publication, les études quantitatives ayant fait l’objet d’une évaluation par les pairs et portant sur les associations entre des mesures objectives de l’environnement bâti et divers problèmes de santé affectant les adultes canadiens. Seules les études menées en milieu urbain ont été incluses. Nous avons catalogué et synthétisé les études pertinentes en fonction de leur sujet et de leur plan d’étude ainsi que de leurs résultats sur le plan de la santé et des caractéristiques de l’environnement bâti.Cinquante-cinq articles ont répondu aux critères d’inclusion, dont 52 publiés après 2008. La plupart des études menées dans une seule province ont porté sur Ontario (n = 22), le Québec (n = 12) ou l’Alberta (n = 7). L’examen a permis de dégager des associations entre les caractéristiques du milieu bâti et 11 résultats généraux en matière de santé, à savoir les blessures (n = 19), le poids (n = 19), les maladies cardiovasculaires (n = 5), la dépression et l’anxiété (n = 5), le diabète (n = 5), la mortalité (n = 4), l’état de santé autoévalué (n = 2), les problèmes de santé chroniques (n = 2), les troubles du métabolisme (n = 2), la qualité de vie (n = 1) et le cancer (n = 1). Nous avons relevé des données probantes cohérentes montrant des associations entre les indicateurs agrégés de l’environnement bâti (p. ex. le potentiel piétonnier) et le diabète et le poids, ainsi qu’entre la connectivité et les caractéristiques des itinéraires (p. ex. itinéraires de transport, pistes, sentiers, trottoirs, tracés de rue, intersections) et les blessures. Nous avons également extrait des données montrant l’impact qu’ont les espaces verts, les parcs et les installations récréatives sur de multiples résultats de santé.En contexte canadien, l’environnement bâti est associé à un éventail de problèmes de santé chroniques et de blessures chez les adultes, mais les données probantes disponibles sont limitées. Il faut mener davantage de recherches sur l’environnement bâti et la santé fondées sur des plans d’étude rigoureux afin de produire des données probantes plus solides sur les relations causales aptes à orienter les politiques et les pratiques.The most frequently reported associations among Canadian studies on urban form and health outcomes were related to injury and weight status. Not all provinces and territories were represented in this review, with much of the evidence coming from studies in Ontario, Quebec, and Alberta. Objectively-measured aggregate built environment indicators, connectivity and route features, destinations, food environment, population density, and greenspace, parks and recreation features are associated with a range of modifiable health conditions and injury. This scoping review identifies that more Canadian research, with rigorous designs that allow for causal inference, is required to inform policy and practice.Les associations les plus fréquemment signalées dans les études canadiennes entre l’aménagement urbain et les résultats en matière de santé concernent les blessures et le poids. Cet examen ne couvre pas l’ensemble des provinces et des territoires : la plupart des données proviennent d’études menées en Ontario, au Québec et en Alberta. Les indicateurs agrégés de l’environnement bâti mesurés objectivement, la connectivité et les caractéristiques des itinéraires, les destinations, l’environnement alimentaire, la densité de la population et les espaces verts, parcs et installations récréatives présentent des corrélations avec un éventail de problèmes de santé et de blessures évitables. Cet examen de la portée révèle la nécessité de conduire d’autres recherches canadiennes dotées de plans rigoureux aptes à établir des inférences causales, afin de pouvoir orienter les politiques et les pratiques.

