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IntroductionEvidence suggests the presence of deficiencies in the quality of care provided to up to half of all paediatric trauma patients in Canada, the USA and Australia. Lack of adherence to evidence-based recommendations may be driven by lack of knowledge of clinical practice guidelines (CPGs), heterogeneity in recommendations or concerns about their quality. We aim to systematically review CPG recommendations for paediatric injury care and appraise their quality.Methods and analysisWe will identify CPG recommendations through a comprehensive search strategy including Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, Cochrane library, Web of Science, ClinicalTrials and websites of organisations publishing recommendations on paediatric injury care. We will consider CPGs including at least one recommendation targeting paediatric injury populations on any diagnostic or therapeutic intervention from the acute phase of care with any comparator developed in high-income countries in the last 15 years (January 2007 to a maximum of 6 months prior to submission). Pairs of reviewers will independently screen titles, abstracts and full text of eligible articles, extract data and evaluate the quality of CPGs and their recommendations using Appraisal of Guidelines Research and Evaluation (AGREE) II and AGREE Recommendations Excellence instruments, respectively. We will synthesise evidence on recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework and present results within a recommendations matrix.Ethics and disseminationEthics approval is not a requirement as this study is based on available published data. The results of this systematic review will be published in a peer-reviewed journal, presented at international scientific meetings and distributed to healthcare providers.PROSPERO registration numberInternational Prospective Register of Systematic Reviews (CRD42021226934).

Globally, residential fires constitute a substantial public health problem, causing major fire-related injury morbidity and mortality. This review examined the literature on residential fire prevention interventions relevant to Indigenous communities and assessed their effectiveness on mitigating fire incidents and their associated human and economic burden. Electronic databases including MEDLINE, EMBASE, CENTRAL, and Web of Science Core Collection were reviewed for studies on fire prevention interventions published after 1990 and based on the 4E’s of injury prevention approaches (Education, Enforcement, Engineering, and Engagement). The grey literature and sources including indigenous organizational websites were also searched for eligible studies. Two authors independently screened, selected, and extracted data, in consultation with experts in the field. Outcomes measured included enhanced safety knowledge and practices, decreased residential fires incidents, reduced fire-related injuries and deaths, and lowered costs for healthcare needs. After removing duplicates, screening titles and abstracts, and assessing full texts, 81 articles were included in this review. Of the included studies, 29.1% implemented educational interventions within a variety of settings, including schools, community centres and homes, and included healthcare professionals and firefighters to raise awareness and the acquisition of fire safety skills. Engineering and environmental modifications were adopted in 20.2% of the studies with increased smoke alarm installations being the leading effective intervention followed by sprinkler inspections. Moreover, engagement of household members in hands-on safety training proved to be effective in enhancing household knowledge, fire safety decisions and practices. More importantly, effective outcomes were obtained when multi-faceted fire safety interventions were adopted, e.g., environmental modification and educational interventions, which together markedly reduced fire incidents and associated injuries. This review reveals the dearth of fire prevention evidence gathered directly within Indigenous communities. Nonetheless, relevant fire prevention recommendations can be made, calling for the adoption of combined and context-sensitive fire prevention interventions tailored to targeted Indigenous and vulnerable communities through multiple approaches and measures. Follow-ups and longitudinal studies are critical for accurate evaluation of the long-term outcomes and impacts on preventing residential fires.

BackgroundSupracondylar humerus fractures (SCHF) are the most common fractures sustained following a fall onto an outstretched hand among healthy children, and one of the leading causes of hospital admission and surgical intervention. The aim of this study was to examine SCHF occurring at public play spaces—particularly to determine whether or not the playground equipment implicated in injurious falls aligned with Canadian playground safety standards.MethodsCases of children who attended the provincial paediatric orthopaedic clinic following SCHF at a public playground between April 2017 and October 2019 were included in the study. A research assistant visited each playground to measure the play structure type and dimensions, height of the equipment at the point from which the child fell and the type and depth of the surface material, and compare measurements to the 2016 safety standards. Child demographics and injury classification were also noted. Descriptive statistics were calculated and a scatterplot of fall height and surface depth was generated.ResultsForty-three sites, representing 47 SCHF cases (18 female, 29 male), were included in the final analysis. Fourteen children sustained type 1 fracture, 23 had type 2 fracture and the remaining 10 had type 3 fracture. Five children with type 2 fracture and all 10 children with type 3 fracture required surgery. The majority of sites had engineered wood fibre surfacing, with surfacing at 35 sites being less than 300 mm deep. Twenty-six play structures were upper body equipment (ie, monkey bars or similar), seven were track rides, five were rotating structures and the rest comprised a variety of classified and unclassified structures. Twenty-seven children fell from a height exceeding 2 m.ConclusionsThe majority of SCHF cases occurred at playgrounds with insufficient surface depth and/or non-compliant equipment. Upper body equipment, track rides and rotating play structures were of particular concern, as the children fell from heights exceeding the recommended standard, likely reflecting the degradation and compaction of the surfacing material over time.

Canada's opioid crisis has taken thousands of lives, increasing awareness of poisoning-related injuries as an important public health issue. However, in British Columbia (BC), where overdose mortality rates are the highest in Canada, studies have not yet identified which demographic populations most often visit emergency departments (ED) due to all poisonings, nor which substances are most commonly involved. The aim of this study was to explore these gaps, after developing a methodology for calculating ED visit rates in BC.Poisoning-related ED visit rates during fiscal years 2012/13 to 2016/17, inclusive, were calculated by sex, age group, poisoning substance and socioeconomic status, using a novel methodology developed in this study. ED data were sourced from the National Ambulatory Care Reporting System and population data from Statistics Canada's 2016 (or 2011) census profiles.During the study period, there were an estimated 81 463 poisoning-related ED visits (351.2 per 100 000 population). Infants, toddlers, youth and those aged 20-64 years had elevated risks of poisoning-related ED visits. Rates were highest among those in neighbourhoods with the greatest material (607.8 per 100 000 population) or social (484.2 per 100 000 population) deprivation. Over time, narcotics and psychodysleptics became increasingly common poisoning agents, while alcohol remained problematic.A methodology for estimating ED visit rates in BC was developed and applied to determine poisoning-related ED visit rates among various demographic groups within BC. British Columbians most vulnerable to poisoning have been identified, emphasizing the need for efforts to limit drug overdoses and excessive alcohol intoxication to reduce rates of these preventable injuries.La crise des opioïdes au Canada a coûté la vie à des milliers de personnes, mettant davantage en lumière que les blessures liées aux intoxications constituent un problème de santé publique important. Cependant, en Colombie-Britannique, où le taux de mortalité par surdose est le plus élevé au Canada, les études n’ont pas encore permis de déterminer quelles populations visitent le plus souvent les urgences pour une intoxication ni quelles substances sont le plus souvent en cause. L’objectif de cette étude était d’explorer ces lacunes après avoir élaboré une méthodologie pour calculer les taux de visite aux urgences en Colombie Britannique.Grâce à une nouvelle méthodologie élaborée dans cette étude, nous avons calculé les taux de visite aux urgences liée à une intoxication sur la période 2012-2013 à 2016-2017 par sexe, groupe d’âge, substance ayant mené à l’intoxication et statut socioéconomique. Les données relatives aux urgences proviennent du Système national d’information sur les soins ambulatoires et les données de population proviennent des profils de recensements de 2016 (ou 2011) de Statistique Canada.Au cours de la période étudiée, on estime qu’il y a eu 81 463 visites aux urgences en raison d’une intoxication (351,2 pour 100 000 habitants). Les nourrissons, les tout-petits, les jeunes et les personnes de 20 à 64 ans présentaient un risque élevé de visites aux urgences en raison d’une intoxication. Les taux les plus élevés touchaient les personnes vivant dans les quartiers les plus défavorisés sur le plan matériel (607,8 pour 100 000 habitants) ou social (484,2 pour 100 000 habitants). Au fil du temps, les intoxications causées par les narcotiques et les psychodysleptiques sont devenues de plus en plus fréquentes, l’alcool demeurant toujours un problème.Nous avons élaboré et appliqué une méthodologie d’estimation des taux de visite aux urgences en Colombie-Britannique pour déterminer ceux liés à une intoxication au sein de divers groupes de population de la province. Maintenant que nous savons quelles populations sont les plus vulnérables aux intoxications en Colombie-Britannique, il faut déployer des efforts pour limiter les surdoses de drogues et les intoxications liées à une consommation excessive d’alcool afin de réduire les taux de ces blessures évitables.Between 1 April, 2012 and 31 March, 2017, there were about 81 463 poisoning-related emergency department visits in British Columbia, Canada. The highest poisoning-related emergency department visit rates were among individuals aged 25 to 44 years for males and 15 to 19 years for females, while for both sexes the lowest rate was among children aged 5 to 9 years. Broken down by age group and substance, the highest poisoning-related emergency department visit rate resulted from alcohol consumption among those aged 15 to 19 years. Poisoning-related emergency department visits were highest among those living in neighbourhoods with the greatest material and social deprivation. Overall, alcohol was the substance that most commonly resulted in poisoning-related emergency department visits; however, in 2016/17, narcotics and psychodysleptics surpassed alcohol as the substance type associated with the highest rate of poisoning-related emergency department visits.Entre le 1er avril 2012 et le 31 mars 2017, il y a eu environ 81 463 visites aux urgences en raison d’une intoxication en Colombie-Britannique (Canada). Les taux de visite aux urgences liée à une intoxication étaient plus élevés pour les 25 à 44 ans chez les hommes et pour les 15 à 19 ans chez les femmes, les taux les plus faibles ayant été enregistrés, chez les deux sexes, pour les 5 à 9 ans. Les données ventilées par groupe d’âge et substance indiquent que le taux le plus élevé de visites aux urgences en raison d’une intoxication correspondait à la consommation d’alcool chez les 15 à 19 ans. Les visites aux urgences liées à une intoxication étaient plus nombreuses chez les personnes vivant dans les quartiers les plus défavorisés sur le plan matériel et social. Si, dans l’ensemble, l’alcool est la substance qui a entraîné le plus souvent des visites aux urgences liées à une intoxication, les narcotiques et les psychodysleptiques ont, en 2016-2017, dépassé l’alcool comme substance associée au taux le plus élevé de visite aux urgences liée à une intoxication.

Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18–0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.

There has been increasing scrutiny of opioid prescribing following injury because of concerns that prescribed opioids may contribute to addiction and overdose. This study aimed to better understand the relationship between injury, opioids prescribed before and after injury, and non-medical drug poisoning.Working age (15 to 65 years old) residents of British Columbia's Fraser Health region with an injury that involved an emergency department visit were included. Factors examined included the prescription of opioid and opioid agonist therapy (OAT) medications before and after injury, age, sex, work-related injuries, and socioeconomic status, as well as how they were associated with non-medical drug poisoning risk and post-injury prescriptions.Opioid-naive individuals (those without an opioid prescription captured before their injury) who were prescribed OAT medication-a marker of opioid use disorder-following their injury had a higher risk of subsequent non-medical drug poisoning (Hazard ratio (HR): 21.4 to 22.4 compared with opioid-naive individuals without an opioid or OAT prescription). Post-injury opioid prescription in these individuals increased poisoning risk (HR: 1.27 compared with those without a prescription). Being of male sex (HR: 1.80), being younger (HR: 0.76 for every 10-year increase in age) and living in the lowest-income neighbourhoods (HR: 1.44 compared with the middle quintile) increased poisoning risk. Compared with injuries sustained outside of work, work-related injuries reduced risk (HR: 0.62).Among a cohort of British Columbians visiting emergency departments following an injury, opioid prescribing in patients who were opioid-naive appears to be a minor contributor to non-medical drug poisoning, particularly when compared with other patient factors, such as being male, being younger and having a low socioeconomic status.

Indicators can help decision-makers evaluate interventions in a complex, multi-sectoral injury system. We aimed to create indicators for road safety, seniors falls, and ‘all-injuries’ to inform and evaluate injury prevention initiatives in British Columbia, Canada. The indicator development process involved a five-stage mixed methodology approach, including an environmental scan of existing indicators, generating expert consensus, selection of decision-makers and conducting a survey, selection of final indicators, and specification of indicators. An Indicator Reference Group (IRG) reviewed the list of indicators retrieved in the environmental scan and selected candidate indicators through expert consensus based on importance, modifiability, acceptance, and practicality. Key decision-makers (n = 561) were invited to rank each indicator in terms of importance and actionability (online survey). The IRG applied inclusion criteria and thresholds to survey responses from decision-makers, which resulted in the selection of 47 road safety, 18 seniors falls, and 33 all-injury indicators. After grouping “like” indicators, a final list of 23 road safety, 8 seniors falls, and 13 all-injury indicators were specified. By considering both decision-maker ranking and expert opinion, we anticipate improved injury system performance through advocacy, accountability, and evidence-based resource allocation in priority areas. Our indicators will inform a data management framework for whole-system reporting to drive policy and funding for provincial injury prevention improvement.

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

Road traffic injury and death continue to be a concern in Canada. The built environment (BE) is a contributing factor affecting the health of road users, yet there are significant challenges to making injury-reducing BE changes. This research increases our knowledge of these challenges by investigating the opinions of injury prevention and road safety professionals working in Canada about the barriers and facilitators to BE change. Cross-referencing themes with the CFIR situated our findings within the scope of implementation science, which demonstrated how barriers and facilitators influence BE change project implementation. The prioritization of motor vehicles results in disproportionate injury and health risks for VRUs. Collaboration across sectors, with the support of champions and advocates, can facilitate sharing of resources, data, and expertise, which results in more opportunities to enact BE change. Knowledge of these barriers and facilitators, contextualized by the CFIR, makes a case for policy/decision-makers in Canada to approve BE projects that reduce risk of road traffic injury and death.

Background: Refugees are susceptible to various types of injury mechanisms associated with their dire living conditions and settlements. This study aims to compare and characterize the emergency department admissions due to physical trauma and injuries among local residents and refugees in greater Beirut. Methods: This epidemiological study analyzes injury incidence and characteristics of patients presenting to Emergency Departments of 5 sentinel hospitals between 2017 and 2019. Using the WHO Injury Surveillance Guidelines and Pan-Asia Trauma Outcomes Study form, an injury data surveillance form was designed and used in hospital settings to collect data on injuries. Chi-square test analysis was performed to compare differences in injury characteristics between local residents and refugees. Regression models were constructed to assess the effect of being a refugee on the characteristics of injuries and outcomes of interest. Results: A total of 4847 injuries (3933 local residents and 914 refugees)were reported. 87.4% of the total injuries among refugees were sustained by the younger age groups 0-45 years compared to 68.8% among local residents. The most prevalent injury mechanism was fall (39.4%) for locals and road traffic injury (31.5%) for refugees. The most injured body part was extremities for both populations (78.2% and 80.1%). Injuries mostly occurred at home or its vicinity (garden or inside the camp) for both populations (29.3% and 23.1%). Refugees sustained a higher proportion of injuries at work (6%) compared to locals (1.3%). On multivariate analysis, refugee status was associated with higher odds of having an injury due to a stab/gunshot (odds ratio (OR) = 3.392, 95% confidence interval (CI) = 2.605-4.416), having a concussion injury (OR = 1.718, 95% CI = 1.151-2.565), and being injured at work (OR = 4.147, 95% CI = 2.74-6.278). Refugee status was associated with increased odds of leaving the hospital with injury-related disability (OR = 2.271, 95% CI = 1.891-2.728)] Conclusions: Injury remains a major public health problem among resident and refugee communities in Beirut, Lebanon. Refugees face several injury-related vulnerabilities, which adversely affect their treatment outcomes and long-term disabilities. The high prevalence of occupational and violence-related injuries among refugees necessitates the introduction of targeted occupational safety and financial security interventions, aiming at reducing injuries while enhancing social justice among residents.

