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BACKGROUND Cultures of safety in farm work settings are under the authority of a responsible owner-operator, who establishes rules, attitudes, and behaviors for farm work practices. This novel analysis provides new evidence to show that risks that can lead to injury and are commonly practiced on Canadian farms are indeed transferred between generations. METHODS Baseline data were provided by representatives from eligible and consenting farms (n = 589) in the province of Saskatchewan, Canada, during the first quarter of 2013. Mailed questionnaires were sent to participating farms and completed by a single respondent. Questionnaires included scaled assessments of hazards and safety practices by farm operators, and young workers on each farm. Descriptive and multiple regression analyses were used to examine relationships between farm owner-operator risks and safety practices and those reported for the young workers. FINDINGS Graphical descriptive analyses showed that as farm owner-operator risks increased, so did those reported for children and young workers. Similarly, as farm owner-operator safe work practices increased, young worker hazards decreased, albeit more modestly. The young worker hazard scale increased by 0.20 (95% CI: 0.10-0.30) points, and decreased by 0.08 (95% CI: -0.016 to -0.000) points for each one-point increase in the owner-operator hazard and safe work practices scales, respectively. CONCLUSIONS Occupational health and safety risks and protections experienced on farms appear to be transferred between generations. This suggests the need to target farm owner-operators, the responsible authority on the farm, as a focus of primary prevention strategies aimed at injury risks to children and young workers.

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

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

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

Objectives Patients with concussion commonly present to the emergency department (ED) for assessment. Misdiagnosis of concussion has been documented in children and likely impacts treatment and discharge instructions. This study aimed to examine diagnosis of concussion in a general adult population. Methods Patients >17 years old presenting meeting the World Health Organization's definition of concussion were recruited in one academic (Hospital 1) and two community (Hospitals 2 and 3) EDs in a Canadian city. A physician questionnaire and patient interviews documented recommendations given by emergency physicians. Bi-variable comparisons are reported using chi-square tests, t-tests or Mann-Whitney tests, as appropriate. Multivariate analyses were performed using logistic regression methods. Results Overall, the study enrolled 250 patients. The median age was 35 (IQR: 23 to 49) and 52% were female. A variety of concussion causes were documented. Forty-one (16%) patients were not diagnosed with a concussion despite meeting criteria. Concussion diagnosis was less likely with a longer ED length of stay (OR = 0.71; 95% CI: 0.60 to 0.83), presenting to the non-academic centers (Hospital 2: OR = 0.21, 95% CI: 0.08 to 0.58; Hospital 3: OR = 0.07, 95% CI: 0.02 to 0.24), or involvement in a motor vehicle collision (OR = 0.11; 95% CI: 0.03 to 0.46). Conclusion One in six patients with concussion signs and symptoms were misdiagnosed in the ED. Misdiagnosis was related to injury mechanism, length of stay, and enrolment site. Closer examination of institutional factors is needed to identify effective strategies to promote accurate diagnosis of concussion.

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

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

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

Significance The agricultural industry differs from other businesses in the composition of its workforce. Often farm owner-operators work beyond what society would expect to be a normal retirement age. Older farmers may be less receptive to behavioral changes designed to improve worksite safety and are at increased risk for experiencing a work-related injury. We had a unique opportunity to evaluate the relative influence of specific occupational conditions and practices reported by older farm operators (age ≥55 years) on the occurrence of injury using a longitudinal approach. Materials and methods Baseline data were provided by eligible and consenting farm members in the first quarter of 2013. These farms were then followed longitudinally by mail surveys over 24 months to document injury experiences. For each survey, mailed questionnaires were sent to participating farms and completed by a single respondent. Cox proportional hazard models were used to determine which characteristics of the farm work environment were protective. Results A total of 96 farm injuries were reported by 73 of 566 farm operators. Medium (hazard ratio [HR] = 0.58; confidence interval [CI], 0.35-0.96) or high (HR = 0.53; CI, 0.30-0.94) worksite physical safety and high economic security (HR = 0.41; CI, 0.24-0.71) were protective in reducing injury among older farmers. Conclusion Safety features in the physical environment and economic security are important protective factors for injury among older farmers. This supports injury prevention theory that suggests that engineering controls are superior to changes in work practices or the use of personal protective equipment in reducing injuries among older farmers.

