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First Nations, Inuit, and Métis, Indigenous peoples in Canada, have long experienced racism within health services resulting in a health service system that many Indigenous people in Canada do not want to access. Research informing Indigenous health services must consider how findings and analysis happen within the community, what information is shared, and how it improves access to health services. Information shared in Indigenous research methods was communicated at the end and throughout the project. Indigenous knowledge mobilization in Indigenous research methods requires researchers to receive knowledge from the community and research participants. Also, knowledge sharing and moving into practice happen continuously throughout the research process. These qualities of Indigenous knowledge mobilization facilitate increasing accessibility to health services through Indigenous knowledge identified in research. This article describes an Indigenous knowledge mobilization framework that may be adapted within Indigenous communities looking to make transparent how Indigenous knowledge is incorporated within health services. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the strength of relationships between socioeconomic status and injury in a large Canadian farm population. Methods: We conducted a prospective cohort study of 4,769 people from 2,043 farms in Saskatchewan, Canada. Participants reported socioeconomic exposures in 2007 and were followed for the occurrence of injury through 2009 (27 months). The relative hazards of time to first injury according to baseline socioeconomic status were estimated via Cox proportional hazards models. Findings: Risks for injury were not consistent with inverse socioeconomic gradients (adjusted HR 1.07; 95% CI: 0.76 to 1.51 for high vs low economic worry; adjusted HR 1.72; 95% CI: 1.23 to 2.42 for completed university education vs less than high school). Strong increases in the relative hazard for time to first injury were identified for longer work hours on the farm. Conclusions: Socioeconomic factors have been cited as important risk factors for injury on farms. However, our findings suggest that interventions aimed at the prevention of farm injury are better focused on operational factors that increase risk, rather than economic factors per se.

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Treaty-based strategies are required to address the unique needs of Indigenous communities in Canada during the COVID-19 pandemic. A treaty-based approach should recognize provisions within the Numbered Treaties, including the Famine and Pestilence Clause and Medicine Chest Clause, agreed to during the signing of Treaty 6 in 1876. The Famine and Pestilence Clause established the Crown's obligation to aid Indigenous Peoples within Treaty 6 Territory in the event of calamities such as locust raids, storms, starvation, and disease. The Medicine Chest Clause instituted the means through which the Crown would provide medical care for Indigenous Peoples within the jurisdiction. The Government of Canada has a legal obligation to invoke the Famine and Pestilence Clause and Medicine Chest Clause in a strategy to address the spread of COVID-19 in Indigenous communities. [ABSTRACT FROM AUTHOR]

Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP). Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3). Results: The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery. Conclusion: Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit. [ABSTRACT FROM AUTHOR]

Background: In 2013, Hockey Canada introduced an evidence-informed policy change delaying the earliest age of introduction to body checking in ice hockey until Bantam (ages 13-14) nationwide.Objective: To determine if the risk of injury, including concussions, changes for Pee Wee (11-12 years) ice hockey players in the season following a national policy change disallowing body checking.Methods: In a historical cohort study, Pee Wee players were recruited from teams in all divisions of play in 2011-2012 prior to the rule change and in 2013-2014 following the change. Baseline information, injury and exposure data for both cohorts were collected using validated injury surveillance.Results: Pee Wee players were recruited from 59 teams in Calgary, Alberta (n=883) in 2011-2012 and from 73 teams in 2013-2014 (n=618). There were 163 game-related injuries (incidence rate (IR)=4.37/1000 game-hours) and 104 concussions (IR=2.79/1000 game-hours) in Alberta prior to the rule change, and 48 injuries (IR=2.16/1000 game-hours) and 25 concussions (IR=1.12/1000 game-hours) after the rule change. Based on multivariable Poisson regression with exposure hours as an offset, the adjusted incidence rate ratio associated with the national policy change disallowing body checking was 0.50 for all game-related injuries (95% CI 0.33 to 0.75) and 0.36 for concussion specifically (95% CI 0.22 to 0.58).Conclusions: Introduction of the 2013 national body checking policy change disallowing body checking in Pee Wee resulted in a 50% relative reduction in injury rate and a 64% reduction in concussion rate in 11-year-old and 12-year-old hockey players in Alberta. [ABSTRACT FROM AUTHOR]

Objectives: To examine sleep patterns in a large cohort of rural children and explore the association between sleep patterns and injury occurrence. Methods: Cross-sectional analyses of the baseline survey from a prospective cohort study (2012 to 2017) was conducted with 46 rural schools in Saskatchewan, Canada who distributed surveys to parents of 2275 rural dwelling farm and nonfarm children aged 0 to 17 years. Parents reported child sleep characteristics and farm or nonfarm injury in the previous calendar year. Multivariable log-binomial regression examined associations between sleep characteristics and injury risk. Results: There was a significant trend of decreasing sleep duration with increasing age (P-trend < 0.001). Short sleep duration on weekdays (RR: 2.14; 95% CI: 1.25 to 3.66) and sleep debt (RR: 1.89; 95% CI: 1.21 to 2.95) increased injury risk in school-age children (7 to 12 years) but not in teens. A nearly fivefold increase in injury risk was identified among school-age children reporting all sleep problems (RR: 4.99; 95% CI: 1.99 to 12.50). Snoring in teens (13 to 17 years), often a symptom of obstructive sleep apnea, was associated with increased injury risk (RR: 1.98; 95% CI: 1.17 to 3.33). There were no statistically significant associations identified between sleep characteristics and injury risk in preschool children. Conclusion: Injuries to rural children are an important public health concern. This study highlights the impact of sleep problems on risk for injury among rural children. These findings are discussed in light of the recent American Academy of Pediatrics Technical Report on Insufficient Sleep in Adolescents and Young Adults. [ABSTRACT FROM AUTHOR]