The design and synthesis of a proline-based reporter isobaric Tandem Mass Tag structure (TMTpro) is presented. An analysis is made of the performance of the new TMTpro tags in comparison with the current commercially available dimethylpiperidine-reporter-based TMT10/11 reagents. The new reporter structure provides a set of 16 tags for use with resolution of 6.3 mDa mass differences in high resolution mass spectrometers and a set of 9 reagents with 1 Da spacing between reporter ions for single dalton analysis using 9 heavy nuclei per tag. We show similar performance in terms of peptide identification rates and quantification between the TMTpro 16-plex and TMT10/11-plex reagents. We also demonstrate the suitability of the TMTpro reagents for phosphopeptide analysis. The ability to pool 16 samples reduces the overall amount of sample required for each channel, and we anticipate that TMTpro reagents will be a useful enhancement for any protocol that benefits from sample pooling and should reduce missing data.

Burn-related injury is a global public health problem with significant rates of morbidity and mortality. The adverse effect of burn leads to substantial functional, psychological, and economic repercussions. Low- and middle-income countries, including Lebanon, carry a disproportionately greater burden of burn injuries. This study adopted a mixed method approach to explore burn-related injuries in a sample (n = 347) of refugee children settling in Lebanon. We reviewed 179 cases of patients records that met the criteria of a child aged 0 to 19 years and has sustained a burn due to living conditions. War-related burn injuries were excluded. The findings demonstrate that there is a significantly higher proportion of 0- to 4-year-olds with burn injuries (53.6%) compared with the older age groups. Scald burns, caused by boiling liquid, were the most common cause of burns (58.6%), followed by fire/open flame (12.8%) and heat contact (6.7%). Upper trunk and arm burns were significantly higher than other body parts (35.2%), females were among the potential at-risk group with due to boiling liquids caused by food preparation and serving. Fifteen to nineteen years showed a high proportion of fire/flame burn caused by labor accident. Qualitative analysis of case reports further confirmed our findings and emphasized the impact of low socioeconomic status, overcrowded living conditions and open floor cooking and heating on increasing risk of pediatric burns. Additional research is needed to increase understanding on risk factors pertaining to pediatric burns in the refugee community with a view to integrating appropriate preventive measures and informing evidence-based policies and programs.

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.

Introduction Sachant que l’association entre l'état de santé et le statut socioéconomique (SSE) est largement documentée et que les blessures non intentionnelles continuent de se classer parmi les principales causes de décès chez les Britanno-Colombiens, nous avons voulu quantifier les disparités liées au SSE dans les taux de mortalité associés à trois secteurs prioritaires pour la Colombie-Britannique en matière de prévention des blessures : le suicide chez les jeunes, les blessures liées aux chutes chez les aînés et les blessures liées au transport. Méthodologie Nous avons jumelé les données liées aux décès (2009 à 2013) tirées des statistiques de l’état civil et des données socioéconomiques de CensusPlus de 2011 à l’échelle de l’aire de diffusion ou de la circonscription sanitaire afin d'étudier les taux de mortalité normalisés selon l’âge (TMNA) et les disparités des TMNA concernant les blessures non intentionnelles et leurs sous-types, notamment les blessures liées aux chutes chez les aînés (65 ans et plus) et les blessures liées au transport, ainsi que le suicide chez les jeunes (15 à 24 ans), ce dernier étant considéré comme une forme de blessure intentionnelle. Nous avons étudié les disparités spatiales et les disparités selon le sexe et nous avons mesuré les disparités relatives et absolues entre les zones moins favorisées et les zones plus favorisées en fonction des quintiles de revenu, de scolarité, d’emploi, de défavorisation matérielle et de défavorisation sociale. Résultats Notre étude a mis en évidence d’importantes différences entre les sexes en matière de taux de mortalité attribuable au suicide chez les jeunes, à des blessures liées aux chutes chez les aînés et à des blessures liées au transport, les hommes affichant des taux de mortalité beaucoup plus élevés que les femmes. Nous avons également observé des variations spatiales notables dans les TMNA pour l’ensemble des blessures non intentionnelles à l’échelle de la province. En général, la population vivant dans des zones où les revenus étaient faibles et où la défavorisation matérielle était importante a affiché des taux de mortalité plus élevés que la population vivant dans des zones favorisées. Conclusion Le repérage de différences importantes dans les taux de mortalité liée à des blessures intentionnelles et non intentionnelles entre les sexes et en fonction du SSE ouvre des possibilités quant à l’élaboration de stratégies de prévention ciblées pour réduire ces disparités.

Although automated speed enforcement (ASE) technologies have broad potential to reduce the societal and economic impacts of transport injuries, perceptions of poor public support have thwarted their widespread deployment in British Columbia (B.C.), Canada. This study in-vestigates the levels of acceptance and support for different types of speed enforcement, partic-ularly ASE, and the influence of informative statements or suggested ASE policies on levels of acceptance and support among a representative sample of British Columbians. The online survey was conducted by Insights West, a public opinion research firm, in March 2018. The majority of British Columbians polled demonstrated acceptance and support for the use of ASE technologies in B.C., and strategies designed to foster strong public buy-in for implementation and expansion of ASE technologies were delineated. This survey highlighted the areas which need to be strengthened in order to garner and maintain sufficient community acceptance and support for the ASE program. The findings would be instructive for any jurisdiction that aims to deploy ASE technologies to reduce the burden of preventable transport injuries and deaths.

Child and youth self-poisoning is a growing public health issue in many regions of the world, including British Columbia (BC), Canada, where 15–19-year-olds have the highest rates of self-poisoning hospitalizations compared with those of all other ages. The purpose of this study was to identify what substances children and youth commonly used to poison themselves in BC and how socioeconomic status may impact self-poisoning risk. Self-poisoning hospitalization rates among 10–14 and 15–19-year-olds from 1 April 2012 to 31 March 2020 were calculated by substance using ICD-10-CA codes X60-X69 and T36-T65, as well as by socioeconomic status using the Institut National de Santé Publique du Québec’s Deprivation Index. Nonopioid analgesics, antipyretics, and antirheumatics were the most common substances involved, with rates of 27.6 and 74.3 per 100,000 population among 10–14 and 15–19-year-olds, respectively, followed by antiepileptic, sedative–hypnotic, antiparkinsonism, and psychotropic drugs, with rates of 20.2 and 68.1 per 100,000 population among 10–14 and 15–19-year-olds, respectively. In terms of socioeconomic status, rates were highest among 10–19-year-olds living in neighbourhoods with the fewest social connections (243.7 per 100,000 population). These findings can inform poisoning prevention strategies and relevant policies, thereby reducing the number of self-poisoning events among children and youth.

COVID-19 restrictions led to reduced levels of physical activity, increased screen usage, and declines in mental health in youth, however, in-depth understandings of the experiences of high school student-athletes have yet to be explored. To describe the experiences of the COVID-19 pandemic on student-athletes’ physical activity, social connection, and mental health, 20 high school student-athletes living in Calgary, Alberta participated in semi-structured interviews, designed using phenomenography. Participants reported variations in physical activity, social connections, and mental health which were influenced by stay-at-home restrictions and weather. Access to resources, changes to routines, online classes, and social support all influenced engagement in physical activity. School and sports provided opportunities for in-person social connections, impacted by the onset of the pandemic. Participants reported their mental health was influenced by social connections, online classes, and physical activity. Findings from this study will inform the development of resources for high school student-athletes amidst COVID-19.

BackgroundIn 2010 in British Columbia (BC), Canada, total injury costs per capita were higher among youth aged 15–24 years than in any other age group. Injury prevention efforts have targeted injuries with high mortality (transportation injuries) or morbidity (concussions). However, the profile and health costs of common youth injuries (types, locations, treatment choices and prevention strategies) and how these change from adolescence to young adulthood is not known.MethodsParticipants (n=662) were a randomly recruited cohort of BC youth, aged 12–18, in 2003. They were followed biennially across a decade (six assessments).ResultsSerious injuries (defined as serious enough to limit normal daily activities) in the last year were reported by 27%–41% of participants at each assessment. Most common injuries were sprains or strains, broken bones, cuts, punctures or animal bites, and severe bruises. Most occurred when playing a sport or from falling. Estimated total direct cost of treatment per injury was approximately $2500. In addition, 25% experienced serious injuries at three or more assessments, indicating possible differences that warrents further investigation.ConclusionsThe occurence and health cost of common injuries to youth and young adults are underestimated in this study but are nevertheless substantial. Ongoing surveillence, awareness raising, and prevention efforts may be needed to reduce these costs.

