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Up to 40% of patients are receiving opioids at the time of total knee arthroplasty (TKA) in the United States despite evidence suggesting opioids are ineffective for pain associated with arthritis and have substantial risks. Our primary objective was to determine whether preoperative opioid users had worse knee pain and physical function outcomes 12 months after TKA than patients who were opioid-naive preoperatively; our secondary objective was to determine the prevalence of opioid use before and after TKA in Alberta, Canada.In this retrospective analysis of population-based data, we identified adult patients who underwent TKA between 2013 and 2015 in Alberta. We used multivariable linear regression to examine the association between preoperative opioid use and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores 12 months after TKA, adjusting for potentially confounding variables.Of the 1907 patients, 592 (31.0%) had at least 1 opioid dispensed before TKA, and 124 (6.5%) were classified as long-term opioid users. Long-term opioid users had worse adjusted WOMAC pain and physical function scores 12 months after TKA than patients who were opioid-naive preoperatively (pain score β = 7.7, 95% confidence interval [CI] 4.0 to 11.6; physical function score β = 7.8, 95% CI 4.0 to 11.6; p0.001 for both). The majority (89 ([71.8%]) of patients who were long-term opioid users preoperatively were dispensed opioids 180-360 days after TKA, compared to 158 (12.0%) patients who were opioid-naive preoperatively.A substantial number of patients were dispensed opioids before and after TKA, and patients who received opioids preoperatively had worse adjusted pain and functional outcome scores 12 months after TKA than patients who were opioidnaive preoperatively. These results suggest that patients prescribed opioids preoperatively should be counselled judiciously regarding expected outcomes after TKA.Jusqu’à 40 % des patients se font prescrire des opioïdes lors d’une chirurgie pour prothèse totale du genou (PTG) aux États-Unis, et ce, malgré des données selon lesquelles les opioïdes sont inefficaces pour la douleur associée à l’arthrite et comportent des risques substantiels. Notre objectif principal était de déterminer si les patients qui utilisaient déjà des opioïdes en période préopératoire obtenaient des résultats plus négatifs aux plans de la douleur et du fonctionnement 12 mois après leur PTG, comparativement aux patients qui ne prenaient pas d’opioïdes avant leur intervention; notre objectif secondaire était de mesurer la prévalence du recours aux opioïdes avant et après la PTG en Alberta, au Canada.Dans cette analyse rétrospective menée sur des données de population, nous avons identifié les patients adultes soumis à une PTG entre 2013 et 2015 en Alberta. Nous avons utilisé un modèle de régression linéaire multivarié pour examiner le lien entre l’utilisation d’opioïdes en période préopératoire et les scores de douleur et de fonctionnement à l’échelle WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) 12 mois après la PTG, en tenant compte de potentielles variables de confusion.Sur les 1907 patients, 592 (31,0 %) ont reçu au moins 1 opioïde avant leur PTG, et 124 (6,5 %) en étaient considérés des utilisateurs de longue date. Les utilisateurs d’opioïdes de longue date présentaient de moins bons scores WOMAC ajustés pour les domaines de douleur et de fonctionnement 12 mois après la PTG, comparativement aux patients qui n’en prenaient pas avant l’intervention (score de douleur β = 7,7, intervalle de confiance [IC] de 95 % 4,0 à 11,6; score de fonctionnement β = 7,8, IC de 95 % 4,0 à 11,6; p0,001 pour les 2 domaines). La majorité (89 [71,8 %]) des patients utilisateurs d’opioïdes de longue date avant l’intervention se sont fait servir des opioïdes 180–360 jours après la PTG, comparativement à 158 patients (12,0 %) qui n’en prenaient pas avant l’intervention.Un nombre substantiel de patients ont reçu des opioïdes avant et après la PTG, et ceux qui en prenaient avant l’intervention présentaient des scores de douleur et de fonctionnement ajustés plus défavorables 12 mois après la PTG, comparativement aux patients qui n’en prenaient pas avant l’intervention. Selon ces résultats, il faut adresser des conseils judicieux aux patients qui sont déjà sous opioïdes en période préopératoire et les informer des résultats possibles de la PTG.

Objectives Police officers run a risk of injury that is higher than in most other occupations. This study aims to quantify injury prevalence and identify common musculoskeletal injuries (MSIs) among police officers, using injury data from a municipal police service in Alberta, Canada. Material and methods This is a descriptive study based on a secondary data analysis of the MSIs reported to the police service over a 41-month period; January 1, 2013 - June 2, 2016. Data from 1325 active police officers were examined, and injury prevalence was reported according to sex, injury diagnosis, the body part injured, and the work area. Results The prevalence of strains and sprains was very high, at 89.2%. The back and shoulder were most frequently affected. Overall, injury proportions did not differ significantly across work areas. The injury risk was age-related but no significant differences in injuries between sexes were identified. Conclusions Minor injuries such as strains and sprains occur frequently in the police occupation. Future research should focus on specific risk factors for MSIs in police officers in order to aid prevention. Int J Occup Med Environ Health. 2020;33(1):59-66.

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

Children on Canadian farms are at high risk for fatal injury. Ongoing surveillance of these deaths is required to affirm recurrent patterns of injury, and to determine whether historical approaches to prevention have resulted in declines in the occurrence of these traumatic events. We analyzed epidemiological patterns and trends in the occurrence of fatal pediatric farm injuries over 23 years. Records of deaths were obtained from the Canadian Agricultural Injury Reporting system. To contrast more recent data with injury patterns described historically, cases were compared between two time periods. An intentional consensus process was used to finalize key patterns and their clinical or social importance. 374 fatal farm injuries to children in Canada were identified over the 23 years of study; 253 in period 1 and 121 in period 2. While machinery and non-machinery causes of death varied between the two study periods, mean annual rates of fatal injury (approximately 4 per 100,000 children) remained similar. Notably emergent types of injury in recent years included those caused by all-terrain vehicles, skid steer loaders, and drownings. Observed declines in the numbers of fatal farm injuries are most likely attributable to analogous declines in the number of registered farms in Canada. Our findings call into question the effectiveness of pediatric farm safety initiatives that primarily focus on education. Second, while CAIR fatality data are maintained, surveillance of hospitalized injuries has been disbanded and the fatality records require updating. Only by doing so will such surveillance findings provide comprehensive information to inform prevention.

