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Funding information: Grant funding for this analysis was provided by the: (1) Centre for Surveillance and Research, Public Health Agency of Canada (6D016-123071/001/SS); 2) Canadian Institutes of Health Research (Project Grant PJT 162237); 3) Polish National Science Centre (2013/09/B/HS6/03438). Corresponding author, Valerie F. Pagnotta, is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship. Background Strong variations in injury rates have been documented cross-nationally. Historically, these have been attributed to contextual determinants, both social and physical. We explored an alternative, yet understudied, explanation for variations in adolescent injury reporting-that varying access to medical care is, in part, responsible for cross-national differences. Methods Age-specific and gender-specific rates of medically treated injury (any, serious, by type) were estimated by country using the 2013/2014 Health Behaviour in School-aged Children study (n=209 223). Available indicators of access to medical care included: (1) the Healthcare Access and Quality Index (HAQ; 39 countries); (2) the Universal Health Service Coverage Index (UHC; 37 countries) and (3) hospitals per 100 000 (30 countries) then physicians per 100 000 (36 countries). Ecological analyses were used to relate injury rates and indicators of access to medical care, and the proportion of between-country variation in reported injuries attributable to each indicator. Results Adolescent injury risks were substantial and varied by country and sociodemographically. There was little correlation observed between national level injury rates and the HAQ and UHC indices, but modest associations between serious injury and physicians and hospitals per 100 000. Individual indicators explained up to 9.1% of the total intercountry variation in medically treated injuries and 24.6% of the variation in serious injuries. Conclusions Cross-national variations in reported adolescent serious injury may, in part, be attributable to national differences in access to healthcare services. Interpretation of cross-national patterns of injury and their potential aetiology should therefore consider access to medical care as a plausible explanation. Postprint

BackgroundLittle is known about the impact of being a bystander to bullying. This study compared health outcomes among bullies, victims and bystanders, and investigated actions taken by bystanders when they saw bullying.MethodParticipants included 7522 students aged 12–18 years that completed self-report questionnaires in the 2013/2014 Health Behaviour in School-aged Children survey. Binary logistic regression models (controlled for bully, victim, bystander status and demographic variables) were used to investigate the associations between participation in bullying as a bully, victim and bystander and health outcomes.ResultsOverall, 13.3% of adolescents reported being a bully, 25.1% reported being a victim and 30.5% reported that they saw bullying, in the last couple of months. Bystanders were significantly more likely to experience psychological symptoms (OR 1.355), somatic symptoms (OR 1.392) and low life satisfaction (OR 1.268) than those who were not bystanders. Helping the victim was significantly associated with experiencing psychological symptoms (OR 1.240), somatic symptoms (OR 1.251) and low life satisfaction (OR 1.198). Being a bully was significantly associated with experiencing psychological symptoms (OR 1.382) and not having excellent health (OR 1.252). Victims were significantly more likely to experience psychological symptoms (OR 2.437), somatic symptoms (OR 2.364), low life satisfaction (OR 2.564) and not having excellent health (OR 1.559).ConclusionIn Ireland, being a bystander to bullying is more prevalent in schools than bullying perpetration or victimisation. The impact of being a bystander to bullying needs to be highlighted and included in intervention development.

To compare estimates of the prevalence of injury among adolescents in 35 countries, and to examine the consistency of associations cross nationally between socioeconomic status then drunkenness and the occurrence of adolescent injury.Cross sectional surveys were obtained from national samples of students in 35 countries. Eight countries asked supplemental questions about injury.Surveys administered in classrooms.Consenting students (n = 146 440; average ages 11-15 years) in sampled classrooms. 37 878 students (eight countries) provided supplemental injury data.Exposure measures: Socioeconomic status (material wealth, poverty) and social risk taking (drunkenness).Specific types and locations of medically treated injury.By country, reports of medically treated injuries ranged from 33% (1060/3173) to 64% (1811/2833) of boys and 23% (740/3172) to 51% (1485/2929) of girls, annually. Sports and recreation were the most common activities associated with injury. High material wealth was positively (OR1.0; p0.05) and consistently (6/8 countries) associated with medically treated and sports related injuries. Poverty was positively associated with fighting injuries (6/8 countries). Drunkenness (social risk taking) was positively (p0.01) and consistently (8/8 countries) associated with medically treated, street, and fighting injuries, but not school and sports related injuries.The high prevalence of adolescent injury confirms its importance as a health problem. Social gradients in risk for adolescent injury were illustrated cross nationally for some but not all types of adolescent injury. These gradients were most evident when the etiologies of specific types of adolescent injury were examined. Prevention initiatives should focus upon the etiologies of specific injury types, as well as risk oriented social contexts.