ObjectivesAn online, evidence-based resource was created to support the development of sport and recreational injury prevention programmes. The resource, called Active & Safe Central (www.activesafe.ca), provides evidence-based information across the public health approach for a number of sport and recreational activities. The objective of this project was to evaluate the perceived usefulness of Active & Safe Central as an educational tool.DesignA mixed-methods study design, guided by the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework, was used to evaluate Active & Safe Central.SettingData were collected using an online survey, available to all users of the site, and focus groups (n=2) that took place in Vancouver and Toronto, Canada.ParticipantsSurvey respondents (n=87) were recruited online, including parents, coaches, youth and adult athletes, and teachers. Focus group participants (n=16) were key stakeholders and end users, recruited from academia, local health sectors, sport and recreational organisations, and not-for-profit injury prevention organisations.ResultsPost launch, there were 1712 users visiting the website 2306 times (sessions), with the majority representing new users, over returning users (87.5% and 12.5%, respectively). There were 6340 page visits, with the most popular pages including soccer, playgrounds and ice hockey. Active & Safe Central was reported as a credible source of evidence-based sport and recreational information and that the site would be recommended to others. Information collected from focus group participants was used to inform necessary adaptations to the online platform, including critical navigation issues, visualisations and interactivity. The major themes that emerged from focus group and survey data included increased awareness of injury prevention recommendations and that the recommendations would be used in one’s own sporting activity and/or practice.ConclusionsThe results of the evaluation suggest the tool is a useful resource for sport and recreational injury information that has significant potential to impact prevention practice.

When children do not have sufficient height or weight to use seatbelts, the straps tend to rest on the wrong places: the lap belt on their bellies and the shoulder belt across their necks. As a result, in the event of a motor vehicle crash, there may be injuries to internal organs and the spine. Thus, it is recommended that children use booster seats to ensure correct fit of the seatbelt. Unfortunately, research indicates that: (a) rates of booster seat use are low even in jurisdictions where it is mandatory, and (b) many parents believe that booster seats are not necessary. Using fuzzy-trace theory, we propose that injuries to children riding in automobiles are stereotypically (and incorrectly) seen as ejection related. This ejection stereotype undermines the perceived safety benefit of booster seats, because seatbelts alone can prevent ejection and, therefore, are thought to provide adequate protection. Interventions to promote booster seat use can be improved, if they include mechanisms to diffuse the ejection stereotype.

Background Routinely gathered injury data, such as hospitalisations, may be subject to variation from sources other than injury incidence. There is a need for an indicator that defines severe injury, which may be less vulnerable to fluctuations due to changes in care policies. The purpose of this study was to identify International Classification of Diseases-10 codes associated with severe paediatric injuries and to specify and validate a severe paediatric injury indicator. Methods Two data sets that included the ISS and the survival risk ratio were used to produce a list of diagnoses to define severe paediatric injury. The list was sent to trauma surgeons who classified each code as severe enough or not severe enough to require care in a trauma centre. The indicator was fully specified, then validated by using a different data set to validate the codes in a real-world situation. Results Sixty diagnoses were identified as representing severe paediatric injury. Following specification, the indicator was applied to an existing comprehensive data set of paediatric injuries. The decline in hospitalisation of paediatric injuries was significantly steeper for severe than non-severe injuries, suggesting that factors related to the decline in this trauma subset are unlikely to be related to changes in access or other components of trauma care delivery. Conclusions This indicator can be used for the evaluation of trends in severe paediatric trauma and will help identify populations at risk. This research may inform policies and procedures for referrals of severe childhood injury to appropriate levels of care.

BackgroundSocial marketing is a tool used in the domain of public health for prevention and public education. Because injury prevention is a priority public health issue in British Columbia, Canada, a 3-year consultation was undertaken to understand public attitudes towards preventable injuries and mount a province-wide social marketing campaign aimed at adults aged 25–55 years.MethodsPublic response to the campaign was assessed through an online survey administered to a regionally representative sample of adults within the target age group between 1 and 4 times per year on an ongoing basis since campaign launch. A linear regression model was applied to a subset of this data (n=5186 respondents) to test the association between exposure to the Preventable campaign and scores on perceived preventability of injuries as well as conscious forethought applied to injury-related behaviours.ResultsCampaign exposure was significant in both models (preventability: β=0.27, 95% CI 0.20 to 0.35; conscious thought: β=0.24, 95% CI 0.13 to 0.35), as was parental status (preventability: β=0.12, 95% CI 0.03 to 0.21; conscious thought: β=0.18, 95% CI 0.06 to 0.30). Exposure to the more recent campaign slogan was predictive of 0.47 higher score on conscious thought (95% CI 0.27 to 0.66).DiscussionThis study provides some evidence that the Preventable approach is having positive effect on attitudes and behaviours related to preventable injuries in the target population. Future work will seek to compare these data to other jurisdictions as the Preventable social marketing campaign expands to other parts of Canada.

To reflect on the role of risk-taking and risky play in child development and consider recommendations for the injury prevention field, a symposium was held prior to the November 2013 Canadian Injury Prevention and Safety Promotion Conference. Delegates heard from Canadian and international researchers, practitioners and play safety experts on child development, play space design and playground safety, provision of recreation, and legal and societal perceptions of risk and hazard. The presenters provided multidisciplinary evidence and perspectives indicating the potential negative effect on children's development of approaches to injury prevention that prioritise safety and limit children's opportunities for risky play. Delegates considered the state of the field of injury prevention and whether alternative approaches were warranted. Each presenter prepared a discussion paper to provide the opportunity for dialogue beyond attendees at the symposium. The resulting discussion papers provide a unique opportunity to consider and learn from multiple perspectives in order to develop a path forward.

Plasma proteome composition reflects the inflammatory and metabolic state of the organism and can be predictive of system-level and organ-specific pathologies. Circulating protein aggregates are enriched with neurofilament heavy chain—axonal proteins involved in brain aggregate formation and recently identified as biomarkers of the fatal neuromuscular disorder amyotrophic lateral sclerosis. Using unbiased proteomic methods, we have fully characterized the content in neuronal proteins of circulating protein aggregates from amyotrophic lateral sclerosis patients and healthy controls, with reference to brain protein aggregate composition. We also investigated circulating protein aggregate protein aggregation propensity, stability to proteolytic digestion and toxicity for neuronal and endothelial cell lines. Circulating protein aggregates separated by ultracentrifugation are visible as electron-dense macromolecular particles appearing as either large globular or as small filamentous formations. Analysis by mass spectrometry revealed that circulating protein aggregates obtained from patients are enriched with proteins involved in the proteasome system, possibly reflecting the underlying basis of dysregulated proteostasis seen in the disease, while those from healthy controls show enrichment of proteins involved in metabolism. Compared to the whole human proteome, proteins within circulating protein aggregates and brain aggregates show distinct chemical features of aggregation propensity, which appear dependent on the tissue or fluid of origin and not on the health status. Neurofilaments’ two high-mass isoforms (460 and 268 kDa) showed a strong differential expression in amyotrophic lateral sclerosis compared to healthy control circulating protein aggregates, while aggregated neurofilament heavy chain was also partially resistant to enterokinase proteolysis in patients, demonstrated by immunoreactive bands at 171 and 31 kDa fragments not seen in digested healthy controls samples. Unbiased proteomics revealed that a total of 4973 proteins were commonly detected in circulating protein aggregates and brain, including 24 expressed from genes associated with amyotrophic lateral sclerosis. Interestingly, 285 circulating protein aggregate proteins (5.7%) were regulated (P, Circulating protein aggregates in blood contain 4973 brain peptides including heavy chain neurofilaments and 24 amyotrophic lateral sclerosis-associated proteins. In amyotrophic lateral sclerosis, circulating protein aggregates express proteins involved in metabolism and proteosome and may be biologically active on endothelial cells., Graphical Abstract Graphical Abstract

BackgroundThe British Columbia Coroners Service implemented a policy in 2010 advising the reclassification of underlying causes of deaths due to falls from ‘natural’ to ‘accidental’. This study investigates whether observed data trends reflect this change in practice, are artefacts of inconsistent reporting, or indicate a true increase in fall-related deaths.MethodsMortality data were analysed from 2004 to 2017 for cases with International Statistical Classification of Diseases and Related Health Problems, 10th Revision fall codes W00–W19, occurring among adults aged 60 years and older.ResultsFrom 2010 to 2012, accidental fall-related deaths increased among those aged 80 years and older, followed by an increase in natural deaths with fall as the contributing cause.ConclusionsChanges in reporting resulting from the 2010 policy change were observed; however, post-2012 data indicate a reversion to previous reporting practices.