It is challenging to detect long-term opioid therapy (LTOT) using administrative data, as refill gaps can disrupt opioid utilization episodes. Previous studies have used various methods to define LTOT and allowable refill gaps with little supporting evidence.To describe the effect of allowable refill gaps on detecting LTOT among a cohort of patients with arthritis awaiting total knee arthroplasty (TKA) using 3 different methods.A retrospective analysis of multicenter population-based data between January 1, 2012, and December 31, 2016, identified patients prescribed opioids before TKA in Alberta, Canada. We described 3 methods to detect LTOT based on a (1) fixed number of days between prescriptions; (2) fraction of the preceding prescription length; and (3) combination method that selected whichever refill gap was greatest. We then compared the number of patients classified as long-term opioid users by varying the number of days between prescriptions from 1-90 days (fixed method) or 0.04-3.2 times the duration (fraction method) for each method and refill gap.Of the 14,252 patients included in our cohort, 4,393 patients (31%) had an opioid prescription within 180 days before TKA. Detection of LTOT varied from 4.4% to 14.6% (fixed method), 4.2% to 13.2% (fraction method), and 4.5% to 15.1% (mixed method) as refill gaps varied from minimum to maximum. As refills gaps increased, the dose and duration of opioids in the utilization episode decreased for all 3 methods.The allowable refill gap between opioid prescriptions can influence the estimated rate of LTOT when using administrative pharmaceutical dispensing data. Definitional parameters should be carefully considered when using administrative data to define consistent opioid use.This work was supported by the Department of Surgery's Clinical Research Grant at the University of Alberta (RES0039945). The authors have no potential conflicts of interest.

BackgroundThe emergency department (ED) is the first point of care for many patients with concussion, and post-concussion syndrome can impact vocational outcomes like successful return to work. Evaluation of concussion in general adult populations is needed.AimsTo document the occurrence and outcomes of work-related concussion presenting to the ED for treatment.MethodsThis study enrolled adults presenting with concussion to three urban Canadian EDs. Baseline ED interviews, physician questionnaires and patient phone interviews at 30 and 90 days documented work-related events, ED management, discharge advice, patient adherence and symptom severity. Work-related injury and return to work were modelled using logistic or linear regression, as appropriate.ResultsOverall, 172 enrolled workers completed at least one follow-up. Work-related concussions were uncommon (n = 28). Most employees (80%) missed at least 1 day of work (median = 7; interquartile range: 3–14). Most (91%) employees returned to work within 90 days, while 41% reported persistent symptoms. Manual labour and self-reported history of attention deficit hyperactivity disorder were associated with work-related concussion, while days of missed work increased with marital status (divorced), history of sleep disorder and physician’s advice to avoid work.ConclusionWork-related concussions are infrequent; however, most workers who sustain a concussion will miss work, and many return while still experiencing symptoms. Work-related concussion and days of missed work are mainly affected by non-modifiable factors. Workers, employers and the workers’ compensation system should take necessary precautions to ensure that workers return to work safely and successfully following a concussion.

ObjectivesThis retrospective cohort study compared rates of emergency department (ED) visits after a diagnosis of chronic obstructive pulmonary disease (COPD) in the three Aboriginal groups (Registered First Nations, Métis and Inuit) relative to a non-Aboriginal cohort.MethodsWe linked eight years of administrative health data from Alberta and calculated age- and sex-standardized ED visit rates in cohorts of Aboriginal and non-Aboriginal individuals diagnosed with COPD. Rate ratios (RR) with 95% confidence intervals (CIs) were calculated in a Poisson regression model that adjusted for important sociodemographic factors and comorbidities. Differences in ED length of stay (LOS) and disposition status were also evaluated.ResultsA total of 2,274 Aboriginal people and 1,611 non-Aboriginals were newly diagnosed with COPD during the study period. After adjusting for important sociodemographic and clinical factors, the rate of all-cause ED visits in all Aboriginal people (RR=1.72, 95% CI: 1.67, 1.77), particularly among Registered First Nations people (RR=2.02; 95% CI: 1.97, 2.08) and Inuit (RR=1.28; 95% CI: 1.22, 1.35), were significantly higher than that in non-Aboriginals, while ED visit rates were significantly lower in the Métis (RR=0.94; 95% CI: 0.90, 0.98). The ED LOS in all Aboriginal groups were significantly lower than that of the non-Aboriginal group.ConclusionsAboriginal people with COPD use almost twice the amount of ED services compared to their non-Aboriginal counterparts. There are also important variations in patterns of ED services use among different Aboriginal groups with COPD in Alberta.

A police officer&rsquo, s career is hazardous and physically demanding. In order to perform occupational tasks effectively and without injury, officers require adequate physical abilities. The aim of this study was to investigate the relationship between scores on several fitness tests and musculoskeletal injury in a group of municipal police officers. This retrospective study used existing data to examine the relationship between risk of injury and fitness test performance. Injured and uninjured police officers scored significantly differently on several fitness measures. A multivariate regression indicated that a combination of age, sex, number of pull ups completed and maximal oxygen consumption (VO2max) best explained injury risk. Additionally, the findings indicated an interaction between sex and VO2max, and so the effect of VO2max on injury risk cannot be understood without accounting for sex.

Introduction: Patients with concussion often present to the emergency department (ED). Although sports and recreation (SR) activities account for less than half of all adult concussions, guidelines developed for management of SR-related concussions (SRC) are widely used for all concussion patients. This study aimed to identify whether there are clinically relevant differences in patient and injury characteristics between SRC and those occurring outside of SR activities. Methods: Adults ( >17 years) presenting from April 2013 to April 2015 with a concussion to one of three EDs with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, lifestyle, relevant medical history), ED presentation (i.e., EMS arrival, hours since injury, CTAS, Glasgow Coma Scale score) and injury characteristics (i.e., activity leading to injury, loss of consciousness [LOC], signs and symptoms [scored using the Rivermead Post-Concussion Questionnaire], and health-related quality of life [from the 12-Item Short Form Health Survey [SF-12]) were collected from structured interviews and the ED chart. Dichotomous and categorical variables were compared using Fisher's exact test; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Results: In total, 248 patients were enrolled (47% male, median [IQR] age: 35 [23, 49]). Patients with SRC were younger (median: 23.5 years vs 35 years; p < 0.001), more likely to be a student (31% vs 8%; p > 0.001), and more likely to exercise regularly (89% vs 66%; p = 0.001). Patients with SRC were less likely to present during the daytime (66% vs. 77%; p = 0.022), less likely to have a history of mental health issues (18% vs 33%; p = 0.011) and had significantly higher median SF-12 physical components scores (55.5 [IQR: 51.4 to 57.8] vs. 53.5 [IQR: 45.5 to 56.7]; p = 0.025). All other characteristics were similar between the two groups. Conclusion: Although differences in demographics and lifestyle have been identified between patients sustaining a SRC and those concussed during other activities, injury characteristics, such as presentation acuity, proxies for severity, and signs and symptoms, were similar in both groups. Further analysis to assess whether the demographic and lifestyle differences affect clinical outcomes, such as time to symptom resolution, between these two groups is required to assess if sport-based treatment guidelines are appropriate for all patients.