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

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

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

Background Patients with mild traumatic brain injury or concussion commonly present to the emergency department for assessment; providing patients with information on usual symptoms and their progression may encourage faster recovery. Objectives This study aimed to document the role of an electronic clinical practice guideline (eCPG) patient handout on concussion recovery in adult patients discharged from the hospital. Methods A prospective cohort study was carried out in 3 Canadian urban emergency departments. Adults (≥17 years of age) with a Glasgow Coma Scale score of 13 to 15 who sustained a concussion were recruited by on-site research assistants. Physician use of a concussion-specific eCPG was documented from physician and patient reports. Patient follow-up calls at 30 and 90 days documented return to work/school activities and patient symptoms. Multivariate analyses were performed using logistic regression methods. Results Overall, 250 patients were enrolled; the median age was 35 (interquartile range 23–49) and 52% were female. Approximately half (n = 119, 48%) of patients received the eCPG handout, and return to work/school recommendations varied. Symptoms persisted in 60% of patients at 30 days; patients in the eCPG group had fewer symptoms (odds ratio 0.57, 95% confidence interval 0.33–0.99). At 90 days, 40% of patients reported persistent symptoms, with no significant difference between groups. Conclusion An eCPG handout improved patients’ short-term outcomes; however, physician use and adherence to guideline recommendations was low. To further facilitate physician compliance and therefore patient recovery, barriers to use of the eCPG handout need to be identified and addressed.

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

BackgroundEvidence supports the expectation that changes in time of alcohol sales associate with changes in alcohol-related harm in both directions. However, to the best of our knowledge, no comprehensive systematic reviews had examined the effect of policies restricting time of alcohol trading on specific alcohol-related harms.ObjectiveTo compile existing evidence related to the impact of policies regulating alcohol trading hours/days of on specific harm outcomes such as: assault/violence, motor vehicle crashes/fatalities, injury, visits to the emergency department/hospital, murder/homicides and crime.MethodsSystematic review of literature studying the impact of policies regulation alcohol trading times in alcohol-related harm, published between January 2000 and October 2016 in English language.ResultsResults support the premise that policies regulating times of alcohol trading and consumption can contribute to reduce injuries, alcohol-related hospitalisations/emergency department visits, homicides and crime. Although the impact of alcohol trading policies in assault/violence and motor vehicle crashes/fatalities is also positive, these associations seem to be more complex and require further study.ConclusionEvidence suggests a potential direct effect of policies that regulate alcohol trading times in the prevention of injuries, alcohol-related hospitalisations, homicides and crime. The impact of these alcohol trading policies in assault/violence and motor vehicle crashes/fatalities is less compelling.

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

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

OBJECTIVE:: To examine ice hockey injury rates presenting to emergency departments (EDs) in 2 separate cohorts of players before and after a policy change for age groups in minor hockey. DESIGN:: Retrospective cross-sectional study. SETTING:: Retrospective review of ice hockey injuries presenting to 2 tertiary care and 5 community care EDs in Edmonton, Alberta. PATIENTS:: Two cohorts of minor ice hockey players were constructed. The pre-age change cohort consisted of 4215 registered male hockey players. The post-age change cohort consisted of 3811 registered male hockey players. ASSESSMENT OF RISK FACTORS:: The risk of fracture, head and neck injury (intracranial and nonintracranial), and all other injuries presenting to EDs were compared between the pre-age change and post-age change cohorts. MAIN OUTCOME MEASURES:: Presentation to an ED with an injury occurring in ice hockey between September 1, and April 31, for the years 1997 through 2010. RESULTS:: Overall, significantly lower injury rates were observed in the post-age change cohort for players in the Peewee division; however, no significant differences were observed for the rate of fractures, and intracranial or nonintracranial head and neck injuries. There were no statistically significant differences observed between the pre-age change and post-age change cohorts in the Atom or Bantam divisions. CONCLUSIONS:: Introducing body checking 1 year earlier than in a previous cohort (11 vs 12 years of age) neither significantly decreased nor increased the rate of serious ice hockey injuries occurring 2 years after the introduction of body checking. Further research is recommended to evaluate the claim that introducing body checking lowers injury rates in older divisions of hockey. Language: en