Children under the age of 5 years have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns. This study aimed to develop a costing model for burn injuries among children to estimate the economic burden of child burns in British Columbia, Canada. Costs of services and resources used by children aged 0 to 4 years old who were treated at BC Children’s Hospital (BCCH) between January 1, 2014 and March 15, 2018 for a burn injury were estimated and summed, using a micro-costing approach. The average cost of burn injuries per percentage of total body surface area (%TBSA) was then applied to the number of 0 to 4 years old children treated for a burn injury across British Columbia between January 1 and December 31, 2016. Based on 342 included children, a 1–5%, 6–10%, 11–20%, and >20% burn, respectively cost an average of $3338.80, $13,460.00, $20,228.80, and $109,881.00 to society. The societal cost of child burns in BC in 2016 totaled $2,711,255.01. In conclusion, pediatric burn injuries place an important, yet preventable economic burden on society. Preventing even a small number of severe pediatric burns or multiple small burns may have considerable economic impacts on society and allow for the reallocation of healthcare funds toward other clinical priorities.

BACKGROUND Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play. OBJECTIVE The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. METHODS The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. RESULTS A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. CONCLUSIONS The trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. CLINICALTRIAL ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-018-2552-4

Background: plasma proteins composition reflects the inflammatory and metabolic state of an organism and can be predictive of system-level and organ-specific pathologies. Circulating protein aggregates (CPA) are enriched with heavy chain neurofilaments (NfH), axonal proteins involved in brain protein aggregates (BPA) formation and recently identified as biomarkers of the fatal neuromuscular disorder amyotrophic lateral sclerosis (ALS). Methods: here we use mass spectrometry and brain-enhanced TMTcalibrator™-based proteomics to evaluate the composition and the brain-derived protein component of CPA extracted from ALS and healthy controls (HC) plasma samples using high-performance ultracentrifugation. We also test CPA and BPA proteins aggregation propensity and the resistance to proteases digestion by trypsin, chymotrypsin, calpain and enterokinase of NFH within aggregates. Finally, we study CPA biological effects on neuronal and endothelial cell lines. Results: electron microscopy confirms the presence in CPA of electron-dense macromolecular particles appearing as either large globular or as small filamentous formations. CPA from ALS are enriched with proteasome system proteins while HC CPA show a prominent expression of proteins involved in metabolism. CPA enterokinase digestion in ALS generates 171 and 31 KDa NfH fragments not seen in HC samples. Compared to the whole human proteome, proteins within CPA and BPA show distinct chemical features of aggregation propensity, which appear dependent on the tissue or fluid of origin and not on the healthy or pathological source of plasma. The use of a TMTcalibrator™ proteomics workflow reveals 4973 brain-derived low-abundance proteins in CPA, including products of translation of 24 ALS risk genes. 285 (5.7%) are regulated in ALS (p < 0.05) and belong to biochemical pathways previously linked to ALS pathogenesis and aggregates formation. CPA from both ALS and HC have a higher effect on hCMEC/D3 endothelial and PC12 neuronal cells viability than immunoglobulins extracted from the same plasma samples. Compared to HC, CPA from ALS plasma samples exert a higher toxic effect on both cell lines at lower concentrations.Conclusions: this study demonstrates that CPA are significantly enriched with brain proteins which are representative of ALS pathology and a potential source of biomarkers and therapeutic targets for this incurable disorder.

Education is a common strategy used to prevent occupational injuries. However, its effectiveness is often measured using surrogate measures instead of true injury outcomes. To evaluate the effectiveness of workplace educational interventions, we selectively analyzed studies that reported injury outcomes (PROSPERO ID: CRD42019140631). We searched databases for peer-reviewed journal articles and sources of grey literature such as abstracts, registered trials, and theses published between 2000 and 2019. Studies on educational interventions that reported fatal or non-fatal occupational injury outcomes were selected. Two reviewers independently and in duplicate screened the studies, extracted data, and assessed risk of bias. Heterogeneity in the data precluded meta-analysis, and the results were reviewed narratively. In total, 35 studies were included. Of which, 17 found a significant reduction in injuries, most of which featured a multifaceted approach or non-didactic education. The remaining studies either described equivocal results or did not report statistical significance. Overall, interventions in the manufacturing industry were more effective than those in the construction sector. Risk of bias among included studies was moderate to high. In conclusion, educational interventions could be an effective part of multifaceted injury prevention programs. However, over-reliance on didactic education alone is not advised.

Background Outdoor play and risk-taking behaviors, including play at heights, are important to children’s physical, social, and cognitive development. These aspects of play are important to consider when informing prevention policies for serious injuries that commonly occur on play structures. Supracondylar fractures of the humerus (SCH) are the most common type of elbow fractures that result from falls on an outstretched hand among healthy children. Despite being one of the leading causes of admission to the hospital and surgical intervention, the details surrounding the cause of these injuries are often not recorded. Previous research has correlated decreased overall playground safety with higher rates of SCH fractures. Play structure height and the type of undersurface have been identified as potential risk factors for severe injuries, including SCH fractures, in part due to low compliance with safety standards. This paper explores the challenges we encountered designing the study and the resulting insights and methodological modifications we made. Objective The aim of this paper is to discuss the challenges related specifically to clinical research in pediatrics and strategies developed to conduct a study that prioritizes the engagement and perspective of children and their families. Methods To explore the link between the severity of SCH fractures and children’s behavioral, environmental, and mechanistic factors, we conducted a mixed-methods study. Results During phase 1 (the original methodology) from April 2017 to July 2018, there were 58 eligible study participants and 17 were recruited. For phase 2 (the revised methodology) between October 2018 and October 2019, there were 116 eligible participants and 47 were recruited. Conclusions The changes in methodology made following the first phase of data collection were effective in our ability to recruit participants. By identifying and addressing challenges pertaining to recruitment and resource limitations, we were able to collect data in a concise manner while not compromising the quality of the data and make for an easily adoptable methodology for other sites interested in participating in the study. We hope that future studies that plan to employ a similar methodology can gain insight through the methodological challenges we have encountered and the way we adapted the methodology to build a more pragmatic approach. International Registered Report Identifier (IRRID) DERR1-10.2196/21816

BACKGROUND Outdoor play and risk-taking behaviors, including play at heights, are important to children’s physical, social, and cognitive development. These aspects of play are important to consider when informing prevention policies for serious injuries that commonly occur on play structures. Supracondylar fractures of the humerus (SCH) are the most common type of elbow fractures that result from falls on an outstretched hand among healthy children. Despite being one of the leading causes of admission to the hospital and surgical intervention, the details surrounding the cause of these injuries are often not recorded. Previous research has correlated decreased overall playground safety with higher rates of SCH fractures. Play structure height and the type of undersurface have been identified as potential risk factors for severe injuries, including SCH fractures, in part due to low compliance with safety standards. This paper explores the challenges we encountered designing the study and the resulting insights and methodological modifications we made. OBJECTIVE The aim of this paper is to discuss the challenges related specifically to clinical research in pediatrics and strategies developed to conduct a study that prioritizes the engagement and perspective of children and their families. METHODS To explore the link between the severity of SCH fractures and children’s behavioral, environmental, and mechanistic factors, we conducted a mixed-methods study. RESULTS During phase 1 (the original methodology) from April 2017 to July 2018, there were 58 eligible study participants and 17 were recruited. For phase 2 (the revised methodology) between October 2018 and October 2019, there were 116 eligible participants and 47 were recruited. CONCLUSIONS The changes in methodology made following the first phase of data collection were effective in our ability to recruit participants. By identifying and addressing challenges pertaining to recruitment and resource limitations, we were able to collect data in a concise manner while not compromising the quality of the data and make for an easily adoptable methodology for other sites interested in participating in the study. We hope that future studies that plan to employ a similar methodology can gain insight through the methodological challenges we have encountered and the way we adapted the methodology to build a more pragmatic approach. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/21816