Objectives: This article aimed to compare alcohol consumption between the populations of Queensland in Australia and Alberta in Canada. Furthermore, the associations between greater alcohol consumption and socio-demographic characteristics were explored in each population. Methods: Data from 2500 participants of the 2013 Alberta Survey and the 2013 Queensland Social Survey were analyzed. Regression analyses were used to explore the associations between alcohol risk and socio-demographic characteristics. Results: A higher rate of hazardous alcohol use was found in Queenslanders than in Albertans. In both Albertans and Queenslanders, hazardous alcohol use was associated with being between 18 and 24 years of age. Higher income, having no religion, living alone, and being born in Canada were also associated with alcohol risk in Albertans; while in Queenslanders, hazardous alcohol use was also associated with common-law marital status. In addition, hazardous alcohol use was lower among respondents with a non-Catholic or Protestant religious affiliation. Conclusions: Younger age was associated with greater hazardous alcohol use in both populations. In addition, different socio-demographic factors were associated with hazardous alcohol use in each of the populations studied. Our results allowed us to identify the socio-demographic profiles associated with hazardous alcohol use in Alberta and Queensland. These profiles constitute valuable sources of information for local health authorities and policymakers when designing suitable preventive strategies targeting hazardous alcohol use. Overall, the present study highlights the importance of analyzing the socio-demographic factors associated with alcohol consumption in population-specific contexts.

Introduction: Patients with concussion frequently present to the emergency department (ED). Studies of athletes and children indicate that concussion symptoms are often more severe and prolonged in females compared with males. To-date, study of sex-based concussion differences in general adult populations have been limited. This study examined sex-based differences in concussion outcomes. Methods: Adult (>17 years) patients presenting to one of three urban EDs in Edmonton, Alberta with Glasgow coma scale score 13 within 72 hours of a concussive event were recruited by on-site research assistants. Follow-up calls at 30 and 90 days post ED discharge captured extent of PCS using the Rivermead Post-Concussion questionnaire (RPQ), effect on daily living activities measured by the Rivermead Head Injury Questionnaire (RHIQ), and overall health-related quality of life using the 12-item Short Form Health Survey (SF-12). Dichotomous and categorical variables were compared using Fishers exact test; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Results: Overall, 130/250 enrolled patients were female. The median age was 35 years; men trended towards being younger (median=32 years; IQR: 23, 45) than women (median=40 years; IQR: 22, 52). Compared to women, more men were single (56% vs 38% (p=0.007) and employed (82% vs 71% (p=0.055). Men and women experienced different injury mechanisms (p=0.007) with more women reporting injury due to a fall (44% vs 26%), while more men were injured at work (16% vs 7%) or due to an assault (11% vs. 3%). Men had a higher return to ED rate (13% vs. 5%; p=0.015). Women had higher RPQ scores at baseline (pConclusion: In a general ED concussion population, demographic differences exist between men and women. Based on self-reported and objective outcomes, womens usual activities may be more affected by concussion and PCS than men. Further analysis of these differences is required in order to identify different treatment options and ensure adequate care and treatment of injury.

Introduction: Patients with concussion often present to the emergency department (ED). Current guidelines recommend graded return to work and physical activity (i.e., sport, recreation and exercise activities); however, whether emergency physicians target this advice based on patient-reported activities is unknown. This study aimed to assess mismatches between physicians’ rest and return-to-activity advice and self-reported pre-injury work and physical activity of adult concussion patients. Methods: Adults (>17 years) presenting with a concussion from April 2013 to April 2015 to a study ED with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, and physical activity level) and activity leading to injury were collected from structured patient interviews. A structured questionnaire collected data from the treating physician about discharge advice provided. “Working” was defined as employed or enrolled in any level of school at the time of injury. “Physically active” was defined by reporting regular exercise (≥2 times a week) or concussed during a sports-related activity. Proportions or medians (interquartile range [IQR]) are reported, as appropriate. Results: Physician questionnaires were completed for 198/248 enrolled patients (median age: 37 years [IQR: 23, 49]; 46% male). Overall, 89% (177/198) were working; 110/177 (62%) received return-to-work advice, while 10/21 (48%) patients also received return-to-work advice, despite not working. Mentally strenuous work/school duties were reported by 143 patients, of which 85 (60%) were recommended cognitive rest. Overall, 148 patients were physically active and 115 (78%) of these were recommended physical rest while 124 (82%) were advised on safe return to physical activity. On the other hand, 35/50 (70%) patients who were not physically active received advice on safe return to physical activity. Sustaining a sports-related injury significantly increased the likelihood of safe return to physical activity advice among physically active patients (Fisher's exact p = 0.001). Conclusion: There is a mismatch between concussed patients’ pre-injury activities, and the rest and return-to-activity (i.e., work and physical activity) advice provided by emergency physicians. The possible effect of this mismatch on patient outcomes should be assessed in future research, as should strategies to improve emergency physician-patient communications around concussion management.

Objectives We study the association between changing residence and risks of attempted suicide and violent assault injury in Alberta, Canada. Our primary objective is to understand whether a change in residence between urban, rural and semiurban areas is associated with increased risk of intentional injury. Methods Study subjects are a cohort of residents linked to data on emergency department and inpatient hospital admissions between 1999 and 2010. We used generalised estimating equations to model the effects of changing residence on risk of intentional injury while controlling for the influence of age, sex, socio-economic status, Aboriginal status and history of intentional injury. Results Changing residence is associated with an increase in the risk of both attempted suicide and violent assault injury. In the case of attempted suicide, this effect is strongest for persons between 20 and 35 years of age. For violent assault injuries, persons from rural regions that have recently moved to urban regions have higher risk of injuries, and women of rural origin are at higher risk of violent assault injury than women of urban origin. Conclusions Our findings reveal an association between risk of intentional injuries and change of residence adjusting for geographical differences in injury risk. These findings suggest that intentional injury risk is associated with change in community at intraregional scales and that these populations may benefit from support that helps integrate them into their new communities.

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups.OBJECTIVE: To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations.METHODS: MEDLINE, EMBASE, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis.RESULTS: Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]).CONCLUSIONS: Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.

Background The international classification of diseases version 10 (ICD-10) uses alphanumeric expanded codes and external cause of injury codes (E-codes). Objective To examine the reliability and validity of emergency department (ED) coders in applying E-codes in ICD-9 and -10. Methods Bicycle and pedestrian injuries were identified from the ED information system from one period before and two periods after transition from ICD-9 to -10 coding. Overall, 180 randomly selected bicycle and pedestrian injury charts were reviewed as the reference standard (RS). Original E-codes assigned by ED coders (ICD-9 in 2001 and ICD-10 in 2004 and 2007) were compared with charts (validity) and also to ICD-9 and -10 codes assigned from RS chart review, to each case by an independent (IND) coder (reliability). Sensitivity, specificity, simple, and chance-corrected agreements (κ statistics) were calculated. Results Sensitivity of E-coding bicycle injuries by the IND coder in comparison with the RS ranged from 95.1% (95% CI 86.3 to 99.0) to 100% (95% CI 94.0 to 100.0) for both ICD-9 and -10. Sensitivity of ED coders in E-coding bicycle injuries ranged from 90.2% (95% CI 79.8 to 96.3) to 96.7% (95% CI 88.5 to 99.6). The sensitivity estimates for the IND coder ranged from 25.0% (95% CI 14.7 to 37.9) to 45.0% (95% CI 32.1 to 58.4) for pedestrian injuries for both ICD-9 and -10. Conclusion Bicycle injuries are coded in a reliable and valid manner; however, pedestrian injuries are often miscoded as falls. These results have important implications for injury surveillance research.