Objectives. To identify from a patient's perspective, difficulties and differences in the comprehension of five global presenteeism measures in patients with inflammatory arthritis and OA across seven countries. Methods. Seventy patients with a diagnosis of inflammatory arthritis or OA in paid employment were recruited from seven countries across Europe and Canada. Patients were randomly allocated to be cognitively debriefed on 3/5 global measures [Work Productivity Scale - Rheumatoid Arthritis, Work Productivity and Activity Impairment Questionnaire (WPAI), Work Ability Index, Quality and Quantity questionnaire, and WHO Health and Work Performance Questionnaire (HPQ)], with the WPAI debriefed in all patients as a standard measure of comparison between countries and patients. NVivo was used to code the data into four themes: construct and anchor, time recall, reference frame, and attribution. Results. Discrepancies were found in the interpretation of the word performance (HPQ) between countries, with Romania and Sweden relating performance to sports rather than work. Seventy percent of patients considered that a 7-day recall (WPAI) can accurately represent how their disease affects work productivity. The compared to normal reference (Quality and Quantity questionnaire) was reportedly too ambiguous, and the comparison with colleagues (HPQ), made many feel uncomfortable. Overall, 29% of patients said the WPAI was the most relevant to them, making it the most favoured measure. Conclusion. Overall, patients across countries agree that the construct of work productivity in the last 7 days can accurately reflect the impact of disease while at work. Some current constructs to assess at-work productivity are not interchangeable between languages. [ABSTRACT FROM AUTHOR]

Background. Ear infections in children are a major health problem and may be associated with hearing impairment and delayed language development. Objective. To determine the prevalence and the associated risk factors of ear infections in children 6–17 years old residing on two reserves and rural areas in the province of Saskatchewan. Methodology. Data were provided from two rural cross-sectional children studies. Outcome variable of interest was presence/absence of an ear infection. Logistic regression analysis was conducted to examine the relationship between ear infection and the other covariates. Results. The prevalence of ear infection was 57.8% for rural Caucasian children and 43.6% for First Nations children living on-reserve. First Nations children had a lower risk of ear infection. Ear infection prevalence was positively associated with younger age; first born in the family; self-reported physician-diagnosed tonsillitis; self-reported physician-diagnosed asthma; and any respiratory related allergy. Protective effect of breastfeeding longer than three months was observed on the prevalence of ear infection. Conclusions. While ear infection is a prevalent condition of childhood, First Nations children were less likely to have a history of ear infections when compared to their rural Caucasian counterparts. [ABSTRACT FROM AUTHOR]

Research has shown that respiratory symptoms, including chronic cough, chronic phlegm, shortness of breath, and wheeze, are important markers that contribute to hospitalization, lung function decline, and other respiratory illness. This report aims to estimate the prevalence of respiratory symptoms and associated environmental risk factors in farming and nonfarming rural-dwelling people. A baseline mail-out questionnaire to assess respiratory health outcomes as well as individual and contextual determinants in farm and small town cohorts was sent to 11,004 households within four geographical regions of Saskatchewan, Canada, in 2010. Completed questionnaires were received from 4624 households (8261 individuals). Outcome variables examined for this report were chronic cough, chronic phlegm, shortness of breath, and ever wheeze. Clustering effect within households was adjusted using generalized estimating equations. The prevalence of respiratory symptoms was chronic cough, 9.2% (farm vs. nonfarm: 8.1% vs. 10.0%); chronic phlegm, 8.2% (farm vs. nonfarm: 6.7% vs. 9.3%); shortness of breath, 29.1% (farm vs. nonfarm: 25.5% vs. 31.6%); and ever wheeze, 40.6% (farm vs. nonfarm: 38.1% vs. 42.5%). There was a significantly higher prevalence of each respiratory symptomin the nonfarming population compared with the farming population (P< .01). Respiratory symptoms were positively associated with smoking, allergic reaction to inhaled allergens, and other environmental factors for farming and nonfarming populations. The prevalence of respiratory symptoms was higher in the nonfarming rural population compared with the farming rural population. Environmental exposures such as work-related or home environment play an important role in the increased prevalence of respiratory symptoms in farming and nonfarming populations. [ABSTRACT FROM PUBLISHER]