This case study describes a participatory research project that engaged young people (ages 11 to 13) in examining the play-friendliness of their local neighborhoods. Part of a larger study related to the city’s ‘Child and Youth Friendly Community Strategy,’ the project involved youth in creating and sharing knowledge about their neighborhood play environments. University researchers, a youth leadership group, city staff, and school personnel collaborated in designing and carrying out the project. Through regular in-school sessions over 3 months, 51 youth participants engaged in activities related to children’s rights, child-friendly cities, outdoor play, photography, and municipal decision making. They also went on a neighborhood walk and took photographs of places and things they perceived as ‘friendly’ and ‘not friendly’ for play. These photographs—and accompanying narratives—were displayed at City Hall and the School Board office. A number of youth participants also delivered presentations and recommendations to City Council and the Board of Education about making the city better for young people. This case study outlines the process of carrying out the research project and identifies impacts of such a project on youth participants, the city’s Child and Youth Friendly Community Strategy, and the local community.

Soccer is the most popular sport in the world. Expectedly, the incidence of soccer-related injuries is high and these injuries exert a significant burden on individuals and families, including health and financial burdens, and on the socioeconomic and healthcare systems. Using established injury prevention frameworks, we present a concise synthesis of the most recent scientific evidence regarding injury rates, characteristics, mechanisms, risk and protective factors, interventions for prevention, and implementation of interventions in soccer. In this umbrella review, we elucidate the most recent available evidence gleaned primarily from systematic reviews and meta-analyses. Further, we express the exigent need to move current soccer injury prevention research evidence into action for improved player outcomes and widespread impact through increased attention to dissemination and implementation research. Additionally, we highlight the importance of an enabling context and effective implementation strategies for the successful integration of evidence-based injury prevention programs into real-world soccer settings. This narrative umbrella review provides guidance to inform future research, practice, and policy towards reducing injuries among soccer players.

Background It is unclear to what extent pre-clinical studies in genetically homogeneous animal models of amyotrophic lateral sclerosis (ALS), an invariably fatal neurodegenerative disorder, can be informative of human pathology. The disease modifying effects in animal models of most therapeutic compounds have not been reproduced in patients. To advance therapeutics in ALS, we need easily accessible disease biomarkers which can discriminate across the phenotypic variants observed in ALS patients and can bridge animal and human pathology. Peripheral blood mononuclear cells alterations reflect the rate of progression of the disease representing an ideal biological substrate for biomarkers discovery. Methods We have applied TMTcalibrator™, a novel tissue-enhanced bio fluid mass spectrometry technique, to study the plasma proteome in ALS, using peripheral blood mononuclear cells as tissue calibrator. We have tested slow and fast progressing SOD1G93A mouse models of ALS at a pre-symptomatic and symptomatic stage in parallel with fast and slow progressing ALS patients at an early and late stage of the disease. Immunoassays were used to retest the expression of relevant protein candidates. Results The biological features differentiating fast from slow progressing mouse model plasma proteomes were different from those identified in human pathology, with only processes encompassing membrane trafficking with translocation of GLUT4, innate immunity, acute phase response and cytoskeleton organization showing enrichment in both species. Biological processes associated with senescence, RNA processing, cell stress and metabolism, major histocompatibility complex-II linked immune-reactivity and apoptosis (early stage) were enriched specifically in fast progressing ALS patients. Immunodetection confirmed regulation of the immunosenescence markers Galectin-3, Integrin beta 3 and Transforming growth factor beta-1 in plasma from pre-symptomatic and symptomatic transgenic animals while Apolipoprotein E differential plasma expression provided a good separation between fast and slow progressing ALS patients. Conclusions These findings implicate immunosenescence and metabolism as novel targets for biomarkers and therapeutic discovery and suggest immunomodulation as an early intervention. The variance observed in the plasma proteomes may depend on different biological patterns of disease progression in human and animal model. Electronic supplementary material The online version of this article (10.1186/s13024-018-0292-2) contains supplementary material, which is available to authorized users.

The purpose of this commentary is to discuss how legalization of non-medical marijuana (LNMM) in Canada can potentially influence child and adolescent unintentional injuries based on evidence from states (American) and jurisdictions that have already legalized cannabis for recreational purposes. Although the evidence is still not conclusive, LNMM can bring about higher exposure, lower perceived harms, and higher prevalence of cannabis use by minors through role modeling and normalization of behaviour within the household and the community, and higher rates of driving under the influence of cannabis, which can contribute to a higher burden of road traffic injuries. Experience of American states with LNMM shows higher rates of emergency visits for pediatric poisoning due to unintentional ingestion of cannabis-containing foods and severe burns due to explosions during the course of home-based cannabis extraction. While the justification for legalization has created a strict legal framework for improved control of cannabis in Canada, the implications for health and safety of children and adolescents necessitate further study, communication with policy-makers and public health practitioners, and evidence-based education of parents, caregivers, and youth.

Protein aggregation in biofluids is a poorly understood phenomenon. Under normal physiological conditions, fluid-borne aggregates may contain plasma or cell proteins prone to aggregation. Recent observations suggest that neurofilaments (Nf), the building blocks of neurons and a biomarker of neurodegeneration, are included in high molecular weight complexes in circulation. The composition of these Nf-containing hetero-aggregates (NCH) may change in systemic or organ-specific pathologies, providing the basis to develop novel disease biomarkers. We have tested ultracentrifugation (UC) and a commercially available protein aggregate binder, Seprion PAD-Beads (SEP), for the enrichment of NCH from plasma of healthy individuals, and then characterised the Nf content of the aggregate fractions using gel electrophoresis and their proteome by mass spectrometry (MS). Western blot analysis of fractions obtained by UC showed that among Nf isoforms, neurofilament heavy chain (NfH) was found within SDS-stable high molecular weight aggregates. Shotgun proteomics of aggregates obtained with both extraction techniques identified mostly cell structural and to a lesser extent extra-cellular matrix proteins, while functional analysis revealed pathways involved in inflammatory response, phagosome and prion-like protein behaviour. UC aggregates were specifically enriched with proteins involved in endocrine, metabolic and cell-signalling regulation. We describe the proteome of neurofilament-containing aggregates isolated from healthy individuals biofluids using different extraction methods., Highlights • NfH is part of high molecular weight protein complexes in blood from healthy controls. • Proteome comparison of plasma aggregates enriched with different methodologies. • Aggregates containing NfH may be potential blood biomarkersof neurodegeneration.