Objective:Chronic obstructive pulmonary disease (COPD) is a widespread illness with an increasing prevalence in older adults; exacerbations resulting in visits to the emergency department (ED) are common. We sought to determine the epidemiology of COPD presentations to EDs by older adults in Alberta.Methods:Administrative databases were used to examine all ED encounters for COPD from April 1999 to March 2005 in Alberta. Data included demographics of patients and timing of ED visits. Data analysis included descriptive summaries and age–sex directly standardized visit rates (DSVRs).Results:There were 85 330 ED visits for acute COPD made by 38 638 patients 55 years of age or older during the study period. More men (53.2%) presented, and the mean age at presentation was 72 years. The age–sex DSVRs remained stable from 2000/01 (24.4/1000) to 2004/05 (25.6/1000). Presentation rates differed among population subgroups. Overall, 67% of visits resulted in discharge from the ED.Conclusion:Chronic obstructive pulmonary disease is a common presentation in Alberta EDs; however, the rates of presentation were stable during the study period, and monthly and hourly trends exhibited similar patterns for each year. Disparities based on age, sex, and socio-economic and cultural statuses were identified. Targeted interventions could be implemented to reduce future ED visits for COPD.

Objectif: Le but de cette etude descriptive etait de preciser le taux d'incidence des traumatisme crâniens dans une grande province canadienne a partir des cas incidents survenus au cours d'une periode de dix ans. Nous decrivons les taux standardises pour l'âge, les caracteristiques demographiques et l'utilisations des services de sante. Methodes: Les donnees ont ete analysees au moyen de methodes statistiques descriptives. Les taux d'incidence ont ete calcules par methode directe. Les indicateurs d'utilisation de ressources hospitalieres etaient les suivants: la duree moyenne d'hospitalisation, le nombre d'hospitalisations a l'unite de soins intensifs (USI) et la duree moyenne du sejour dans une USI. Resultats: Au cours d'une periode de dix ans, on a denombre 48 753 admissions pour un traumatisme crânien incident en Colombie-Britannique. Le diagnostic de traumatisme a la tete le plus frequent etait « traumatisme intracrânien ». L'annee ou le taux total standardise pour l'âge etait le plus eleve etait 1991/92 (174,18 / 100 000). La duree moyenne d'hospitalisation etait de 7,4 jours, 10% avaient sejourne a l'USI et la duree moyenne du sejour etait de 4,4 jours (± 4,8). Le diagnostic qui comportait le sejour moyen le plus long etait « fracture du crâne » et parmi les 5 categories de causes externes de blessures (E-code) les plus frequentes selon la CIM « accident de la route » comportait le sejour moyen le plus long, soit 12,2 jours. Conclusions: Cette etude presente une analyse de l'incidence des traumatismes crâniens en Colombie-Britannique. Ces taux peuvent etre compares a ceux des autres provinces en utilisant comme population de reference la population canadienne en 2001. Nos resultats indiquent qu'on doit porter une attention particuliere a certains groupes « a risque », surtout les hommes jeunes dont le statut socioeconomique est faible. Les indicateurs d'utilisation des services de sante presentes dans cette etude devraient susciter des discussions sur la conception de politiques concernant les traumatismes crâniens.

Objective:To quantify the prevalence of cerebral palsy (CP) in British Columbia within a four-year birth cohort.Methods:The study was a population-based record linkage study of a birth cohort of British Columbian children born between April 1, 1991 and March 31, 1995. Cases were identified by the presence of International Classification of Diseases, Version 9 (ICD-9) diagnostic code “343” recorded at three years of age or older or by having the ICD-9 diagnostic code “343” recorded prior to the third birthday with two confirmatory diagnoses within the first three years of life through a record search of the BC Medical Services Plan billing files for the fiscal years 1991 to 1995.Results/Conclusion:This research has provided an estimate of the prevalence of CP in the four-year birth cohort 1991 to 1995 in British Columbia. An aggregate prevalence rate of CP was measured as 2.68 per 1000 live births, and a congenital rate was measured at 2.57 for the same population. Birth weight and gestational age demonstrated a significant relationship with the development of CP. This study should lend credence to the establishment of a CP register in British Columbia.

The objective of this study was to understand the relationship between health survey and medical chart based information. The study population consisted of adult patients (17 years of age and older) attending the Bella Coola Medical Clinic who also completed a detailed Health and Quality of Life Survey. A total of 674 adults completed the Health and Quality of Life Survey. Demographically there was excellent agreement between self-report and clinic data for age, sex, height, weight and Aboriginal ancestry. For morbidity, there was excellent agreement between self-reported and clinically recorded diabetes. Good agreement was observed for diagnoses of cancer, heart problems, hypertension, arthritis and breathing problems. Poor agreement was observed for diagnoses of depression, back/neck problems, eye problems, walking problems, stroke, hearing problems and bone/joint problems. There was poor agreement between the number of self-reported and charted clinic visits. Excellent agreement was shown between self-reported height and weight and clinic height and weight. When BMI was calculated good agreement was achieved between self-report and chart data. It can be concluded that the relationship between chart review and self-report health information observed in this rural population is similar to findings from other populations. Researchers who use self report data on co-morbidity and obesity measures should be aware of possible error in their estimates and how these errors could affect their findings.

BACKGROUND: Farming is considered to be one of the most dangerous occupations in Canada and internationally, as it often involves work in a high-risk environment due to exposure to such hazards as machinery, large animals and noxious chemicals. The objective of this study was to describe the incidence and nature of farm-related deaths and injuries on British Columbian farms from 1990–2000, with reference to Canadian averages. METHODS: British Columbian farm fatalities and farm injury hospitalizations data from Canadian Agricultural Injury Surveillance Program for 1990–2000 were analyzed in conjunction with the 1996 and 2001 Canada Census of Agriculture. The incidence and nature of farm injuries were quantified and described for age, gender, cause of injury, primary diagnosis and agent of injury. RESULTS: There were 82 fatal injuries from 1990–2000 and 1,407 hospitalizations from 1991/92 to 1999/2000. No significant overall incidence trends were found during the study period. The rate of machinery-related injuries requiring hospitalization is lower in BC than in Canada as a whole. The net effect of higher than expected hospitalization rates in younger BC adults (age 20-49) and lower than expected hospitalization rates in older BC adults (age 70+) was a much slower increase in hospitalization rates as farmers get older. CONCLUSION: The current data suggest that higher than expected non-machinery-related injuries result in higher hospitalization rates of young adult BC farmers. The potential impact of farm fatalities and injury in youth on loss of productivity and quality of life years emphasizes the need for education and prevention.