The extent of the musculoskeletal disorder (MSD) problem is not well understood among Canadian farmers, and little too is known about their epidemiology. The purpose of this study was therefore to (1) determine the prevalence of MSDs among farmers in one Canadian province; and (2) describe the types and severities of these disorders and patterns in their occurrence. This cross-sectional analysis was conducted using baseline survey data from the Saskatchewan Farm Injury Cohort Study. Reports of MSDs, demographic and health-related variables, reports of farm-related injuries, and economic conditions of individual farms were available for 2595 adult participants from 1212 farms in Saskatchewan, Canada. Relationships between MSDs and time spent doing farm work were investigated using tests of association. The participation rate was 48.8%. Most (85.6%) of participants reported having musculoskeletal pain in at least one body part over the past year. The lower back was most frequently affected (57.7%), followed by shoulders (44.0%), and neck (39.6%). More serious pain prevented 27.9% of respondents from performing regular work activities. MSD prevalence did not vary by sex, commodity type, or by total hours of farm work completed; prevalence was significantly (P< .05) related to time spent performing biomechanically demanding tasks such as heavy lifting and working with arms overhead. The most common MSD site in farmers was the low back, followed by the upper and then lower extremities. Although this study aimed to identify high-risk groups, lack of differences between demographic groups suggests that the majority of farmers are at risk for MSDs. [ABSTRACT FROM PUBLISHER]

Background: Obesity is prevalent in rural communities in Canada, however little is known about the social determinants of health and obesity in rural populations. Socioeconomic status has been found to be inversely associated with the risk of obesity in developed countries. This study investigated the relationship between income adequacy, education and obesity in a rural setting. Methods: The study used data from 5391 adults aged 18-69 who participated in the Saskatchewan Rural Health Study in 2010. Participants completed a survey that included questions about location of residence, body weight, height, and socio-demographic and behavioral factors. Obesity was defined as body mass index being ≥ 30 kg/m2. Logistic regression using generalized estimating equation was conducted to assess the associations of income adequacy and education level with the prevalence of obesity taking covariates into consideration. Results: Approximately a third of the participants were obese and the prevalence of obesity was similar for men and women. The prevalence of obesity was significantly higher for rural residents not living on farm compared with those living on farm (p < 0.05). After adjustment for potential confounders, the risk of obesity was increased for those with ≤ 12 years of education compared with those with > 12 years of education (aOR: 1.18; 95 % CI: 1.05 - 1.34). Low income adequacy was significantly associated with an increased risk of obesity but only among those not living on farm (aOR: 1.80; 95 % CI: 1.16 - 2.79). Conclusions: Home location was associated with obesity prevalence in rural Saskatchewan and modified the influence of income adequacy, but not the influence of education, on obesity. Adults not living on farm had an increased risk of obesity and showed a significant impact of income adequacy on obesity. [ABSTRACT FROM AUTHOR]

Objectives The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments ( EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies. Methods Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with after-hours surgery were determined using generalized estimating equations logistic regression. Results Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014). Conclusions Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes. [ABSTRACT FROM AUTHOR]

This study examined self-perceived health status among men and women who live on farms, as well as variations in factors related to negative health status observed by gender. Data were collected in the province of Saskatchewan, Canada, in 2013 through the use of a cross-sectional survey. A multistage sample was developed consisting of farms nested within rural municipalities and then agricultural soil zones. The response rate was 48.8% at the farm level, with a final sample of 2,353 (1,416 men, 937 women) from 1,119 farms. Variables under study included self-reports of health status, as well as demographic, behavioral, and farm operational factors that could influence perceived health status. The analysis was initially descriptive followed by multilevel logistic regression analyses. Self-reports of diagnosed comorbidities were strongly associated with negative health status among both men and women. Daytime sleepiness was more modestly associated with negative health status in both genders. Among men, additional risk factors tended to be functional, and included older age, part-time work status, and binge drinking. Among women, additional risk factors included cigarette smoking, overweight or obesity, and lower levels of education. The study demonstrated that there were both similarities and differences between men and women on farms in the factors related to negative self-perceived health status. These findings should inform the content and targeting of health promotion programs aimed at rural populations. [ABSTRACT FROM AUTHOR]

Bicycling is a popular activity and a healthy, environmentally friendly form of transportation. However, it is also a leading cause of sport and recreational injury in children and adolescents. Head injuries are among the most severe injuries sustained while bicycling, justifying the implementation of bicycle helmet legislation by many provinces. There is evidence that bicycle helmet legislation increases helmet use and reduces head injury risk. Evidence for unintended consequences of helmet legislation, such as reduced bicycling and greater risk-taking, is weak and conflicting. Both research evidence to date and recognition of the substantial impact of traumatic brain injuries support the recommendation for all-ages bicycle helmet legislation. [ABSTRACT FROM AUTHOR]