Background Positive wellbeing, including high life-satisfaction can buffer against negative outcomes such as psychological disorders. Modifiable lifestyle factors including diet may be associated with maintaining positive wellbeing however; this association is not extensively researched in adolescents. Fruit and vegetables are markers of healthy diet quality whereas sugar sweetened beverages are markers of poor diet quality. This study investigates whether markers of diet quality are associated with wellbeing in adolescents aged 12–18. Methods A cross-sectional, nationally representative sample of adolescents aged 12–18 from the Irish, 2014, Health Behaviour in School-aged Children (HBSC) study (n = 8,995). A two-staged sampling strategy was employed, the sampling frame was post-primary schools across Ireland and schools were randomly selected from 8 geographical regions as the primary sampling units. Classes within schools were the secondary sampling units. School and pupil level response rates were 59% and 84.5% respectively. Adolescents self-completed a health and lifestyle questionnaire. Diet was assessed by consumption frequency of fruit, vegetables and soft drinks that contain sugar. Response options were on a 7 point scale ranging from never to everyday more than once (dichotomised as daily vs. less than daily consumption). Adolescents reported general health as good (excellent/good) or poor (fair/poor). Life-satisfaction was assessed on a scale of 0–10 using the Cantril ladder and defined as high (≤7) or low ( Results Just over one-quarter of adolescents rated their life-satisfaction as low (26.9% (95% CI: 26.0% to 27.8%) and 13.4% (12.6% to 14.1%) rated their general health as poor. Overall, 39.0% (95% CI: 38.0% to 40.0%) of adolescents reported daily consumption of fruit, 44.7 (43.7% to 45.7%) consumed vegetables and 12.8% (12.1% to 13.5%) consumed soft drinks daily. In fully adjusted models, adolescents who did not eat fruit (OR (95% CI:) 1.35 (1.18 1.54)) or vegetables (1.34 (1.18 1.53)) daily and those who consumed soft drinks daily (1.45 (1.20 1.76)) had a significantly higher odds of reporting low life-satisfaction. Similar associations were observed for poor general health. Conclusion Consuming a good quality diet is protective of wellbeing. Though this study is cross-sectional, prior longitudinal research found that diet precedes wellbeing. Daily consumption of fruit/veg is worryingly low. Thus creating supportive environments may increase healthy dietary choices which are important for good general health and wellbeing.

Background In the past, first aid for school children was provided by the school nurse, but over the years, this service has been eroded and does not exist anymore in Israeli schools. In 2014, the Ministry of Education, together with the ambulance services in Israel, Magen David Adom, have started a new first aid service that provide service to all schools in Israel. This paper describes the service and the data that were collected as part of it. Methods A national call centre was established to respond to the first aid needs of all educational institutions in Israel. The service operates 7 days a week, between 07:30 to 16:30 throughout the school year. In an event of an injury, school staff call the centre, and the call is being taken within 15 seconds. The call centre is occupied at all time by first aids providers. Once a call is received, the service provider assess the situation as describe and decide whether a phone consultation would suffice, whether a first aid providers is required on site, or, in severe cases, whether an ambulance is required. Every call is recorded and entered to a database. Results Overall, 31217 calls were received to the call centre of which 1% required ambulance, 16% were classified as urgent, 72% were classified as not urgent and 10% were classified as administrative calls. The majority of those injured were between 10–12 years old. The most common injury place was the playground, followed by sports facility and the classroom. Majority of the injuries occurred during break time. The most common anatomic location of injury was the limbs, followed the head. Most of the injuries occurred during paly, followed by slips and trips and by interpersonal violence. Conclusions Traditionally, data on injury in the community was based on self-reporting, with very little data that is based on reporting of the care providers. This is one of the few, and most comprehensive study on injuries in schools as reported by first aid providers. As such, this study provides a unique insight on injuries of school children in Israel.