Study design: Cohort study with 6-years follow-up. Objective: To describe the utilization of health services by persons with spinal cord injury (SCI) and compare it with that of the general population. Setting: Alberta, Canada. Methods: All persons who sustained an SCI in Alberta between April 1992 and March 1994 were followed from date of injury to 6 years postinjury. Cases were matched (1:5) with controls randomly selected from the general population and matched for age, gender, and region of residence. Administrative data from centralized health care databases were compiled to provide a complete picture of health care use, including hospitalizations, physician contacts, long-term care admissions, home care services, and the occurrence of secondary complications. Results: In all, 233 individuals with SCI and 1165 matched controls were followed for 6 years. Compared with the control group, persons with SCI were rehospitalized 2.6 times more often, spent 3.3 more days in hospital, were 2.7 times more likely to have a physician contact, and required 30 times more hours of home care services. Of those with SCI, 47.6% were treated for a urinary tract infection, 33.8% for pneumonia, 27.5% for depression, and 19.7% for decubitus ulcer. Conclusion: SCI places a heavy burden on the health care system. Persons with SCI have greater rates of contact with the health system compared with the general population. Secondary complications continue to affect persons with SCI long after the acute trauma.

The purpose of this projectwas to compare three hospital-based measures ofco-morbidity to patient self-reportco-morbidity and to determine the relativeproportion of outcome predicted by each of theco-morbidity measures in a population ofindividuals receiving major joint arthroplasty. Baseline measures using the SF-36 generalhealth questionnaire and the Western OntarioMcMaster Osteoarthritis Index (WOMAC) wereobtained from 518 persons undergoing total kneeor hip replacement. A second measure wasobtained six months post-surgery. Co-morbiditywas calculated by summing the self-reportedco-morbidity at baseline, using both thechart-based and administrative data version ofCharlson's Co-morbidity Index, and by summingthe number of International Classification ofDiseases – Version 9 (ICD-9) codes appearingin the electronic health record. Linearregression was used to determine how much ofthe variation in outcome was explained by eachof the co-morbidity measurement methods. Self-report co-morbidity explained as muchvariation in outcome as the hospital-basedindices. Self-report co-morbidity did notperform as well as the other methods inexplaining the variance in health systemutilization. It was concluded that self-reportco-morbidity is minimally as useful asrecord-based systems when measuring the impactof co-morbidity on health related quality oflife (HRQL). This is an important finding, asprivacy legislation, the time until data isavailable and cost are all barriers to usingrecord-based co-morbidity measures.

Objectives: To compare emergency department (ED) utilization by individuals who present with self-inflicted injuries with utilization by control populations. Individuals with self-inflicted injuries commonly present to the ED, yet little research has been conducted on this population in this setting. Methods: Individuals who had an ED presentation in 1995–1996 for a self-inflicted injury were tracked prospectively for three to four years of follow-up. This group was matched by age and gender to two groups: individuals who presented with asthma and individuals who presented with other complaints. Data on return visits to the ED were collected from an administrative database. Groups were compared on rates of return visits. Results: There were 478 individuals randomly selected for each group. Individuals in the self-inflicted injury group had higher rates of return visits to the ED over the follow-up period: 232.7 visits per 100 person-years for the self-inflicted injury group, compared with 117.6 for the asthma group, and 83.0 for the “other” group (p < 0.001). The self-inflicted injury group had higher rates for many types of diagnoses: self-inflicted injuries, mental disorders, substance abuse, unintentional injuries, assault, headache pain, and other complaints (all p < 0.001). Patients with more than three repeat visits per year were more common in the self-inflicted injury group (20.1%) than the asthma or “other” groups (9.2% and 5.6%, respectively). Conclusions: Individuals who harm themselves are chronic users of the ED. The ED represents an opportune setting from which individuals can be directed to appropriate treatment programs.

Background and Purpose. Decreasing hospital stays for patients with total knee arthroplasties (TKAs) have a direct effect on rehabilitation. The identification of modifiable determinants of postsurgical functional status would help physical therapists plan for discharge from hospitals. The purpose of this study was to identify preoperative determinants of functional status after a TKA. Participants. Using a community-based, prospective cohort study, data were collected from 276 patients who received a primary TKA in a Canadian health care region. Data were collected in the month before surgery and 6 months after surgery. Methods. Function was measured using the function subscale of a disease-specific measure—the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index—and a generic health status measure—the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Independent variables examined included demographic variables (eg, age, sex), medical variables (eg, diagnosis, number of comorbid conditions, ambulatory status), surgical variables (eg, type of implant, number of complications), and knee range of motion. Results. At 6 months after surgery, the average WOMAC physical function score was 70.5 (SD=18.2) and the average SF-36 physical function score was 44.8 (SD=25.3). Using multiple regression analyses, baseline function, walking device, walking distance, and comorbid conditions predicted 6-month function (WOMAC: R2=.20; SF-36 physical function: R2=.27). Discussion and Conclusion. Patients who have lower preoperative function may require more intensive physical therapy intervention because they are less likely to achieve functional outcomes similar to those of patients who have less preoperative dysfunction.

Objectives:To describe the incidence and pattern of traumatic spinal cord injury and cauda equina injury (SCI) in a geographically defined region of Canada.Methods:The study period was April 1, 1997 to March 31, 2000. Data were gathered from three provincial sources: administrative data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner.Results:From all three data sources, 450 cases of SCI were identified. Of these, 71 (15.8%) died prior to hospitalization. The annual incidence rate was 52.5/million population (95% CI: 47.7, 57.4). For those who survived to hospital admission, the incidence rate was 44.3/million/year (95% CI: 39.8, 48.7). The incidence rates for males were consistently higher than for females for all age groups. Motor vehicle collisions accounted for 56.4% of injuries, followed by falls (19.1%). The highest incidence of motor vehicle-related SCI occurred to those between 15 and 29 years (60/million/year). Fall-related injuries primarily occurred to those older than 60 years (45/million/year). Rural residents were 2.5 times as likely to be injured as urban residents.Conclusion:Prevention strategies for SCI should target males of all ages, adolescents and young adults of both sexes, rural residents, motor vehicle collisions, and fall prevention for those older than 60 years.

OBJECTIVES: This paper describes the temporal and spatial distribution of child pedestrian injury within Edmonton, Alberta for four fiscal years (1995-96 through 1998-99), and compares this pattern to temporal and spatial data on traffic volume. METHODS: We used injury data obtained through an ongoing emergency department (ED) surveillance system involving all hospitals in Alberta's Capital Health Region. We identified peak times of injury occurrence and the location of high injury incidence as indicated by census tract of residence. Empirical Bayes estimation procedures were used to calculate stable injury incidence ratios. Cartographic and correlation analyses identified the relationship between traffic volume and injury incidence. RESULTS: Child pedestrian injury occurred most frequently during morning (0700-0900 hrs) and late afternoon (1500-1800 hrs) which corresponds with peak periods of vehicular traffic flow. The highest incidence rates occurred in or near areas of high traffic volume, notably in the central and west-central parts of Edmonton. DISCUSSION: These findings emphasize the importance of considering spatial and temporal patterns in pedestrian injury research, as well as the need to incorporate these patterns in prevention strategies. Changing the times that children attend school may reduce the convergence of pedestrian and vehicular traffic. Language: en