Background Environmental audit tools must be reliable in order to accurately estimate the association between built environmental characteristics and bicycling injury risk. Objective To examine the inter-rater agreement of a built environment audit tool within a case-control study on the environmental determinants of bicycling injuries. Methods Auditor pairs visited locations where bicycling injuries occurred and independently recorded location characteristics using the Systematic Pedestrian and Cyclist Environmental Scan (SPACES). Two case groups were defined: (1) where a bicyclist was struck by a motor-vehicle (MV) and (2) where the bicyclist's injuries required hospitalisation. The two corresponding control groups were (1) where non-MV bicycle-related injuries occurred and (2) where minor bicycle-related injuries occurred. Inter-rater reliability of each item on the tool was assessed using observed agreement and κ with 95% CI. Results Ninety-seven locations were audited. Interobserver agreement was generally high (≥95%); most items had a 1-2% difference in responses. Items with ≥5% differences between raters included path condition, slope and obstructions. For land use, path and roadway characteristics,κ ranged from 0.3 for presence of offices and cleanliness to 0.9 for schools and number of lanes; overall, 78% of items had at least substantial agreement (κ≥0.61). For bicyclists struck by a MV the proportion of items with substantial agreement was 60%, compared with 73% for non-MV related injuries. For hospitalisations and minor bicycle-related injuries, 76% of items had substantial agreement. Conclusions Agreement was substantial for most, but not all SPACES items. The SPACES provides reliable quantitative descriptions of built environmental characteristics at bicycling injury locations. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the representativeness of sport and recreational injury data from Canadian Hospital Injury Reporting and Prevention Programme (CHIRPP) in Calgary. Internal representativeness was assessed by comparing CHIRPP and regional health administrative data (ambulatory care classification system-ACCS) at Alberta Children's Hospital (ACH). External representativeness was assessed by comparing CHIRPP with ACCS at all hospitals. Comparisons were performed using descriptive statistics for top injury-producing sports and sports that produced severe injuries. Stratified distributions of injury-producing sports by gender, age group and severity of injury in CHIRPP and ACCS were compared. The proportion of all injuries in Calgary captured by CHIRPP was 64.8% (99%CI: 64.02–65.54%) (16,977/26,206). CHIRPP captured more cases of top injury-producing sports than ACCS at ACH. Rankings of top injury-producing sports in CHIRPP and ACCS at ACH were remarkably consistent (ρ  = 0.92,p < 0.0001). Rankings of top injury-producing sports in CHIRPP and ACCS at all hospitals were almost identical (ρ  = 0.98,p < 0.0001). Stratified distributions of top injury-producing sports by gender, age group and the severity of injury showed strong consistency between CHIRPP and ACCS. It is concluded that CHIRPP in Calgary provides a representative profile of injuries compared to regional health administrative data. This project supports the use of CHIRPP for establishing injury prevention priorities. [ABSTRACT FROM AUTHOR]

Machinery entanglements are a leading cause of hospitalized injury on Canadian farms. This study evaluates the role farm tasks play in the occurrence of machinery entanglement events. A retrospective case series of 41 entanglement injuries involving 35 farm-machinery types was assembled. Only a few limited tasks were implicated in the majority of entanglements. These tasks were as follows: (1) field adjustments of machinery; (2) product handling and conveyance; and (3) driveline attachments and servicing. Hazards inherent and common to these tasks affected the behavior of farmers, leading to entanglements. This study establishes a need to identify hazards and assess risks associated with different tasks involving the use of farm machinery under actual field situations. Systemic changes are required to improve existing machinery safety practices through engineering, work methods, and work practice modifications. In addition to design solutions, occupational health and safetystrategies should consider activities associated with hazardous situations to inform the content of injury prevention efforts. [ABSTRACT FROM AUTHOR]

Background Many injury studies use samples of hospital patients. If a study requires further contact, consent is usually required but the sample may be biased if many fail to consent. Objective To determine whether wording requiring 'active' consent resulted in more refusals than wording that was 'passive'--that is, where consent is implied in the absence of direct refusal. Methods Subjects were injured children seen in the emergency departments in five hospitals where the Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) operates. For CHIRPP, parents or older children complete a one-page questionnaire to describe the injury; one question seeks consent to follow-up for research. Three of the hospitals use passive wording for this question and two use active wording. All cases where CHIRPP coordinators completed forms using the medical record were treated as refusals. It was hypothesised that there would be a significant association between the form of wording (active or passive) and the rate of consent, and that this association would be affected by socio-demographic and clinical variables. Results On average, 64.5% of parents gave consent for follow-up at hospitals using passive consent wording versus 42% where active consent wording was used. Passive wording consistently yielded a higher percentage of consents for all variables. The differences were greater than 5% for families living in census tracts with low median household incomes and greater than 10% for those age 15-19 years. For parent completed forms the adjusted OR for active wording was 0.48 (95% CI 0.43 to 0.54). Conclusion Caution is needed when interpreting results from studies using hospital samples, especially when wording of consent for follow-up requires direct affirmation. [ABSTRACT FROM AUTHOR]