Background Sports-related concussion among youth has been identified as a public health problem. As a result, an abundance of concussion education programmes for youth athletes have been developed. Although some of these programmes have resulted in an increase in concussion knowledge, these programmes have failed to increase athletes’ concussion reporting behaviours. Accordingly, research suggests a need for theory-driven concussion interventions that go beyond those that aim at increasing concussion knowledge alone. This study will apply the theory of planned behaviour (TPB) to the development and evaluation of a targeted concussion education programme for athletes aged 13 to 18 years old. The primary aim of this study is to assess the immediate and short-term impact of the programme on intention to report concussion and concussion reporting behaviours; and to explore, the process of implementation and the relationship between this process and the programme’s outcomes. Methods This study will employ a cluster randomised control trial, with data collection at baseline (T0), immediately post-intervention (T1), and three-months after programme implementation (T2). The sample will be comprised of county-level Gaelic Athletic Association (GAA) clubs throughout the Republic of Ireland and will include teams with athletes aged 13 to 18 years old. Using a range of structured questionnaires and qualitative measures, data will be captured on athletes’ (i) attitudes towards concussion and concussion reporting, (ii) subjective norms, (iii) perceived behavioural control, (iv) intention to report concussion, (v) concussion reporting behaviour and (vi) programme fidelity. Results Preliminary results from the evaluation and issues with programme implementation will be presented. Quantitative data will be analysed with SPSS Version 22. Thematic analysis will be used to analyse qualitative data. Conclusions Findings from this evaluation will be used to assess the efficacy of the TPB in programme development and evaluation and will support the knowledge and practice of primary and secondary concussion prevention. Results from the process evaluation will assist in helping understand the context within which the programme was implemented and how these characteristics may affect the quality of implementation.

Background Annually, it is estimated that 3.8 million sports- and recreation-related concussions are sustained in the USA alone, with a particularly high incidence among adolescents. At youth sporting events, however, medical professionals are rarely present. Accordingly, coaches play a crucial role in recognising the signs and symptoms of concussion, and ensuring that players with a suspected concussion are managed correctly. Coaches have also been found to play a central role in reinforcing or undermining a sport culture in which athletes report injuries, including concussion. The aim of this study was to assess perceived ability to assess and manage concussion; and to explore, coaches’ communication practices about concussion safety with their players. Methods Using a self-report questionnaire data were captured on coaches’ communication practices about concussion safety and perceived ability to assess and manage concussion among their athletes. Data was collected electronically from June-September 2015. Results were analysed using SPSS Version 22. Results The final sample consisted of 106 coaches (59 male, 37 female) from the island of Ireland. Results showed that a majority of coaches did not feel equipped to promote concussion education among their athletes (76.5%), determine if a player has sustained a concussion (69.7%) or to help an athlete who obtained a suspected concussion during training or a match (62.6%). Additionally, before the season, a majority of coaches did not talk to their athletes about concussion safety and the importance of concussion reporting. Conclusions Findings from this study suggest that interventions should encourage communication about concussion safety with athletes and should provide coaches with communication skills and strategies about how to do this. Additionally, coach targeted interventions should focus on instructing coaches on how to recognise and manage a suspected concussion in one of their athletes.

Introduction The Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome. Methods A national prospective, observational study was conducted over a 2-year period. All patients under 17 years of age referred to a neurosurgical service following TBI were included. Data on patient demographics, events surrounding injury, injury type and severity, patient management and outcome were collected from ‘on-call’ logbooks and neurosurgical admissions records. Results 342 patients were included. Falls were the leading cause of injury for both sexes. Boys’ injuries tended to involve greater energy transfer and involved more risk-prone behaviour resulting in a higher rate of other (non-brain) injury and a higher mortality rate. Intentional injury occurred only in boys. While injury severity was similar for boys and girls, significant gender differences in injury type were present; extradural haematomas were significantly higher in boys (p=0.014) and subdural haematomas were significantly higher in girls (p=0.011). Mortality was 1.8% for girls and 4.3% for boys. Conclusions Falls were responsible for most TBI, the home is the most common place of injury and non-operable TBI was common. These findings relate to all children. Significant gender differences exist from infancy. Boys sustained injuries associated with a greater energy transfer, were less likely to use protective devices and more likely to be injured deliberately. This results in a different pattern of injury, higher levels of associated injury and a higher mortality rate.