Objectives Sledding is a common recreational activity in northern communities. The objective of this study was to examine the frequency and nature of sledding injuries (SIs) in patients presenting to emergency departments (EDs). Methods The data were derived from a cohort of patients treated at all five EDs in an urban Canadian health region over a two-year period. Following chart review, consenting patients were interviewed by telephone about their sledding activities and the circumstances surrounding the injury. Results Three hundred twenty-eight patients were correctly coded as having SIs, with 212 patients (65%) reached during the follow-up survey. The median age of those with SIs was 12 years (IQR = 8, 21), and 206 (59%) were male. Injury rates peaked in the 10--14-year age group (87/100,000) for boys and in the 5--9-year age group (75/100,000) for girls. Most patients stated they were drivers (75%), fewer than half were thrown from the sled (42%), and fewer than half (44%) were sledding on community-designated sledding hills at the time of injury. Injuries to the lower extremity (32%), upper extremity (31%), and head (13%) were most common. Thirty-seven (11%) patients with SIs were admitted to hospital vs 4% of patients with other sports/recreation injuries (p Conclusions Sledding injuries are common and potentially serious wintertime injuries in northern communities, involving primarily younger patients, with a large pre-adolescent group. However, older sledders (>20 years) have poorer outcomes (hospitalization, lost time from work/school) than their younger counterparts. The SIs treated in the ED appear to lead to hospitalization more frequently than other types of sport/recreation injury, and injury prevention strategies appear warranted.

Objective—To provide an overview of hospital admissions for the treatment of farm injuries. Methods—Design: descriptive analysis of data from the Canadian Agricultural Injury Surveillance Program (CAISP). Population: persons experiencing a farm injury requiring hospitalization, April 1991 to March 1995. Access to hospital separation data was negotiated within Canadian provinces.Individual cases were verified by medical records personnel and supplemental data describing injury circumstances were obtained. Analysis:descriptive analyses characterizing farm injuries by: persons involved, mechanisms, primary diagnoses, and agents of injury. Results—Data from 8/10 Canadian provinces representing 98% of the farm population were obtained. A total of 8263 farm injuries were verified. Adults aged 60 years and older were over-represented in these injuries. Leading external causes of agricultural machinery injury included entanglements, being pinned/struck by machinery, falls, and runovers. Nonmachinery causes included falls from heights, animal related trauma, and being struck/by against objects. Leading diagnoses varied by age group, but included: limb fractures/open wounds, intracranial injuries, skull fractures, and spinal/ truncal fractures. Conclusions—CAISP is a new agricultural injury surveillance program in Canada. Data from this system are actively used to inform prevention initiatives, and to indicate priorities for etiological and experimental research in the Canadian agricultural setting. (Injury Prevention 2001;7:123‐128)

Objective:Our goal was to determine the effectiveness of an intervention aimed at improving the emergency department (ED) documentation of pediatric injuries.Methods:All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training and were instructed how to document 14 injuryspecific data elements. Pocket reminder cards were provided, and pediatric injury charts were flagged. Subsequently, random samples of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention. Postintervention documentation was compared to pre-intervention documentation for the 14 predefined data elements.Results:Six of the 14 data elements were charted more frequently, and 2 less frequently during the post-intervention phase. Odds ratios ranged from 4.59 (95%CI, 3.40 to 6.19) for charting “the presence of an adult observer” to 0.09 (95%CI, 0.01 to 0.76) for charting “sports equipment related to the injury.” The “flagging” of injury charts, as a visual reminder for clinicians to document injury data, seemed to be the most effective component of the intervention.Conclusion:A simple intervention, consisting of staff training, chart modification, and visual flagging of charts, can increase the amount of injury information documented by ED clinicians. Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians.

The 1996 Alberta Sport and Recreation Injury Survey is a retrospective study describing the annual incidence of injuries in the province of Alberta resulting from sport and recreational involvement. Data was collected by means of a telephone survey using random digit dialling techniques to obtain a representative sample of Albertans in the winter of 1995–96. The sample produced a total of 3,790 respondents from 1,478 households evenly split between genders, with an age range of 6 to 93 years. The survey asked information regarding medically attended, non-fatal injuries resulting from sport and recreational activities. Findings reveal an annual incidence of sport or recreational injuries of 11%. Among those reporting a sport or recreational injury, the most common types of injuries were a sprained/torn ligament (31%), strained/pulled muscle (19%), and fracture (13%). The most common bodily locations of injuries were the knees (21%) and the ankle (14%).

Introduction: Some non-urgent/low-acuity Emergency Department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study surveyed patients who presented to the ED and explored their self-reported reasons and barriers for not being connected to a primary care provider (PCP). Methods: Patients aged 17 years and older were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada. Following initial triage, stabilization, and verbal informed consent, patients completed a 47-item questionnaire. Data from the survey were cross-referenced to a minimal patient dataset consisting of ED and demographic information. The questionnaire collected information on patient characteristics, their connection to a PCP, and patients' reasons for not having a PCP. Results: Of the 2144 eligible patients, 1408 (65.7%) surveys were returned and 1402 (65.4%) were completed. The majority of patients (74.4%) presenting to the ED reported having a family physician; however, the ‘closeness’ of the connection to their family physician varied greatly among ED patients with the most recent family physician visit ranging from 1 hour before ED presentation to 45 years prior. Approximately 25% of low acuity ED patients reported no connection with a family physician. Reasons for a lack of PCP connection included: prior physician retired, left, or died (19.8%), they had never tried to find one (19.2%), they had recently moved to Alberta (18.0%), and they were unable to find one (16.5%). Conclusion: A surprisingly high proportion of ED patients (25.6%) have no identified PCP. Patients had a variety of reasons for not having a family physician. These need to be understood and addressed in order for primary care access to successfully contribute to diverting non-urgent, low acuity presentations from the ED.

Objective:We describe the epidemiology of asthma presentations to emergency departments (EDs) for 3 main regions in the province of Alberta.Methods:We used a comprehensive ED database to identify ED visits in Alberta from April 1999 to March 2005. We linked the visits to other provincial administrative databases to obtain all data on follow-up encounters for asthma during that period. Information extracted included demographics, regions of residence (Edmonton, Calgary or non–major urban [NMU]), timing of ED visits, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates.Results:During the 6-year study period, 93 146 patients made 199 991 ED visits for asthma. Crude rates in 2004/05 were 7.9/1000, 6.5/1000 and 15.4/1000 in the Edmonton, Calgary and NMU regions, respectively. The Edmonton and Calgary regions had consistently lower visit rates than the NMU regions. The ED visits were followed by low rates of follow-up visits in a variety of non-ED settings, at different intervals.Conclusion:Asthma is a relatively common presenting problem in Alberta EDs. This study identified relatively stable rates of presentation during the study period, and variation among regions in terms of age and sex. This study provides further understanding of the variation associated with ED presentation and indicates possible targets for specific interventions to reduce asthma-related ED visits.