Introduction En dépit de données canadiennes abondantes sur les associations entre amé¬nagement urbain et comportements liés à la santé, nous savons peu de chose sur les associa¬tions entre aménagement urbain et problèmes de santé. Cet examen de la portée est destiné à offrir une synthèse des données tirées d’études quantitatives ayant examiné la relation entre l’environnement bâti et les problèmes de santé chroniques, l’état de santé et la qualité de vie autodéclarés ainsi que les blessures au sein de la population canadienne adulte. Méthodologie Nous avons examiné les professions des 1 231 177 travailleurs de sexe masculin du Système de surveillance des maladies professionnelles entre 1983 et 2015 et nous avons jumelé ces travailleurs au Registre des cas de cancer de l’Ontario afin de détecter et suivre les cas de diagnostics de cancer de la prostate. Nous avons utilisé des modèles de risques proportionnels de Cox pour calculer les rapports de risques (RR) ajus¬tés selon l’âge et des intervalles de confiance (IC) à 95 % pour estimer le risque de cancer de la prostate par groupe professionnel. Résultats Cinquante-cinq articles ont répondu aux critères d’inclusion, dont 52 publiés après 2008. La plupart des études menées dans une seule province ont porté sur Ontario (n = 22), le Québec (n = 12) ou l’Alberta (n = 7). L’examen a permis de dégager des associations entre les caractéristiques du milieu bâti et 11 résultats généraux en matière de santé, à savoir les blessures (n = 19), le poids (n = 19), les maladies cardiovasculaires (n = 5), la dépression et l’anxiété (n = 5), le diabète (n = 5), la mortalité (n = 4), l’état de santé autoévalué (n = 2), les problèmes de santé chroniques (n = 2), les troubles du métabolisme (n = 2), la qualité de vie (n = 1) et le cancer (n = 1). Nous avons relevé des données probantes cohérentes mon¬trant des associations entre les indicateurs agrégés de l’environnement bâti (p. ex. le potentiel piétonnier) et le diabète et le poids, ainsi qu’entre la connectivité et les caractéristiques des itinéraires (p. ex. itinéraires de transport, pistes, sentiers, trottoirs, tracés de rue, intersections) et les blessures. Nous avons également extrait des données montrant l’impact qu’ont les espaces verts, les parcs et les installations récréatives sur de multiples résultats de santé. Conclusion En contexte canadien, l’environnement bâti est associé à un éventail de problèmes de santé chroniques et de blessures chez les adultes, mais les données probantes dis¬ponibles sont limitées. Il faut mener davantage de recherches sur l’environnement bâti et la santé fondées sur des plans d’étude rigoureux afin de produire des données probantes plus solides sur les relations causales aptes à orienter les politiques et les pratiques.

Policy that disallows body checking (BC) lowers the injury and concussion rate for youth ice hockey players. However, little is known about how disallowing BC influences in-game metrics of performance. This prospective cohort video-analysis study examined offensive performance in Under-15 (ages 13–14) and Under-18 (ages 15–17) youth ice hockey players in leagues allowing and disallowing BC. Fifty-two games were filmed (n = 13 BC, n = 13 non-BC) for Under-15 and Under-18 non-elite (lowest 60% and 45% divisions, respectively) divisions in Calgary, Canada. Footage was analyzed for offensive performance metrics on the puck-carrier using the validated ice hockey adapted team sport assessment procedure. Puck metrics included how the player acquired puck possession (e.g. conquered puck from an opponent, received pass from a teammate) and the outcome (e.g. shot on goal, lost puck to opponent). The puck metrics were used to compute a performance composite score for each player that accounted for the quantity (rate of puck possessions per shift time) and quality (a ratio of positive performance metrics to all metrics) of play. Mean difference's (MD) in performance composite scores were compared using multivariable linear regression (adjusted for player position and cluster by team-game) between leagues allowing and disallowing BC for both age groups. Analyses revealed no significant MD in the performance composite scores between players in BC and non-BC leagues for both age groups (Under-15: MD = 0.02, 95%CI: −0.08, 0.12; Under-18: MD = −0.06, 95%CI: −0.16, 0.03). These findings suggest no differences in offensive performance when BC is disallowed in Under-15 and Under-18 non-elite leagues.