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

Objectives To report the rates of SR-related HIs presenting to EDs in a Canadian population-based sample. Design Descriptive epidemiology study. Methods Using administrative data, sport and recreation-related emergency department presentations for persons 0–35 years of age, from April 1997 through March 2008, were obtained from the Edmonton Zone (formerly the Capital Health Region), Alberta Health Services through the Ambulatory Care Classification System. Results Of the 3,230,890 visits to the emergency departments of the five hospitals in Edmonton, 63,219 sport and recreation-related injury records and 4935 sport and recreation-head injury records were identified. Head injuries were most frequently treated for the activities of hockey (20.7%), cycling (12.0%), and skiing/snowboarding/sledding. Males accounted for 71.9% (n = 3546) and patients less than 18 years of age sustained 3446 (69.8%) sport and recreation-head injuries. Conclusions Sport and recreation-related head injuries most frequently treated in emergency departments involve common activities such as hockey, cycling, skiing/snowboarding/sledding, and soccer. Males and those less than 18 years of age sustain the majority of sport and recreation-related head injuries treated in emergency departments. These findings underscore the importance of sport-specific policies and safety promotion for the prevention of head injuries, in sports and recreational activities.

Objective The goal of the study was to systematically review available evidence regarding differences in injury incidence between rural and urban paediatric populations in Canada and the USA. Data source Eight electronic databases, institutional websites and reference lists of relevant studies including published and unpublished reports. Selection criteria Population-based observational studies or surveys published from 1970 to February 2011 that compared injury incidence or injury-related healthcare outcomes between rural and urban children ( Data collection and analysis Two reviewers independently applied selection criteria and assessed methodological quality of studies. Data were extracted by one author and independently verified by the second author. Injury rate ratios for rural and urban children were extracted or calculated. Data were synthesised descriptively due to substantial heterogeneity among studies. Results A total of 41 studies were included for this review (seven surveys and 34 studies using administrative health databases). Internal validity of included studies was moderate. Rural children were at higher risk of overall injury, motor vehicle crash injury and suicide, whereas urban children in the USA experienced higher rates of firearm-related homicides. Greater rural–urban injury disparities were likely to be found between more extreme rural and urban areas. In particular, children in remote rural areas are at increased risk of severe injuries than urban counterparts. Overall, healthcare costs per child for injury were higher for rural children. Conclusion These findings indicate the need of developing geographic area-specific injury-prevention strategies. Future research is required to investigate rural–urban disparity for less-studied injuries and related health outcomes (eg, disability). Systematic review registration number CRD42011001244 (PROSPERO 2011).

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

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

Bicycle helmets reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation targeted at those less than 18 years old on helmet use for all ages in Alberta.Two comparable studies were conducted two years before and four years after the introduction of helmet legislation in Alberta in 2002. Bicyclists were observed in randomly selected sites in Calgary and Edmonton and eight smaller communities from June to October. Helmet wearing and rider characteristics were recorded by trained observers. Poisson regression adjusting for clustering by site was used to obtain helmet prevalence (HP) and prevalence ratio (PR) (2006 vs. 2000) estimates.There were 4002 bicyclists observed in 2000 and 5365 in 2006. Overall, HP changed from 75% to 92% among children, 30% to 63% among adolescents and 52% to 55% among adults. Controlling for city, location, companionship, neighborhood age proportion18, socioeconomic status, and weather conditions, helmet use increased 29% among children (PR = 1.29; 95% CI: 1.20-1.39), over 2-fold among adolescents (PR 2.12; 95% CI: 1.75-2.56), and 14% among adults: (PR = 1.14; CI: 1.02-1.27).Bicycle helmet legislation was associated with a greater increase in helmet use among the target age group (18). Though HP increased over 2-fold among adolescents to an estimated 63% in 2006, this percentage was approximately 30% lower than among children13.