Background: Suicide among seniors is a significant health problem in north America, particularly for men in whom the rates rise steadily after 50 years of age. The goal of this study was to examine elder suicides identified from a large population-based database using case–control methods to determine disease and medication factors related to suicide. Methods: A population-based 1 : 5 case–control study was conducted comparing seniors aged 66 years and older who had died by suicide with age and sex-matched controls. Case data were obtained through British Columbia (BC) Vital Statistics, whereas controls were randomly selected from the BC Health Insurance Registry. Cases and controls were linked to the provincial PharmaCare database to determine medication use and the provincial Physician Claims and Inpatient Hospitalization databases to determine co-morbidity. Results: Between 1993 and 2002 a total of 602 seniors died by suicide in BC giving an annual rate of 13.2 per 100 000. Firearms were the most common mechanism (28%), followed by hanging/suffocation (25%), self-poisoning (21%), and jumping from height (7%). In the adjusted logistic model, variables related to suicide included: lower socioeconomic status, depression/psychosis, neurosis, stroke, cancer, liver disease, parasuicide, benzodiazepine use, narcotic pain killer use and diuretic use. There was an elevated risk for those prescribed inappropriate benzodiazepines and for those using strong narcotic pain killers. Conclusion: This study is consistent with previous studies that have identified a relationship between medical or psychiatric co-morbidity and suicide in seniors. In addition, new and potentially useful information confirms that certain types and dosages of benzodiazepines are harmful to seniors and their use should be avoided.

To compare emergency department (ED) utilization by individuals who present with self-inflicted injuries with utilization by control populations. Individuals with self-inflicted injuries commonly present to the ED, yet little research has been conducted on this population in this setting.Individuals who had an ED presentation in 1995-1996 for a self-inflicted injury were tracked prospectively for three to four years of follow-up. This group was matched by age and gender to two groups: individuals who presented with asthma and individuals who presented with other complaints. Data on return visits to the ED were collected from an administrative database. Groups were compared on rates of return visits.There were 478 individuals randomly selected for each group. Individuals in the self-inflicted injury group had higher rates of return visits to the ED over the follow-up period: 232.7 visits per 100 person-years for the self-inflicted injury group, compared with 117.6 for the asthma group, and 83.0 for the "other" group (p0.001). The self-inflicted injury group had higher rates for many types of diagnoses: self-inflicted injuries, mental disorders, substance abuse, unintentional injuries, assault, headache pain, and other complaints (all p0.001). Patients with more than three repeat visits per year were more common in the self-inflicted injury group (20.1%) than the asthma or "other" groups (9.2% and 5.6%, respectively).Individuals who harm themselves are chronic users of the ED. The ED represents an opportune setting from which individuals can be directed to appropriate treatment programs.

Background: Cross cultural validity is of vital importance for international comparisons. Objective: To investigate the validity of international Dutch-English comparisons when using the Dutch translation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). Patients and Methods: The dimensionality, reliability, construct validity, and cross cultural equivalence of the Dutch WOMAC in Dutch and Canadian patients waiting for primary total hip arthroplasty was investigated. Unidimensionality and cross cultural equivalence was quantified by principal component and Rasch analysis. Intratest reliability was quantified with Cronbach's α, and test-retest reliability with the intraclass correlation coefficient. Construct validity was quantified by correlating sum scores of the Dutch WOMAC, Arthritis Impact Measurement Scales (Dutch AIMS2), Health Assessment Questionnaire (Dutch HAQ), and Harris Hip Score (Dutch HHS). Results: The WOMAC was completed by 180 Dutch and 244 English speaking Canadian patients. Unidimensionality of the Dutch WOMAC was confirmed by principal component and Rasch analysis (good fit for 20/22 items). The intratest reliability of the Dutch WOMAC for pain and physical functioning was 0.88 and 0.96, whereas the test-retest reliability was 0.77 and 0.92, respectively. Dutch WOMAC pain sum score correlated 0.69 with Dutch HAQ pain, and 0.39 with Dutch HHS pain. Dutch WOMAC physical functioning sum score correlated 0.46 with Dutch AIMS2 mobility, 0.62 with Dutch AIMS2 walking and bending, 0.67 with Dutch HAQ disability, and 0.49 with Dutch HHS function. Differential item functioning (DIF) was shown for 6/22 Dutch items. Conclusions: The Dutch WOMAC permits valid international Dutch-English comparisons after correction for DIF.

Decreasing hospital stays for patients with total knee arthroplasties (TKAs) have a direct effect on rehabilitation. The identification of modifiable determinants of postsurgical functional status would help physical therapists plan for discharge from hospitals. The purpose of this study was to identify preoperative determinants of functional status after a TKA.Using a community-based, prospective cohort study, data were collected from 276 patients who received a primary TKA in a Canadian health care region. Data were collected in the month before surgery and 6 months after surgery.Function was measured using the function subscale of a disease-specific measure--the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index--and a generic health status measure--the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Independent variables examined included demographic variables (eg, age, sex), medical variables (eg, diagnosis, number of comorbid conditions, ambulatory status), surgical variables (eg, type of implant, number of complications), and knee range of motion.At 6 months after surgery, the average WOMAC physical function score was 70.5 (SD=18.2) and the average SF-36 physical function score was 44.8 (SD=25.3). Using multiple regression analyses, baseline function, walking device, walking distance, and comorbid conditions predicted 6-month function (WOMAC: R2=.20; SF-36 physical function: R2=.27).Patients who have lower preoperative function may require more intensive physical therapy intervention because they are less likely to achieve functional outcomes similar to those of patients who have less preoperative dysfunction.

Introduction: Participation in ice hockey by women is increasing in many parts of North America; however, research into injuries and the patterns of injury among female players associated with this activity is limited. Purpose: The purpose of this research was to examine the incidence and nature of injuries suffered by female recreational ice hockey players. Methods: This prospective study followed 314 female players from 33 teams in Edmonton, Canada, during the 1997-1998 hockey season. Injury and game attendance data were collected using monthly telephone interviews throughout the season. Diagnostic information for individuals who received medical treatment was solicited from the attending health professional. Results: A total of 102 players reported a total of 125 injuries for a rate 7.5 injuries/1000 player exposures. The anatomic region most often injured was the lower extremity (31.2%), and the most common diagnosis was sprain/strain (52.0%). The predominant injury mechanism was player contact, either as a result of collision with another player or a body check (40.0%). Of all injuries, 65.6% occurred during league games, 27.2% during play-off, tournament, or exhibition games, and 7.2% during practices. Although less than 1% of injuries resulted in hospitalization, 17.6% of injuries resulted in an absence from hockey of 8 or more days. Conclusion: The diagnostic and anatomic distribution of injury in the women's hockey league was similar to that in leagues where full facial protection is mandatory. The observed injury rate was lower than the rates reported for male recreational and collegiate ice hockey players. Female recreational ice hockey players are at risk for injuries and further research is required to identify areas for injury prevention.