Background Alberta remains the only province in Canada without booster seat legislation. To date, analyses of booster seat effectiveness compared with seatbelt only use have demonstrated mixed findings using observational data. Methods This study uses Alberta police collision report data for the years 2010–2016, inclusive. Using a case-control study design, children aged four to eight years, who were reported by police to be injured (cases), were compared with uninjured controls for restraint use (seatbelt, booster seat or no restraint). Logistic regression was used to estimate the relation between booster seat use and injury with adjusted odds ratios (aORs) and 95% confidence intervals (CI), stratified by collision types. Results There were 12,922 children involved in collisions, of whom 570 were injured. Approximately 62% of all children included in the analysis were in a booster seat or safety seat at the time of collision. Crude analysis indicates higher odds of injury for seatbelt wearers compared with booster seat use (OR = 1.21; 95% CI: 1.02–1.44). Front-end vehicle-vehicle collisions, demonstrated higher odds of injury for seatbelt wearers relative to those in booster seats (aOR = 1.46; 95% CI: 1.03–2.07). Conclusion This analysis indicates a protective effect of booster seats that varies depending on the type of collision and impact location. These regionally-specific injury data may encourage and inform policy on the use of booster seats. Moreover, stratification by collision type may be necessary to inform analyses on booster seat effectiveness.

Background Alberta remains the only province in Canada without booster seat legislation. This presents an opportunity to study the effectiveness of booster seats in real-world settings. To date, results of booster seat effectiveness compared with seat-belt-only use has demonstrated mixed findings. Methods We used Alberta police collision report data from 2010-2016. The study population includes all motor vehicle collisions involving at least one 4-8-year-old. Using a case-control study design, children who were reported by police to be injured (cases) were compared with those uninjured (controls) for booster seat use. Logistic regression was used to estimate the association between booster seat use and injury. Results There were 12,922 children involved in a collision, resulting in 673 child injuries. There were 793 children in the front seat excluded from analysis. Unadjusted analyses indicate that compared with booster seat users, there were greater odds of injury for seat-belt users (OR=1.21; 95% CI: 1.02–1.44) and those not using any restraints (OR= 8.16; 95% CI: 4.66–14.31). When stratifying by impact and collision types, front-end vehicle-on-vehicle collisions demonstrated greater odds of injury for seat-belt wearers relative to those in booster seats (OR= 1.51 95% CI: 1.10–2.08). Conclusion Crude analyses indicate a protective effect of booster seats compared with seat-belts, depending on the type of collision and impact location. Learning Outcomes These regionally-specific injury data may help inform policy on the use of booster seats. Stratification by collision impact location may be necessary to inform analyses on booster seat effectiveness.

Background Motor-vehicle collisions are a leading cause of child bicyclist and pedestrian injuries in Canada. Injury occurrence and severity are associated with vehicle speeds but may be moderated through traffic calming. As a third of child bicyclist and pedestrian injuries occur within 300 meters of schools, it is important to focus interventions at these locations. This study will compare the effect of two traffic calming measures (i.e., in-street signs and traffic-calming-curbs) around elementary (K-Gr8) schools in Calgary. Methods Using a stepped-wedge cluster randomized controlled trial, 70 eligible elementary schools will be randomly assigned one traffic calming intervention, installed between April and August 2020. Traffic speed and volume (pneumatic tubes), and active transportation prevalence (observational counts), will be collected one week before and one week after intervention installation. Change in outcomes between pre- and post-intervention will be compared within schools for each intervention type. Post-intervention data will also be compared with pre-intervention data from schools yet to receive the intervention. Analyses will include generalized linear mixed effects models. Results Reductions in vehicle speeds are expected for both traffic calming features. Smaller changes in traffic volume and active transportation are expected across all traffic calming features. Greater effects are expected from traffic-calming-curbs. Discussion Scientific evidence on traffic calming intervention effectiveness may improve municipal decision-making, standards for new construction, prioritization of interventions in other jurisdictions, and inform further study in non-school environments. This study is a partnership between the City of Calgary and the University of Calgary.