In a case-control study, the authors examined the relation between helmet use and neck injury among Québec, Canada, skiers and snowboarders using 10 years of ski patrol data (1995–1996 to 2004–2005). Cases were defined as persons with any neck injury (n = 2,986), an isolated neck injury requiring ambulance evacuation (n = 522), or a cervical spine fracture or dislocation (n = 318). The control group included persons with non-head, non-neck injuries (n = 97,408) in an unmatched analysis. The authors also matched cases with controls injured at the same ski area, during the same activity (skiing vs. snowboarding), and during the same season. Helmet use was the primary exposure variable. For the unmatched analysis, the authors used unconditional logistic regression and adjusted for clustering by ski area and other covariates. They used conditional logistic regression for the matched analysis. Multiple imputation was used to address missing values. The adjusted odds ratio was 1.09 (95% confidence interval (CI): 0.95, 1.25) for any neck injury, 1.28 (95% CI: 0.96, 1.71) for isolated ambulance-evacuated neck injuries, and 1.02 (95% CI: 0.79, 1.31) for cervical spine fractures or dislocations. Similar results were found in the conditional logistic regression analysis and in analyses restricted to children under age 11 years. These results do not suggest that helmets increase the risk of neck injuries among skiers and snowboarders. [ABSTRACT FROM PUBLISHER]

Background: Deficiencies in emergency department (ED) charting is a common international problem. While unintentional falls account for the largest proportion of injury related ED visits by youth, insufficient charting details result in more than one third of these falls being coded as "unspecified". Non-specific coding compromises the utility of injury surveillance data. Objective: To re-examine the ED charts of unspecified youth falls to determine the possibility of assigning more specific codes. Methods: 400 ED charts for youth (aged 0-19 years) treated at four EDs in an urban Canadian health region between 1997 and 1999 and coded as "Other or unspecified fall" (ICD-9 E888) were randomly selected. A structured chart review was completed and a blinded nosologist recoded the cause of injury using the extracted data. Differences in coding specificity were compared with the original data, and logistic regression was undertaken to examine variables that predicted assignment of a specific E-code. Results: A more specific code was assigned to 46% of cases initially coded as unspecified. Of these, 73% were recoded as "Slips, trips, and stumbles" (E885), which still lacks the specificity required for injury prevention planning; 2% of charts had no fall documented. Multivariate analysis revealed that dichotomized injury severity (adjusted odds ratio (OR) = 1.75 (95% confidence interval, 1.11 to 2.78)), arrival at the ED by ambulance (adjusted OR = 5.41 (1.07 to 27.0)), and the availability of nurse's notes or triage forms, or both, in the chart (adjusted OR = 3.75 (2.17 to 6.45)) were the strongest predictors of a more specific E-code assignment. Conclusions: Deficiencies in both chart documentation and coding specificity contribute to the use of non-specific E-codes. More comprehensive triage coding, improved chart documentation, and alternative methods of data collection in the acute care setting are required to improve ED injury surveillance initiatives. [ABSTRACT FROM AUTHOR]

Background: In 2002, Hockey Canada changed the age classifications for minor ice hockey. Previously, 10- and 11-year-old children played at the Atom level (no bodychecking), and 12- and 13-year-old children played at the Peewee level (bodychecking allowed). After the policy change, 11-year-old players were placed in the Peewee division with 12-year-old players; the Atom division included 9- and 10-year-old players. The objective of this study was to examine the effect that the policy change had on injuries to 11-year-old players and compare this information with injury trends among 10- and 12-year-old players. Methods: The study location was the Capital Health region, which serves the greater Edmonton area in Alberta. Capital Health maintains a database of all emergency department visits in the region. A search of the database identified 10-, 11- and 12-year-old players admitted to 7 emergency departments with hockey-related injuries during the 2 years before and the 2 years after the policy change. We also conducted a chart review for the 11-year-old players, extracting detailed information on the nature and circumstances of their injuries for the same period. Results: The rate of injuries sustained by 11-year-old children playing at the Peewee level (with bodychecking) increased significantly compared with the rate among 11- year-0ld players at the Atom level (rate ratio [RR] 1.9, 95% confidence interval [CI] 1.4-2.4). The rate of severe injuries was more than 2 times greater among 11-year-old Peewee players than among 11-year-old Atom players (RR 2.4, 95% CI 1.6-3.6). Injury rates among the 10-year-old players (bodychecking never allowed) and the 12-year-old players (bodychecking always allowed) changed little over the study period. Interpretation: The introduction of bodychecking to 11-year-old players was associated with a large increase in injury rates. From a public health perspective, the age at which bodychecking is introduced in minor hockey should be raised. [ABSTRACT FROM AUTHOR]

Investigates the relationship between age and various factors associated with farm machine-related injuries using a retrospective review of hospital discharge data in Saskatchewan. Log linear estimates of association of various factors in four age groups; Significant association of nature of injury, mechanism of injury and type of machine varying by age group.