Professionals involved in efforts to promote health in child populations are faced with a growing challenge. Children in many societies are burdened with the disease consequences of overweight and obesity, in part related to physical inactivity.1–3 Prevalence rates of childhood obesity have been increasing since the 1980s,4 5 and their known consequences include reduced quality of life, increased rates of chronic disease and associated healthcare costs, and early mortality.6–10 Obvious solutions to this problem include the promotion of physical activity via sports and active recreational opportunities. Such strategies can lead to reductions in risk for chronic disease which in turn lead to gains in health status that carry forward from childhood into the adult years.11–15 The same health professions that are charged with the responsibility of promoting physical activity in child populations are also faced with the reality of its negative health consequences. Injury related to childhood physical activity can occasionally lead to death or ongoing disability.16 Physical activity injuries are also a leading reason why children present to the emergency department and other acute care settings for urgent medical care.16–21 The obvious benefits (reduced obesity) and risks (increased injury) of childhood physical activity set the stage for a debate within …

Background Data on school injury are not always easy to obtain. Many of the existing data are based on schoolchildren9s self-report. Self-reported data are vulnerable to recall bias, and to interpretation of what is considered as medical treatment, a term usually used as a criterion to prevent children from reporting insignificant injuries. In Israel, all data on school-related injury were collected using self-reported questionnaires. In the academic year of 2007/08, Magen David Adom (MDA), a NGO that provides first aid and ambulance services in Israel, provided first aid services to all schools in the state. This paper presents findings from these data and compares them to previously published self-reported data collected by the Health Behaviour in School Aged Children survey. Methodology During the 2007/08 academic year, MDA had set a call centre for schools. In case of a school injury, schools were encouraged to call the centre for telephone assessment followed by either: advice on treatment at school by school staff; provision of first aid by member of MDA staff on school grounds; or provision of an ambulance service. The service was offered free of charge to all the schools in the state. MDA staff recorded all calls, and collected information on the type of injury, location and time for all types of services. Main Findings The paper will present analysis of the data collected and will compare prevalence to nationally representative sample of self-reported injury in school going children.

Background Unintentional injury and physical inactivity together are the leading causes for disability and chronic illness in young people. Although the benefits of physical activity are well documented, there is evidence highlighting the risk for injury imposed by physical activity, potentially acting as a barrier for active lifestyle. This study aims to investigate characteristics in the local area that could both provide safe environment associated with decreased risk for injury and increased level of participation in physical activity. Methods Nationally representative data from 10 146 students aged 10–17 years were collected as part of the Irish Health Behaviour in School-aged Children (WHO-HBSC) study. All participating children completed a questionnaire during class time. The questionnaire included questions on injury, participation in physical activity, and their perceptions of the area where they live. Associations between local area perceptions and physical activity and injury are expressed in odds ratios from logistic regression models. Results and Conclusions 43% of Irish children reported a medically attended injury in the previous 12 months and 28% reported that they are physically active for 60 min or more every day. While most local area perceptions were not significantly associated with physical activity or injury, perceptions of safeness of the local area were associated with lower level of injury and higher level of participation in physical activity. These findings highlight the need for safe environment for children to play and live, environment that promotes physical activity, and at the same time, are associated with fewer injuries.

Food poverty is intrinsically linked to inadequate income, poor dietary and lifestyle habits, and health inequalities, placing the “food poor” at higher risk of developing chronic diseases such as hypertension, diabetes and cardiovascular disease. Much of the evidence linking food poverty and poor diet is based on ecological level analysis. The Dietary Approaches to Stop Hypertension (DASH), a diet optimising dietary quality specifically limiting the intake …