Objectives: Bronchiolitis is the most common lower respiratory tract disease among infants and results in 35 admissions per 1000 infants in Canada. We describe the epidemiology of bronchiolitis presentations to emergency departments (EDs) made by infants (aged ≤2 years) in Alberta, Canada. Methods: Provincial administrative databases were used to obtain all ED encounters for bronchiolitis during April 1999 to March 2005. Information included demographics, ED visit timing, and subsequent visits to non-ED settings. Data analysis included summaries and standardized rates. Results: There were 26,742 ED visits for bronchiolitis made by 18,155 infants. Most (74.9%) had only 1 bronchiolitis-related ED visit; males (60.6% of ED visits, 59.8% of infants) more commonly presented than females. The standardized rates increased from 23.2 to 46.7 per 1000 in 1999/2000 to 2000/2001 and decreased gradually to 38.8 per 1000 in 2004/2005. Of the total visits, 22.6% required hospitalization. In a discharged subset, 10.4% had a repeat ED visit within 7 days. Most infants (63.3%) had yet to have a non-ED follow-up visit by 1 week; median time to the first follow-up was 18 days. Conclusions: Bronchiolitis is a common presenting problem in Alberta EDs, and further study of these trends is required to understand variation in presentations. The important findings include different trends in rates for the first 3 years before a gradual decrease, disparities based on age, sex, and socioeconomic/cultural status, and the low rate of early follow-up. Targeted interventions could be implemented to reduce bronchiolitis-related hospitalizations.

Background Pneumonia is an infection of the lung and a common presentation problem in EDs. The objective of this study was to describe the epidemiology of pneumonia presentations to EDs in the province of Alberta, Canada. Methods Provincial administrative databases were used to obtain all ED encounters for pneumonia during 6 fiscal years (April 1999 to March 2005). Information extracted included demographics, ED visit timing, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates. Results A total of 190,896 ED visits for pneumonia were made by 140,913 distinct individuals (average of 1.4 visits per individual). Most (80.6%) had only one pneumonia-related ED visit. Male patients presented in slightly higher numbers than female patients. Standardized visit rates decreased overall from 12.5/1,000 population in 1999-2000 to 9.1/1,000 in 2004-2005. Admission occurred in 28.2% of the cases. In a discharged subset, 4.8% had a repeat ED visit within 7 days. Overall, 67.0% of individuals had yet to have a non-ED follow-up visit by 1 week; the estimated median time to the first follow-up visit was 21 days (95% CI, 20-22). Conclusions Pneumonia is a common presenting problem in Alberta EDs, and further study is required to understand the factors associated with the variation in presentations. Findings include a decrease in presentations after the first fiscal year, disparities based on age, sex, and socioeconomic/cultural status, and a low rate of early follow-up.

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

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

Background The health impacts of rapid changes in urban environments due to economic growth and/or retraction are not widely known. This study looks at the effects of urban change on the risk of child pedestrian injury in Edmonton, Alberta, a city that has experienced large economic and population growth following the expansion of the oil and gas industry in Canada. Methods A longitudinal ecological study design was used to model the relationships between several built and social environmental variables and the risk of child pedestrian injury and severe child pedestrian injury between 1996 and 2007. Results The incidence of child pedestrian injury was stable, but the incidence of severe injury increased over the study period. Areas with higher proportions of families on low incomes had higher injury incidence. While new residential development is associated with a lower incidence of injury in most areas, in poor areas, new residential development is associated with a higher incidence, even after controlling for urban planning features and traffic intensity. Conclusion While suburban areas have a lower incidence of child pedestrian injury, residential development in poorer areas is associated with a higher child pedestrian injury risk. Child pedestrians may be less able to adapt to changes in the urban environment due to rapid growth and increasing income, and as a result, may be at greater risk of injury.

Background Asthma has a high prevalence in North American children and exacerbations presenting to the emergency department (ED) setting are common. Objective Describe the epidemiology of asthma presentations to EDs by children residing in a large geographic area (Alberta, Canada). Methods Data were extracted from provincial administrative databases for children