Background: Reports from the U.S. suggest increases in the proportion and rate of head and neck injuries in skiers and snowboarders. It is important to determine if the same is true in Canada. Methods: Skiers and snowboarders (<18 years) presenting to 16 selected emergency departments from 1991 to 1999 were assigned one body region of injury in the following order: i) brain and spine-spinal cord, ii) head and neck, iii) face, iv) other body region (i.e., controls). Crude and adjusted (age, gender, helmet use and hospital admission) odds ratios indicating the proportion of head, brain, face, and neck injury relative to controls by calendar year were estimated. Injury rates were examined for 12 to 17 year olds over the last 4 years of the study. Results: Compared with 1997-1999, there was a lower proportion of skier head injuries from 1991-93 (adjusted odds ratio (AOR)=0.16; 95% Confidence Interval (CI)=0.09-0.30) and from 1995-97 (AOR=0.71; 95% C1=0.49-1.04). The proportion of skier brain injuries was lower from 1993-95 (AOR=0.69; 95% Cl=0.44-1.07) and from 1995-97 (AOR=0.56; 95% CI: 0.35-0.91 ). In snowboarders, however, compared with 1997-99, there was evidence that although the proportion of head injuries was lower from 1991-93 (AOR=0.19; 95% Cl=0.05-0.80), the opposite was true for facial injuries. For 12 to 17 year olds, skier brain and snowboarder head and neck injury rates increased from 1995-99. Conclusions: The results suggest that head and brain injuries in skiers and head and neck injuries in snowboarders may be increasing, particularly in adolescents. [ABSTRACT FROM AUTHOR]

Focuses on a study which determined rates and risks of injury in Canadian intercollegiate basketball. Materials and methods; Results; Conclusions.

Investigates injuries in professional rodeo in Canada. Assessment of risk factors such as past injury in professional rodeo; Types and status of injury; Incidence of head injury in professional rodeo.

Features a study that used the Canadian Intercollegiate Sport Injury Registry to determine the frequency and severity of injury in men's Canada West university football Use of injury data from 1993 to 1997; Statistics of annual injury; Discussion and conclusion.

Background: Bicycle-related injuries are among the most common recreational injuries for children in Canada; moreover, bicycle-motor vehicle collisions often result in serious injuries. This study seeks to examine environmental, motorist, and bicyclist characteristics of bicycle-motor vehicle collisions that resulted in police reported severe injuries in youth (< 18 years old) bicyclists, in Alberta, Canada.Findings: Using Calgary and Edmonton police collision reports, 423 youth bicycle-motor vehicle collisions were identified from 2010 to 2014. Forty-three (10.2%) of these collisions resulted in major/fatal (severe) injuries. These severe injury cases were compared with the 380 youth bicycle-motor vehicle collisions resulting in minor or no injury (controls) using classification tree and logistic regression analyses. There were no driver or bicyclist characteristics with a significant effect on the odds of severe injury to youth bicyclists; however, lower odds were found on each of: divided roads with no barrier (aOR = 0.36; 95% CI: 0.13-0.97) or during peak traffic time (aOR = 0.44; 95% CI: 0.16-0.99).Conclusion: Personal and environment characteristics should be considered in future research and interventions focused on reducing severe youth bicycle-motor vehicle collision injuries. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. Design: Prospective cohort study, Safe to Play (2013-2018). Setting: Youth hockey leagues in Alberta and British Columbia, Canada. Participants: Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. Independent Variables: Psychosocial variables. Main Outcome Measures: Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/ SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. Results: Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child’s well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. Conclusions: Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery. [ABSTRACT FROM AUTHOR]

Background. Skiing and snowboarding are popular competitive and recreational sports with associated head injury risks from impact hazards. Understanding head injury hazards and risks in snow sports can inform injury prevention measures, such as helmets, education and environment design of runs and terrain park features, to manage injury risk. Aim. To identify and discuss (a) the proportion and incidence of head injuries and effectiveness of helmets, (b) circumstances, situational events and characteristics of head injuries and (c) head impact biomechanics in recreational skiing and snowboarding. Methods. A narrative literature review was performed. Results. Head injuries comprise up to 38% and 29% of all injuries in skiing and snowboarding, respectively. Skull fractures were found to comprise nearly half of all moderate to severe head injuries in alpine sports across all studies. The most common intracranial injury in skiing and snowboarding was cerebral contusion and subdural haematoma, respectively. Fatal head injuries in skiing are rare with an incidence of approximately one death per one million skier-visits and less than 1% of all skiing head injuries resulted in death. The majority of head injuries were sustained by novice and intermediate level skiers and snowboarders during falls on mild or moderate gradient slopes. Head injury cases occurred in terrain parks were more common in snowboarders than skiers. Fall-related head injuries to skiers are typically in the forward direction with an impact to the front of the head, whereas snowboarders fall rearward and impact the occipital region. Helmet use has increased in recent years, but recent studies have observed an unexpected reduction of the protective effect of helmets in skiing and snowboarding. Alpine sports helmet standards require linear drops onto rigid anvils, but the correlation with snow surfaces is unknown and no helmet standard requires an oblique impact test. Significant protective effects of helmets have been found for collisions and falls onto hard snow. Conclusions. Alpine sport helmet performance standards should more closely reflect the boundary conditions of impacts to skiers and snowboarders associated with head injury. Administrative and engineering controls may also reduce the risk of head injury in skiing and snowboarding. [ABSTRACT FROM AUTHOR]