Introduction Malgré la protection juridique dont les jeunes travailleurs au Canada font l’objet, les jeunes de 15 à 24 ans sont exposés à un risque élevé de blessures traumatiques au travail. Étant donné que de nombreuses initiatives de prévention des blessures ciblant les jeunes travailleurs existent, les défenseurs des droits des jeunes et les employeurs doivent relever le défi de choisir quels aspects de la prévention vont être les plus efficaces afin d’y consacrer leurs efforts. Une analyse de la littérature universitaire et de la littérature grise a été entreprise afin de compiler les paramètres (indicateurs évalués et méthodes de mesure) couramment utilisés pour évaluer les programmes de prévention des blessures auprès des jeunes travailleurs. Les paramètres constituent des références de mesure permettant d’évaluer l’efficacité, le rendement, le progrès ou la qualité d’un projet, d’un procédé ou d’un produit. Méthodologie Nous avons utilisé le modèle PICO pour définir les termes de recherche. Des recherches ont été effectuées dans Medline, PubMed, OVID, EMBASE, CCOHS, PsychINFO, CINAHL, NIOSHTIC, Google Scholar et dans la littérature grise afin de trouver des articles en anglais publiés entre 1975 et 2015. Deux lecteurs critiques indépendants ont examiné la liste des articles et ont classé les paramètres en trois catégories de prévention des blessures : l’éducation, l’environnement et l’application de règlements. Résultats Sur les 174 articles ayant répondu aux critères d’inclusion, 21 décrivaient et évaluaient une intervention. Parmi ceux-ci, la moitié (n=11) étaient à caractère éducatif. Les paramètres couramment évalués étaient : les connaissances, les perceptions, les comportements ou les intentions autodéclarées, l’exposition aux dangers, les demandes d’indemnisation pour blessures et le taux d’accidents de travail. Une étude présentait une méthode destinée à élaborer des paramètres permettant de prédire les taux de blessure. Conclusion Des paramètres spécifiques à l’évaluation des programmes de prévention des blessures chez les jeunes travailleurs sont nécessaires, car les paramètres actuels sont insuffisants pour prévoir la diminution du nombre de blessures en lien avec la mise en place de programmes. De notre analyse ressort une étude apte à constituer un modèle pertinent pour les recherches futures visant à élaborer des paramètres de base valides destinés aux jeunes travailleurs, afin de les appliquer ensuite aux programmes de prévention des blessures chez les jeunes.

BackgroundInjury prevention report cards that raise awareness about the preventability of childhood injuries have been published by the European Child Safety Alliance and the WHO. These report cards highlight the variance in injury prevention practices around the world. Policymakers and stakeholders have identified research evidence as an important enabler to the enactment of injury legislation. In Canada, there is currently no childhood injury report card that ranks provinces on injury rates or evidence-based prevention policies.MethodsThree key measures, with five metrics, were used to compare provinces on childhood injury prevention rates and strategies, including morbidity, mortality and policy indicators over time (2006–2012). Nine provinces were ranked on five metrics: (1) population-based hospitalisation rate/100 000; (2) per cent change in hospitalisation rate/100 000; (3) population-based mortality rate/100 000; (4) per cent change in mortality rate/100 000; (5) evidence-based policy assessment.ResultsOf the nine provinces analysed, British Columbia ranked highest in Canada and Saskatchewan lowest. British Columbia had a morbidity and mortality rate that was close to the Canadian average and decreased over the study period. British Columbia also had a number of injury prevention policies and legislation in place that followed best practice guidelines. Saskatchewan had a higher rate of injury hospitalisation and death; however, Saskatchewan’s rate decreased over time. Saskatchewan had a number of prevention policies in place but had not enacted bicycle helmet legislation.ConclusionsFuture preventative efforts should focus on harmonising policies across all provinces in Canada that reflect evidence-based best practices.

A subset of C9orf72 repeat expansion-carrying frontotemporal dementia patients display an Alzheimer-like decrease in cerebrospinal fluid amyloid-β (Aβ) biomarker levels. We report that downregulation of C9orf72 in non-neuronal human cells overexpressing amyloid-β protein precursor (AβPP) resulted in increased levels of secreted AβPP fragments and Aβ, while levels of AβPP or its C-terminal fragments (CTFs) remained unchanged. In neuronal cells, AβPP and C83 CTF levels were decreased upon C9orf72 knockdown, but those of secreted AβPP fragments or Aβ remained unchanged. C9orf72 protein levels significantly increased in human brain with advancing neurofibrillary pathology and positively correlated with brain Aβ42 levels. Our data suggest that altered C9orf72 levels may lead to cell-type specific alterations in AβPP processing, but warrant further studies to clarify the underlying mechanisms.

OBJECTIVES: The primary objectives of this work were to (1) identify the risk and/or protective factors associated with playground injuries among children less than 18 years of age and (2) identify interventions/programs/policies aimed at preventing playground-related injuries among children less than 18 years of age. Secondary objectives include a summary of the data that reflect alignment with current playground standards. METHODS: For the primary outcome, 4 databases and 12 online resources were systematically searched to include observational and experimental studies examining risk and/or protective factors or interventions associated with playground injury or outcomes related to playground injury (e.g., risky playground behaviour). Data extraction included study design, participants, outcome, exposure or intervention, data analysis, and effect estimates. The quality of evidence for all studies was assessed using the Downs and Black criteria. RESULTS: This review included studies of moderate quality, revealing a number of risk factors and effective interventions for playground injury. Risk factors included absence of handrails and guardrails on playground equipment, non-impact-absorbing surfacing, and critical fall heights. Effective interventions included modifying playground surfacing and reducing equipment height to less than 1.5 m. CONCLUSION: Equipment- and structure-based playgrounds should adhere to and maintain playground standards in order to reduce the risk of serious injury. Organizations responsible for installing and maintaining playgrounds should consider alternative play spaces that allow children to play outdoors, in a natural environment that supports healthy child development and promotes physical activity.

Objectives: To explore the relationship between neighborhood social and material deprivation and the rates of abusive head trauma (AHT), and whether it differs according to sex, and following the implementation of the Period of PURPLE Crying ( PURPLE) program. Method: A cross-sectional study design was applied to data from children 0 to 24 months old with a confirmed AHT diagnosis between 2005 and 2017 in British Columbia. Dissemination area–based social and material deprivation scores were assigned to residential areas, where AHT cases were recorded. Poisson regression models tested the relationship between deprivation scores and AHT rates, adding sex and pre–post program implementation as interaction terms. Results: With each increase in material and social deprivation quintiles, AHT rates increased by 42% (95% CI [1.18, 1.72]) and 25% (95% CI [1.06, 1.51]), respectively, following a social gradient. AHT rate disparities between neighborhoods did not change following the PURPLE program implementation. Conclusions: This study stresses the need to provide additional AHT prevention services proportionately to the levels of neighborhood disadvantage, in addition to universal AHT programs, to successfully protect all children.

BACKGROUND: This study assessed whether socioeconomic factors affect the rates of residential fire incidence and fire-related injuries and deaths, and whether children are affected differently than the general population. METHODS: We employed a cross-sectional study design using data for British Columbia, Alberta, Manitoba and Ontario from the National Fire Information Database, which includes fire incidents and losses reported by provincial fire marshals across Canada between 2005 and 2015. It also contains 2011 census subdivision social domain data from Statistics Canada based on fire location. Multivariable negative binomial regressions tested the significance of relations between census subdivision socioeconomic factors (average household size, educational attainment, median income and unemployment rate) and the rates of residential fires and casualties per person-year, and casualties per fire incident. RESULTS: Census subdivisions with higher educational attainment and unemployment rates had higher rates of residential fires (incidence rate ratio [IRR] 1.07, 95% confidence interval [CI] 1.05–1.10, and IRR 1.24, 95% CI 1.18–1.31, respectively) and of residential fire casualties per person-year (IRR 1.09, 95% CI 1.05–1.13, and IRR 1.29, 95% CI 1.20–1.40, respectively). Census subdivisions with smaller average households had higher rates of residential fire casualties per person-year (IRR 0.43, 95% CI 0.22–0.83) and per fire incident (IRR 0.75, 95% CI 0.58–0.97), and the association was even stronger for children (IRR 0.17, 95% CI 0.08–0.36, and IRR 0.41, 95% CI 0.20–0.86, respectively). INTERPRETATION: The results suggest that efforts to prevent residential fires should be prioritized in neighbourhoods with higher educational attainment and unemployment, whereas house fire safety programs should be intensified in neighbourhoods with smaller households to prevent fire casualties, especially among children, once a fire does occur.

ObjectivesThe objective of this study was to explore parent perspectives of and interest in an interactive knowledge translation platform called Child-Sized KT that proposes to catalyse the collaboration of patients, families, practitioners and researchers in patient-oriented research at British Columbia Children’s Hospital (BCCH).MethodsAn explanatory sequential mixed methods design was used over 1 year. Over 500 parents across BC completed an online survey, including a subsample of 102 parents who had accessed care at BCCH within the past 2 years. The survey explored parent perspectives about the value of their engagement at all stages of the research process and their interest in and concerns with using an online platform. Following the online survey, two focus groups were held with parents in the Vancouver area to explore themes emerging from the survey.ResultsParents expressed keen interest in engaging in research at BCCH. Parents perceived benefit from their input at all stages of the research process; however, they were most interested in helping to identify the problem, develop the research question and share the results. Although parents preferred online participation, they had concerns about protecting the privacy of their child’s information.ConclusionsParents see value in their involvement in all stages of child health research at BCCH. Their input suggests that Child-Sized KT, a hypothetical online platform, would facilitate meaningful stakeholder engagement in child health research, but should offer a customised experience and ensure the highest standard of data privacy and protection.