Background Motor vehicle collision is a leading cause of injury and mortality in teens. Graduated drivers licensing (GDL) is a common practice to help mitigate risk associated with younger and inexperienced drivers. However, gaps and inconsistencies exist across regions in how restrictive GDL rules are. Methods This study used police collision report data from Alberta, Canada for the years 2010–2016. An automated, previously validated, culpability analysis tool was applied to collisions involving drivers between 16 and 19 years of age to score fault. Factors that increase odds of fault in all-collisions were identified using logistic regression. Results There were 45,938 motor vehicle collisions involving young drivers. of these, approximately 71% of young drivers were identified as at-fault. Crude analyses indicate that driving between 2300 hrs and 600 hrs increase odds of being at-fault (OR= 1.39; 95% CI: 1.27–1.51). Odds of being at-fault in collision were lower with the presence of an adult passenger over 20 years of age (OR= 0.62; 95% CI: 0.57–0.67) or a single peer of similar age (OR= 0.90; 95% CI: 0.83–0.97). Other passenger categories (younger passenger or multiple teens) were not significantly associated with young driver culpability. Conclusion Passenger type and time of day may both be contributing to young driver fault in collisions. Future directions include multivariable analysis as well as analysis on teen driver fault in severe injury collisions. Learning Outcomes There exists a potential opportunity for policy regulations that may modify or reduce exposure to factors contributing to teen driver culpability in motor vehicle collisions.

Concussion is the most common match injury in rugby union. Some players wear padded headgear, but whether this protects against concussion is unclear. In professional male rugby union players, we examined: (i) the association between the use of headgear and match concussion injury incidence, and (ii) whether wearing headgear influenced time to return to play following concussion. Using a nested case-control within a cohort study, four seasons (2013–2017) of injury data from 1117 players at the highest level of rugby union in England were included. Cases were physician-diagnosed concussion injuries. Controls were other contact injuries (excluding all head injuries). We determined headgear use by viewing video footage. Sixteen percent of cases and controls wore headgear. Headgear use had no significant effect on concussion injury incidence (adjusted odds ratio=1.05, 95% CI: 0.71–1.56). Median number of days absent for concussion whilst wearing headgear was 8 days, compared with 7 days without headgear. Having sustained a concussion in the current or previous season increased the odds of concussion more than four-fold (odds ratio=4.55, 95% CI: 3.77–5.49). Wearing headgear was not associated with lower odds of concussions or a reduced number of days' absence following a concussion.

The objective of this study is to examine sport and recreational (SR) activity participation and injury rates (IR) in high school students (ages 14-19).High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified 'other' or missing; ages 14-19) in Alberta completed a web-based survey during class (October 2018-March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any SR-related injury, (b) most serious SR-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from SR for at least one day.In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as 'other' or missing] participated in an SR activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67-39.00), ice hockey (20.46%; 95% CI 14.87-27.47), and soccer (19.42%; 95% CI 15.67-23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98-27.82), basketball (18.32%; 95% CI 14.32-23.14), and badminton (17.84%; 95% CI 13.35-23.43). Of the 1,971 students completing the SR injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72-50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49-34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47-41.93).High school student SR IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in SR activities has multiple physical, psychological, and health benefits for adolescents, but some SR activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.

AimTo undertake a comprehensive review of the best available evidence related to risk factors for child pedestrian motor vehicle collision (PMVC), as well as identification of established and emerging prevention strategies.MethodsArticles on risk factors were identified through a search of English language publications listed in Medline, Embase, Transport, SafetyLit, Web of Science, CINHAL, Scopus and PsycINFO within the last 30 years (~1989 onwards).ResultsThis state-of-the-art review uses the road safety Safe System approach as a new lens to examine three risk factor domains affecting child pedestrian safety (built environment, drivers and vehicles) and four cross-cutting critical issues (reliable collision and exposure data, evaluation of interventions, evidence-based policy and intersectoral collaboration).ConclusionsResearch conducted over the past 30 years has reported extensively on child PMVC risk factors. The challenge facing us now is how to move these findings into action and intervene to reduce the child PMVC injury and fatality rates worldwide.

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.