Objectives: To examine factors associated with rates of game and practice-related concussion in youth ice hockey. Design: Five-year prospective cohort (Safe2Play). Setting: Community arenas (2013-2018). Participants: Four thousand eighteen male and 405 female ice hockey players (6584 player-seasons) participating in Under-13 (ages 11-12), Under-15 (ages 13-14), and Under-18 (ages 15-17) age groups. Assessment of Risk Factors: Bodychecking policy, age group, year of play, level of play, previous injury in the previous year, lifetime concussion history, sex, player weight, and playing position. Main Outcome Measurements: All game-related concussions were identified using validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician for diagnosis and management. Multilevel Poisson regression analysis including multiple imputation of missing covariates estimated incidence rate ratios (IRRs). Main Results: A total of 554 game and 63 practice-related concussions were sustained over the 5 years. Female players (IRRFemale/Male51.79; 95% CI: 1.26-2.53), playing in lower levels of play (IRR51.40; 95% CI: 1.10-1.77), and those with a previous injury (IRR51.46; 95% CI: 1.13, 1.88) or lifetime concussion history (IRR 5 1.64; 95% CI: 1.34-2.00) had higher rates of game-related concussion. Policy disallowing bodychecking in games (IRR50.54; 95% CI: 0.40-0.72) and being a goaltender (IRRGoaltenders/Forwards50.57; 95% CI: 0.38-0.87) were protective against game-related concussion. Female sex was also associated with a higher practice-related concussion rate (IRRFemale/Male 5 2.63; 95% CI: 1.24-5.59). Conclusions: In the largest Canadian youth ice hockey longitudinal cohort to date, female players (despite policy disallowing bodychecking), players participating in lower levels of play, and those with an injury or concussion history had higher rates of concussion. Goalies and players in leagues that disallowed bodychecking had lower rates. Policy prohibiting bodychecking remains an effective concussion prevention strategy in youth ice hockey. [ABSTRACT FROM AUTHOR]

Objective: To help address the high concussion burden in Canadian youth ice hockey, our primary objective was to examine the concurrent validity of youth ice hockey referees' ability to assess head contacts (HCs) and associated penalties using video analysis methods after implementation of the "zero tolerance for HC" policy by Hockey Canada. Study Design: Cross-sectional study. Participants: Certified Level II-III referees in Alberta, Canada. Intervention: A secured online survey with 60 videos (10 to 15 seconds) containing a player-to-player physical contact with or without a HC from elite U15 (ages 13 to 14) youth ice hockey games. OutcomeMeasures: Survey questions were completed by all referees for each video, including (1). 'Did you see a player-toplayer contact?', (2). 'Should a penalty be assessed?', and if yes, (3). 'Which player, penalty type, and penalty intensity?' Referee assessments were compared with a consensus agreement from 2 national and member (top level) gold standard referees for concurrent validity through percent agreement and sensitivity/specificity measures. Results: Complete-case analysis of 100 referees (131 recruited) showed an overall median agreement of 83.5% (sensitivity 5 0.74; specificity 5 0.69) with the gold standard. Agreement with the gold standard was highest for HC infractions [85.1% (sensitivity 50.80; specificity50.69)], followed by HC penalty type (81.5%) and penalty intensity (53.7%). Conclusions: Concurrent validity through percent agreement was high (.80%) compared with the gold standard for identifying both HC and other infractions; however, it was moderate for penalty intensity. Although knowledge of identifying HCs and penalties in this survey was acceptable, this study suggests in-game factors (eg, game management and positioning) may be a primary limitation for HC enforcement. [ABSTRACT FROM AUTHOR]

Objective: To examine injury and concussion rates, mechanisms, locations, and types of injury in Canadian high school male rugby. Design: Prospective cohort study. Setting: High school male rugby. Participants: A total of 429 high school players (2018: n = 225, 2019: n = 256) were recruited from 12 teams in 7 schools in Calgary, Canada. Interventions: None. Main Outcome Measures: Injury surveillance included baseline questionnaires, weekly exposure, and injury reports. Injuries included those requiring medical attention, resulted in time loss and/or inability to complete a session. Concussion was defined as per the fifth Consensus on Concussion in Sport, and all players with a suspected concussion were referred to a study sport medicine physician. Results: A total of 134 injuries were captured, leading to an injury incidence rate (IR) of 57.9/1000 hours [95% confidence intervals (CIs): 45.4-73.8]. Median time loss was 6 days (range: 0-90). Injuries to the head were the most common (40%), followed by shoulder (12%) and ankle (10%). The concussion IR was 22.0/1000 hours (95% CIs: 15.9-30.4), which was the most common injury type (38%), followed by sprain (20%) and strain (15%). Sixty-five percent of injuries occurred in the tackle (ball carrier 35%, tackler 30%) and 76% of concussions (ball carrier 41%, tackler 35%). Conclusions: The rate of injury and concussion in Canadian youth high school male rugby is high, with tackle-related injuries and concussions the most common. Given this, there is a critical need for implementation of prevention strategies, in particular targeting concussion and the tackle event (eg, neuromuscular, tackle training, and law changes). [ABSTRACT FROM AUTHOR]