Background Incorrect bicycle helmet use increases head injury risk. Objective To evaluate the patterns of incorrect helmet use based on unobtrusive field observations. Methods Two observational surveys conducted in Alberta in 2000 and 2006 captured information on cyclist characteristics, including correct helmet use. Prevalence of correct helmet use was compared across multiple factors: age, gender, riding companionship, and environmental factors such as riding location, neighbourhood median family income, and region. Poisson regression analysis was used to relate predictor variables to the prevalence of incorrect helmet use, adjusting for clustering by site of observation. Results Among helmeted cyclists (n=5862), 15.3% were wearing their helmet incorrectly or were using a non-bicycle helmet. Children (53%) and adults (51%) tended to wear their helmet too far back, while adolescents tended not have their straps fastened (48%). Incorrect helmet use declined approximately 50% over the study period for children and adolescents, but 76% (95% CI 68% to 82%) in adults. Children were 1.8 times more likely to use their helmets incorrectly in 2000 compared with adults, but this effect increased to 3.9 (95% CI 2.9 to 5.4) in 2006. Adolescents were more likely to use their helmets incorrectly in 2006 compared with adults (prevalence ratio 2.76; 95% CI 1.9 to 4.02). Children and adolescents cycling alone, compared with adults cycling alone, cycling at non-school sites and cycling in Edmonton, was associated with incorrect helmet use. Conclusions Important factors not previously identified were associated with incorrect bicycle helmet use. This information can be used to target interventions to increase correct use.

BACKGROUND: Agricultural work in the United States and Canada continues to be one of the most dangerous vocations. Surveillance evidence suggests that older farmers (>60 years of age) are at greater risk of serious injury than their younger counterparts. The purpose of this article was to outline illnesses and medications that may contribute to older farmers' increased risk of agricultural injury and to determine a minimum set of health-related covariates that could be used in farm injury studies. METHODS: A review of English language literature in Medline, CINAHL, and NIOSH databases was conducted examining disease and medication factors related to farm injury. RESULTS: Health- and disease-related factors most commonly reported as significantly contributing to agricultural injury included previous injury, hearing problems, depression, arthritis, and sleep deprivation. The use of "any medication" was identified as a significant risk factor for injury in a number of studies. The use of sleep medication was significantly related to injury in two studies. CONCLUSIONS: Based on the findings, it is recommended that at a minimum, researchers collect information on the prevalence of previous injury, hearing problems, depression, arthritis/muscular-skeletal problems and sleep disturbance as these have been identified as significant risk factors in a number of studies. In addition, where subjects that identify any of these afflictions, further information should be sought on any medications used in their treatment which can add data on disease severity. More research and surveillance activities need to be focused on the older farm worker. This population is critical to the maintenance of the agricultural base in North America and health and safety research initiatives need to address this. By integrating research from the fields of gerontology, occupational health and safety, and injury prevention, innovative interventions could be constructed to assist the aging farmer in the continuation of safe farming. Am. J. Ind. Med. 2009 (c) 2009 Wiley-Liss, Inc. Language: en

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

Background Asthma is a widespread disease with a prevalence of approximately 7 to 10% in adults. Exacerbations are common in the emergency department (ED) setting. The objective of this study was to describe the epidemiology of asthma presentations to EDs made by adults in the province of Alberta, Canada. Methods The Ambulatory Care Classification System of Alberta and provincial administrative databases were used to obtain all ED encounters for asthma during 6 fiscal years (April 1999 to March 2005). Information extracted included demographics, ED visit timing, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates. Results There were 105,813 ED visits for asthma made by 48,942 distinct adults, with an average of 2.2 visits per individual. Most patients (66%) had only one asthma-related ED visit. Female patients (61.2%) presented more commonly than male patients. The gender- and age-standardized visit rates declined from 9.7/1,000 in 1999/2000 to 6.8/1,000 in 2004/2005. The welfare and Aboriginal subsidy groups had larger age-specific ED visits rates than other populations. Important daily, weekly, and monthly trends were observed. Hospital admission occurred in 9.8% of the cases; 6.4% had a repeat ED visit within 7 days. Overall, 67.4% of individuals had yet to have a non-ED follow-up visit by 1 week. The estimated median time to the first follow-up visit was 19 days (95% confidence interval, 18 to 21). Conclusions Asthma is a common presenting problem in Alberta EDs, and further study of these trends is required to understand the factors associated with the variation in presentations. The important findings include an overall decrease in the rates of presentation over the study period, disparities based on age, gender, and socioeconomic/cultural status, and the low rate of early follow-up. Targeted interventions could be implemented to address specific groups and reduce asthma-related visits to Alberta EDs.