Background Pedestrian related deaths have recently been on the rise in Canada. The effect of changing posted speeds on the frequency and severity of pedestrian motor vehicle collisions (PMVC) is not well studied using controlled quasi-experimental designs. The objective of this study was to examine the effect of lowering speed limits from 40 km/h to 30 km/h on PMVC on local roads in Toronto, Canada. Methods A 30 km/h speed limit on local roads in Toronto was implemented between January 2015 and December 2016. Streets that remained at a 40 km/h speed limit throughout the study period were selected as comparators. A quasi-experimental, pre-post study with a comparator group was used to evaluate the effect of the intervention on PMVC rates before and after the speed limit change using repeated measures Poisson regression. PMVC data were obtained from police reports for a minimum of two years pre- and post-intervention (2013 to 2018). Results Speed limit reductions from 40 km/h to 30 km/h were associated with a 28% decrease in the PMVC incidence rate in the City of Toronto (IRR = 0.72, 95% CI: 0.58–0.89). A non-significant 7% decrease in PMVC incidence rates were observed on comparator streets that remained at 40 km/h speed limits (IRR = 0.93, 95% CI: 0.70–1.25). Speed limit reduction also influenced injury severity, with a significant 67% decrease in major and fatal injuries in the post intervention period on streets with speed limit reductions (IRR = 0.33, 95% CI: 0.13–0.85) compared with a 31% not statistically significant decrease in major and fatal injuries on comparator streets (IRR = 0.69, 95% CI: 0.37–1.31). The interaction term for group and pre-post comparisons was not statistically significant (p = 0.14) indicating that there was no evidence to suggest a pre-post difference in IRRs between the intervention and comparator streets. Conclusions Declines in the rate of PMVC were observed on roads with posted speed limit reductions from 40 km/h to 30 km/h, although this effect was not statistically greater than reductions on comparator streets.

BackgroundConcussion is the most common injury in youth ice hockey. Whether mouthguard use lowers the odds of concussion remains an unanswered question.ObjectiveTo determine the association between concussion and mouthguard use in youth ice hockey.MethodsNested case–control design. Cases and controls were identified from two prospective cohort studies using valid injury surveillance methods. Cases were players concussed during a game or practice; controls were players who sustained a non-concussion injury during a game or practice. The primary exposure was mouthguard use at time of injury; mouthguard type (dental custom fit or off the shelf) was a secondary exposure. Physician-diagnosed or therapist-suspected concussion was the primary outcome. Dental injury was a secondary outcome. Multilevel logistic regression with random effect at a team level was used to obtain ORs for the mouthguard effect, adjusted for level of play, age group, position, concussion history, mechanism of injury, cohort, session type and body checking policy.ResultsAmong cases, 236/315 (75%) were wearing a mouthguard at time of injury, while 224/270 (83%) controls were wearing a mouthguard at time of injury. Any mouthguard use was associated with an adjusted OR for concussion of 0.36 (95% CI 0.17 to 0.73). Off-the-shelf mouthguards were associated with a 69% lower odds of concussion (adjusted OR: 0.31; 95% CI 0.14 to 0.65). Dental custom-fit mouthguards were associated with a non-significant 49% lower odds of concussion (adjusted OR: 0.51; 95% CI 0.22 to 1.10). No dental injuries were identified in either cohort.ConclusionMouthguard use was associated with lower odds of concussion. Players should be required to wear mouthguards in youth ice hockey.

ObjectiveTo synthesise the current evidence regarding the risk factors, the injury prevention strategies and the profile of injured skiers and snowboarders in terrain parks (TPs) and half-pipes (HPs).DesignSystematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Data sourcesLiterature searches from six electronic databases and manual searches were performed.Eligibility criteria for selecting studiesInclusion criteria were: (1) publication based on original data; (2) injuries sustained in TPs or HPs; (3) recreational skiing or snowboarding injuries; (4) observational or experimental study design with a comparison group.ResultsNo study explored the risk factors in HPs or the prevention strategies in TPs or HPs. From the literature retrieved, there is strong evidence that skiing or snowboarding in a TP is a risk factor for head, neck, back and severe injuries. Two papers assessed the risk factors for injuries in TPs, mainly demonstrating that features promoting aerial manoeuvres or a large drop to the ground were associated with higher feature-specific injury rates. The profile of injured skiers and snowboarders in TPs described in the literature suggested some evidence of associations between factors including activity, sex, skill level, helmet use, age and TP injuries.Summary/conclusionsThis systematic review demonstrates the need for studies identifying the risk factors for injuries to skiers and snowboarders and on interventions to reduce the risk of injury in TPs and HPs. Studies addressing the issue of TP design should be considered.PROSPERO registration numberCRD42016045206.