Objective: To describe levels of sport specialization in Canadian high school students and investigate whether sport specialization and/or sport participation volume is associated with the history of musculoskeletal injury and/or concussion. Design: Cross-sectional study. Setting: High schools, Alberta, Canada. Participants: High school students (14-19 years) participating in various sports. Independent Variables: Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year). Main Outcome Measures: Twelve-month injury history (musculoskeletal and concussion). Results: Of the 1504 students who completed the survey, 31% were categorized as highly specialized (7.5% before the age of 12 years). Using multivariable, negative, binomial regression (adjusted for sex, age, total yearly training hours, and clustering by school), highly specialized students had a significantly higher musculoskeletal injury rate [incidence rate ratio (IRR) = 1.36, 95% confidence interval (CI), 1.07-1.73] but not lower extremity injury or concussion rate, compared with low specialization students. Participating in one sport for more than 8 months of the year significantly increased the musculoskeletal injury rate (IRR = 1.27, 95% CI, 1.02-1.58). Increased training hours significantly increased the musculoskeletal injury rate (IRR = 1.18, 95% CI, 1.13-1.25), lower extremity injury rate (IRR = 1.16, 95% CI, 1.09-1.24), and concussion rate (IRR = 1.31, 95% CI, 1.24-1.39). Conclusions: Approximately one-third of Canadian high school students playing sports were categorized as highly specialized. The musculoskeletal injury rate was higher for high sport specialization students compared with low sport specialization students. Musculoskeletal injuries and concussion were also more common in students who train more and spend greater than 8 months per year in one sport. [ABSTRACT FROM AUTHOR]

Objective: The risk of concussion is high in Canadian youth ice hockey. Aiming to reduce this burden, in 2011, Hockey Canada implemented a national "zero tolerance for head contact (HC)" policy mandating the penalization of any player HC. In 2018 to 2020, Hockey Canada further amended this HC policy including stricter enforcement of severe HCs. This study aimed to compare HC rates, head impact location, and HC enforcement prepolicy, postpolicy, and after policy amendments in elite U15 Canadian youth ice hockey. Design: This is a prospective cohort study. Setting: A collection of events with the video camera located at the highest point near center ice in public ice hockey arenas in Calgary, Alberta. Participants: A convenience sample of 10 AA U15 games prepolicy (2008-2009), 8 games postpolicy (2013-2014), and 10 games after policy amendments (2020-2021). Independent Variables: An analysis of 3 cohort years regarding the HC-policy implementation and amendments. Main Outcome Measures: Using Dartfish video-analysis software, all player contacts and HCs [direct (HC1), indirect (eg, boards, ice) (HC2)] were tagged using validated criteria. Univariate Poisson regression clustering by team-game offset by game length (minutes) was used to estimate incidence rates (IR) and incidence rate ratios (IRR) between cohorts. Results: With additional rule modifications, a 30% reduction in HC1s emerged (IRR2013-2020 = 0.70, 95% CI, 0.51-0.95). Since the HC-policy implementation, HC1s decreased by 24% (IRR2008-2020 = 0.76, 95% CI, 0.58-0.99). The proportion of HC1s penalized was similar across cohorts (P2008-2009 = 14.4%; P2013-2014 = 15.5%; P2020-2021 = 16.2%). Conclusions: The HC-policy amendments have led to decreased HC1 rates. However, referee enforcement can further boost the HC-policy effectiveness. These findings can help future referee training and potential rule modifications to increase player safety nationally. [ABSTRACT FROM AUTHOR]

The article discusses a study on the contribution of human factor in taking risk in an avalanche terrain. It mentions that the study aims to reveal potential connections between the said factor and the incidents of avalanche. It indicates that people exposed themselves to avalanche risk due to satisfaction and motivational needs. It also adds that a woman's presence moderates the risk taking of men.

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

Objectives: Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years). Methods: Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach. Results: Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization. Conclusions: Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required. [ABSTRACT FROM AUTHOR]

Abstract: Background: Bicycle helmets reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation targeted at those less than 18 years old on helmet use for all ages in Alberta. Methods: Two comparable studies were conducted two years before and four years after the introduction of helmet legislation in Alberta in 2002. Bicyclists were observed in randomly selected sites in Calgary and Edmonton and eight smaller communities from June to October. Helmet wearing and rider characteristics were recorded by trained observers. Poisson regression adjusting for clustering by site was used to obtain helmet prevalence (HP) and prevalence ratio (PR) (2006 vs. 2000) estimates. Results: There were 4002 bicyclists observed in 2000 and 5365 in 2006. Overall, HP changed from 75% to 92% among children, 30% to 63% among adolescents and 52% to 55% among adults. Controlling for city, location, companionship, neighborhood age proportion <18, socioeconomic status, and weather conditions, helmet use increased 29% among children (PR=1.29; 95% CI: 1.20–1.39), over 2-fold among adolescents (PR 2.12; 95% CI: 1.75–2.56), and 14% among adults: (PR=1.14; CI: 1.02–1.27). Conclusions: Bicycle helmet legislation was associated with a greater increase in helmet use among the target age group (<18). Though HP increased over 2-fold among adolescents to an estimated 63% in 2006, this percentage was approximately 30% lower than among children <13. [Copyright &y& Elsevier]