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

Objective: To compare the onset of symptomatic urinary tract infection in individuals with spinal cord injury in a rehabilitation setting who are randomized to clean or sterile intermittent catheterization technique. Design: Randomized controlled design. Setting: Spinal cord rehabilitation units in western Canada. Subjects: Thirty-six patients with cervical spinal cord injuries requiring intermittent catheterization by nursing staff were recruited. None had a previous history of voiding dysfunction or urinary tract infections. Interventions: Subjects were randomized to either clean or sterile intermittent catheterization technique. Protocols for both clean and sterile techniques were standardized and followed by nursing staff and caregivers. Main measures: Primary outcome measure was symptomatic urinary tract infection as diagnosed by urine culture ≥ 105 colony-forming units/mL, pyuria (≥ 10 leukocytes on high-power field), and accompanying symptoms. Results: A total of 189 urine specimens from 36 subjects were cultured. Of the 36 subjects, 15 (43%) developed a symptomatic urinary tract infection: 6/16 (37%) from the clean group; 9/20 (45%) from the sterile group (P>0.05). Mean time to onset for symptomatic urinary tract infection for the clean group was 3.0 (standard deviation (SD) 2.4) weeks and for the sterile group, 3.6 (SD 1.3) weeks (P>0.05). The most common urinary organisms at onset of symptomatic urinary tract infection were Enterococcus species followed by Klebsiella. Conclusion: Clean intermittent catheterization in the rehabilitation setting does not appear to place the patient with spinal cord injury at increased risk for developing symptomatic urinary tract infection, and has significant cost and time saving benefits for the health care system, as well as enhancing the transition for the patient from rehabilitation to community.

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

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

BACKGROUND: Agricultural work continues to be a dangerous occupation. Older farmers experience high risks for work-related injury. The purpose of this research was to determine if there is a relationship between medication use and injury among older male farmers in Alberta. METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 1:5. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury. RESULTS: Overall, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.37 [95% CI:4.95, 17.72]) and non-steroidal anti-inflammatories (OR = 2.40 [95% CI:1.43, 4.03]) 30 days prior to the date of injury were at risk of injury. Those farmers taking sedatives up until the date of injury were also at risk (OR = 3.01 [95 CI:1.39, 6.52]). In addition, those suffering from incontinence/urinary tract disorders (OR = 2.95 [95% CI:1.30, 6.71]), and prior injury (OR = 1.42 [95% CI:1.04, 1.95]) were also at greater risk of injury. CONCLUSIONS: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. We hypothesize that distraction from either pain or co-morbidity may play an important role in the etiology of injuries suffered in this active older working population. Further investigations in this area are required to confirm these findings.

We report on our strategies to minimize bias in the FIRM study, a prospective case-control study of risk factors for serious farmwork-related injury. The study base is adult males working on farms in the catchment regions of 14 larger regional hospitals in one Australian state. Cases are identified on presentation to the emergency departments, while age-matched controls are recruited via random telephone survey. Eligibility criteria for cases include a maximum abbreviated injury severity score of at least 2, to minimize the potential for selection bias against those with less severe injuries treated outside the hospital system. An audit at one hospital showed that 93% of eligible patients identified in the electronic surveillance system had been approached regarding participation. Results to date show that 38% of those approached decline to have their contact details made available to researchers. Those who decline are asked to complete two key questions to enable comparison with those who participate. Control recruitment relies on telephoning regional households until an individual from the study base, satisfying the matching criteria, is identified. This process minimizes the potential for selecting against farm workers who may live off-farm. Ninety-four percent of age-matched eligible controls have participated to date. We are testing a dynamic pool of individuals identified as study base members but not matched on the first call to determine its effect on the probabilities of selection. Our strategies appear to be minimizing detection, selection, and response bias, thereby enhancing the validity of the study results.

A nighttime roadside survey of rural Alberta drivers was conducted to quantify the nature and extent of impaired driving on Alberta's rural roads during nighttime. The survey also sought to describe driver demographics and information about the trip, such as origin and destination, among rural Alberta's nighttime drivers. Surveys were administered to drivers of vehicles that were randomly sampled at rural locations in Alberta between the hours of 10:00 PM and 4:00 AM between 22 August and 1 September 2001. Drivers who agreed to participate were asked a series of short questions. The interview concluded with the driver providing a breath sample to measure the driver's BAC level. Of the drivers surveyed, 3% had a BAC that was over the legal limit of 80 mg%. A total of 13% of drivers tested had detectable amounts of alcohol in their system.

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

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

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

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

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