Background Although lower urinary tract symptoms have been associated with falls, few studies have been undertaken to understand this relationship in vulnerable community dwelling older adults. The purpose of this study was to describe the relationship over time of falls risk and lower urinary tract symptoms among community based older women receiving home support services. Methods A prospective cohort study which took place in an urban setting in western Canada. Participants were 100 older women receiving home care or residing in assisted living with home support services and were followed for six months. Demographic characteristics were collected at baseline, with the Timed Up and Go (TUG), International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), and self-report of falls collected at baseline, 3 and 6 months. Descriptive statistics were used to summarize demographic data. Differences between the three visits were analyzed using the Friedman test with post hoc analysis and associations between variables by the Spearman Rank-Order Correlation Coefficient. Results One hundred women initially enrolled; 88 and 75 remained at three months and six months. Mean age = 84.3 years; 91% reported at least one urinary symptom at baseline and 35% reported falling in the six months prior to enrollment; 15.9% reported falling between the baseline and three months and 14.6% between three and six months. Mean TUG scores at each time point indicated falls risk (27.21, 29.18 and 27.76 seconds). Significant correlations between TUG and ICIQ-FLUTS (r = 0.33, p

Background The Alberta injury death rate per 100 000 has remained unchanged from 1999 (47.1) to 2008 (48.3). The Alberta Injury Control Strategy (AICS) was developed to address this need. Aims/Objectives/Purpose The purpose was to develop an implementation plan for the AICS. The Plan aims to accomplish results these areas: engage Albertans, to make the injury issue a priority and reduce the frequency and severity of injuries. Methods A Steering Committee comprised of top bureaucrats from 13 ministries within the Alberta Government was created to oversee the development and execution of the implementation plan for the AICS. Results/Outcome A framework was developed identifying actions to be taken across all ministries within the Provincial government. Three types of actions were identified. Core actions—essential actions to be taken to achieve the intended outcomes. Supporting actions—integral to all injury prevention initiatives and supporting the outcomes for each of the core actions. Promoting actions—actions that promote initiatives that are already underway. Significance/Contribution to the Field This document provides a template for use by all stakeholders involved in injury prevention regardless of the type of injury. Although specific injury priorities are identified, it is intended that all organisations, communities and individuals will be able to identify actions they can take to reduce injuries.

Background There is limited literature regarding the effectiveness of visibility aids (eg, reflectors, lights, fluorescent clothing) in reducing the risk of a bicyclist- motor-vehicle (MV) collision. Objectives To determine if visibility aids reduce the risk of a bicyclist-MV collision. Methods Cases were bicyclists who were struck by a MV and assessed at emergency departments (EDs) from May 2008-October 2010 in Calgary and Edmonton, Alberta, Canada. Controls were bicyclists with non-MV injuries from the same EDs over the same time period. Participants were interviewed about their personal and injury characteristics, including use of visibility aids (clothing colour or reflective clothing, bike reflectors, etc). Injury information was collected from charts. ORs and 95% CIs were estimated for visibility aids after adjustment for confounders using logistic regression. Results There were 2403 injured bicyclists with 278 MV cases. The risk of a bicyclist-MV collision increased with age. Commuting also increased the odds of MV collision (OR 5.8; 95% CI 4.5 to 7.5). After accounting for location speed limit, bicyclist speed, and previous injury, white (OR 0.25; 95% CI 0.07 to 0.9) or other coloured (OR 0.45; 95% CI 0.2 to 0.9) compared with black clothing on the upper body reduced the odds of collision. Fluorescent clothing was associated with MV collisions (OR 1.7; 95% CI 1.0 to 2.8), even after adjusting for commuting and bicycling location. Significance Clothing choice may be important in reducing the risk of MV collision; however, factors beyond the individual also need to be examined.

Aims Parkinson9s disease (PD) constitutes a significant risk for falls and subsequent hip fracture, yet the rate of hip fracture in this patient population has not been clearly delineated. We looked at the incidence rate of hip fracture in a provincial-based population 65 years or older who had PD. Methods To identify PD cases record linkage of inpatient hospitalisation, physician billing and prescription records were examined for PD specific diagnostic codes for British Columbia, Canada. Hip fracture cases were identified using the International Classification of Diseases Version 9 codes. Data for the fiscal years 1991/92 to 2000/2001 were stratified by year, age group, sex. Incidence rates of hip fractures in PD were calculated using prevalent PD cases in year as the denominator. Results For females rates of hip fracture were the highest in first years of the study peaking at 31.0/1000 PD case in 1991/92 and dropping to 20.8/1000 in 1999/00. Female9s rates were consistently about 1.7 times that of male rates. The male rate of hip fracture peaked in 1993/94 at 19.8/1000 PD cases dropping to 12.6/1000 in 1999/00. Rates increased with age in both sexes. Conclusions The PD population appears to be at greater risk (3 to 4 times) of hip fracture when compared to rates reported for the general Canadian population. The differential in rates appears to be most apparent in younger PD (

Background As utilization rates for total joint arthroplasty increase, there is a hesitancy to perform this surgery on very old patients. The objective of this prospective study was to compare pain, functional, and health-related quality-of-life outcomes after total hip and total knee arthroplasty in an older patient group (≥80 years) and a representative younger patient group (55-79 years). Methods In an inception community-based cohort within a Canadian health care system, 454 patients who received primary total hip arthroplasty (n = 197) or total knee arthroplasty (n = 257) were evaluated within a month prior to surgery and 6 months postoperatively. Pain, function, and health-related quality of life were evaluated with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and the 36-Item Short-Form Health Survey (SF-36). Results There were no age-related differences in joint pain, function, or quality-of-life measures preoperatively or 6 months postoperatively. Furthermore, after adjusting for potential confounding effects, age was not a significant determinant of pain or function. Although those in the older and younger groups had comparable numbers of comorbid conditions and complications, those in the older group were more likely to be transferred to a rehabilitation facility than younger patients. Regardless of age, patients did not achieve comparable overall physical health when matched with the general population for age and sex. Conclusions With increasing life expectancy and elective surgery improving quality of life, age alone is not a factor that affects the outcome of joint arthroplasty and should not be a limiting factor when considering who should receive this surgery.

Objective In a contemporary sample of Saskatchewan farm people, to relate the degree of mechanized and also non-mechanized farm work to the occurrence of being overweight or obese. Secondarily to determine the prevalence of being overweight or obese, and to compare these prevalence levels with those reported for general populations. Method Cross-sectional analyses of baseline survey data provided for 2849 individuals (2619 adults) from 1216 Saskatchewan farms in 2013. Age/sex-standardized prevalence levels of overweight and obesity were compared between the farm cohort and general populations. Durations of specific types of work were described by metabolic equivalent scoring. Multi-level binomial regression was used to study relations between mechanized and also non-mechanized farm work with overweight and obesity. Results Overall, 65.1% of the adult farm cohort was overweight (39.6%) or obese (25.5%), with prevalence levels that exceeded estimated norms for Canada but not the province of Saskatchewan. Increases in risks for obesity were related to higher amounts of mechanized but not non-mechanized farm work. Conclusion While the mechanization of farm work has obvious benefits in terms of productivity, its potential effects on risks for overweight and obesity must be recognized.