Walking and bicycling to school (active school transportation, AST) has been in decline for decades in North America and globally with the rise of automobility. This cross-sectional study estimated associations between the built environment and AST in seven Canadian communities. We observed the travel behaviours of almost 118,000 students at 552 schools. Using beta regression, we modeled the proportion of children using AST, considering built environment and social environment factors around schools. Across all schools, the average proportion of children using AST was 54.3% (SD 18.9%), with variability among cities from a low of 39.5% (SD 22.1%) in Laval, Quebec to 69.7% (SD 18.1%) in Montreal, Quebec. Overall, several modifiable road design features were associated with AST, including the presence of school crossing guards, cycling infrastructure, Walk Score® and traffic signal density. There was variability in the directionality and statistical significance of associations with design variables across cities, suggesting that the local context and directed local interventions are important to support AST. Natural experiment studies are necessary to examine local approaches related to the built environment to increase AST and ensure appropriate new policy and program interventions are developed.

Background Higher traffic speeds increase the risk of serious or fatal injury to child pedestrians and may deter parents from encouraging their children to walk to school. This cross-sectional study examined the association between measured vehicle speed and active school transportation. Methods The study sample included public elementary schools in Calgary (n = 46) and Toronto (n = 42), Canada. Speed limits in school zones were 30 km/h in Calgary but ranged from 30 to 60 km/h in Toronto. In May and June 2018, trained observers counted children arriving to school and recorded their mode of travel. Vehicle speeds around schools were measured between 07:30 and 18:00 (school activity hours) and quantified as the 85th percentile speed, the percentage of vehicles exceeding 30 km/h, and the percentage of vehicles exceeding the speed limit. Multivariable beta regression was used to examine the relationship between vehicle speed and active transportation to school for each city, adjusting for school environment features. Results A high percentage of vehicles were travelling over the speed limit in front of schools: 45% in Calgary and 42% in Toronto. No association between vehicle speed and active school transportation was found in Calgary (mean 85th percentile speed OR: 0.99, 95% CI: 0.93, 1.06). There was an inverse association between vehicle speed and active school transportation in Toronto, where for every 1 km/h increase in the mean 85th percentile speed, the odds of active school transportation decreased by 3% (OR: 0.97, 95% CI: 0.95, 0.99). Conclusion There was a high prevalence of speeding in front of schools, which could increase the risk of traffic-related injuries and fatalities to children. Speed limit reductions to 30 km/h on roads near schools may be a useful preventive intervention in Toronto during school activity hours. Such targeted interventions can help improve child pedestrian safety and promote active school transportation.

ObjectiveTo compare rates of injury and concussion among non-elite (lowest 60% by division of play) Bantam (ages 13–14 years) ice hockey leagues that disallow body checking to non-elite Bantam leagues that allow body checking.MethodsIn this 2-year cohort study, Bantam non-elite ice hockey players were recruited from leagues where policy allowed body checking in games (Calgary/Edmonton 2014–2015, Edmonton 2015–2016) and where policy disallowed body checking (Kelowna/Vancouver 2014–2015, Calgary 2015–2016). All ice hockey game-related injuries resulting in medical attention, inability to complete a session and/or time loss from hockey were identified using valid injury surveillance methodology. Any player suspected of having concussion was referred to a study physician for diagnosis and management.Results49 body checking (608 players) and 33 non-body checking teams (396 players) participated. There were 129 injuries (incidence rate (IR)=7.98/1000 hours) and 54 concussions (IR=3.34/1000 hours) in the body checking teams in games. After policy change, there were 31 injuries (IR=3.66/1000 hours) and 17 concussions (IR=2.01/1000 hours) in games. Policy disallowing body checking was associated with a lower rate of all injury (adjusted incidence rate ratio (IRR)=0.44; 95% CI: 0.27 to 0.74). The point estimate showed a lower rate of concussion (adjusted IRR=0.6; 95% CI: 0.31 to 1.18), but this was not statistically significant.ConclusionPolicy change disallowing body checking in non-elite Bantam ice hockey resulted in a 56% lower rate of injury. There is growing evidence that disallowing body checking in youth ice hockey is associated with fewer injuries.