The lack of biomarkers for early diagnosis, clinical stratification and to monitor treatment response has hampered the development of new therapies for amyotrophic lateral sclerosis (ALS), a clinically heterogeneous neurodegenerative disorder with a variable site of disease initiation and rate of progression. To identify new biomarkers and therapeutic targets, two separate proteomic workflows were applied to study the immunological response and the plasma/brain proteome in phenotypic variants of ALS. Conventional multiplex (TMT) proteomic analysis of peripheral blood mononuclear cells (PBMCs) was performed alongside a recently introduced method to profile neuronal-derived proteins in plasma using brain tissue-enhanced isobaric tagging (TMTcalibrator). The combined proteomic analysis allowed the detection of regulated proteins linked to ALS pathogenesis (RNA-binding protein FUS, superoxide dismutase Cu-Zn and neurofilaments light polypeptide) alongside newly identified candidate biomarkers (myosin-9, fructose-bisphosphate aldolase and plectin). In line with the proteomic results, orthogonal immunodetection showed changes in neurofilaments and ApoE in bulbar versus limb onset fast progressing ALS. Functional analysis of significantly regulated features showed enrichment of pathways involved in regulation of the immune response, Rho family GTPases, semaphorin and integrin signalling. Our cross-phenotype investigation of PBMCs and plasma/brain proteins provides a more sensitive biomarker exploratory platform than conventional case-control studies in a single matrix. The reported regulated proteins may represent novel biomarker candidates and potentially druggable targets.

The association between health outcomes and socioeconomic status (SES) has been widely documented, and mortality due to unintentional injuries continues to rank among the leading causes of death among British Columbians. This paper quantified the SES-related disparities in the mortality burden of three British Columbia's provincial injury prevention priority areas: falls among seniors, transport injury, and youth suicide.Mortality data (2009 to 2013) from Vital Statistics and dissemination area or local health area level socioeconomic data from CensusPlus 2011 were linked to examine age-standardized mortality rates (ASMRs) and disparities in ASMRs of unintentional injuries and subtypes including falls among seniors (aged 65+) and transport-related injuries as well as the intentional injury type of youth suicide (aged 15 to 24). Disparities by sex and geography were examined, and relative and absolute disparities were calculated between the least and most privileged areas based on income, education, employment, material deprivation, and social deprivation quintiles.Our study highlighted significant sex differences in the mortality burden of falls among seniors, transport injury, and youth suicide with males experiencing significantly higher mortality rates. Notable geographic variations in overall unintentional injury ASMR were also observed across the province. In general, people living in areas with lower income and higher levels of material deprivation had increasingly higher mortality rates compared to their counterparts living in more privileged areas.The significant differences in unintentional and intentional injury-related mortality outcomes between the sexes and by SES present opportunities for targeted prevention strategies that address the disparities.Sachant que l’association entre l'état de santé et le statut socioéconomique (SSE) est largement documentée et que les blessures non intentionnelles continuent de se classer parmi les principales causes de décès chez les Britanno-Colombiens, nous avons voulu quantifier les disparités liées au SSE dans les taux de mortalité associés à trois secteurs prioritaires pour la Colombie-Britannique en matière de prévention des blessures : le suicide chez les jeunes, les blessures liées aux chutes chez les aînés et les blessures liées au transport.Nous avons jumelé les données liées aux décès (2009 à 2013) tirées des statistiques de l’état civil et des données socioéconomiques de CensusPlus de 2011 à l’échelle de l’aire de diffusion ou de la circonscription sanitaire afin d'étudier les taux de mortalité normalisés selon l’âge (TMNA) et les disparités des TMNA concernant les blessures non intentionnelles et leurs sous-types, notamment les blessures liées aux chutes chez les aînés (65 ans et plus) et les blessures liées au transport, ainsi que le suicide chez les jeunes (15 à 24 ans), ce dernier étant considéré comme une forme de blessure intentionnelle. Nous avons étudié les disparités spatiales et les disparités selon le sexe et nous avons mesuré les disparités relatives et absolues entre les zones moins favorisées et les zones plus favorisées en fonction des quintiles de revenu, de scolarité, d’emploi, de défavorisation matérielle et de défavorisation sociale.Notre étude a mis en évidence d’importantes différences entre les sexes en matière de taux de mortalité attribuable au suicide chez les jeunes, à des blessures liées aux chutes chez les aînés et à des blessures liées au transport, les hommes affichant des taux de mortalité beaucoup plus élevés que les femmes. Nous avons également observé des variations spatiales notables dans les TMNA pour l’ensemble des blessures non intentionnelles à l’échelle de la province. En général, la population vivant dans des zones où les revenus étaient faibles et où la défavorisation matérielle était importante a affiché des taux de mortalité plus élevés que la population vivant dans des zones favorisées.Le repérage de différences importantes dans les taux de mortalité liée à des blessures intentionnelles et non intentionnelles entre les sexes et en fonction du SSE ouvre des possibilités quant à l’élaboration de stratégies de prévention ciblées pour réduire ces disparités.Mortality due to unintentional injuries and youth suicide continue to rank among the leading causes of death among British Columbians. In BC, males and those living in areas with lower income experience significantly higher mortality burden due to youth suicide, unintentional injuries from falls among seniors and transport incidents. Disparities in unintentional and intentional injury-related mortality outcomes between the sexes and by socioeconomic status could provide evidence for targeted injury prevention strategies to narrow the gap and increase overall population-level health outcome.Le suicide chez les jeunes et les blessures non intentionnelles continuent à se classer parmi les principales causes de décès chez les Britanno-Colombiens. En Colombie-Britannique, les hommes ainsi que la population vivant dans des zones où les revenus sont faibles présentent un taux de mortalité beaucoup plus élevé en ce qui concerne le suicide chez les jeunes ainsi que les blessures non intentionnelles attribuables à des chutes chez les aînés et celles liées au transport. L'observation de disparités concernant la mortalité liée à des blessures intentionnelles et à des blessures non intentionnelles à la fois entre les sexes et selon le statut socioéconomique contribue à fournir des données probantes aptes à soutenir l'élaboration de stratégies ciblées en matière de prévention des blessures visant à réduire les disparités en matière de santé et à améliorer l'état de santé global de la population.

The purpose of this research paper is to assess the response on Facebook to a social marketing campaign for recreational boating safety. The campaign ran for the 2018 and 2019 boating seasons in British Columbia, Canada. Messages related to boating safety were delivered in multi-media formats, including ten Facebook posts. All public comments on the campaign Facebook page in response to the ads were included in the analysis. Comments were reviewed for tone and subject, those that related directly to the campaign or boating safety-related topics, such as alcohol use or enforcement, were labeled positive, negative or neutral in tone. Metrics such as likes and shares were also noted. The overall engagement rate (defined as engagements over people reached) was 4.1%. The posts were liked &gt, 7000 times and received 901 shares. A total of 219 comments were analysed. Almost half of the comments were positive (n = 106, 48.4%). Fifty comments were off-topic (22.8%), 45 were neutral (20.5%) and 18 were negative (8.2%). The majority of comments were positive, indicating that the campaign performed as planned and was generally well received by the people for whom it was intended. Comments illuminated prevailing attitudes towards risks, injuries and safety practices related to recreational boating. Positive comments valued safety as an aspect of having a pleasant experience, rather than a barrier. Negative comments were about perceiving reduced fun of boating, rather than objecting to the campaign itself. As a component of a multi-media social marketing strategy, Facebook can be a source of instant feedback from the campaign audience.

Background Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play. Objective The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. Methods The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. Results A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. Conclusions The trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. Trial Registration ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2552-4