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Ingram MC, Becker S, Olson SL, Tsai S, Sarkar A, Rothstein DH, Skarsgard ED, Raval MV. Disparities in surgical health service delivery and outcomes for indigenous children. J Pediatr Surg 2023; 58:375-383. [PMID: 36241445 DOI: 10.1016/j.jpedsurg.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence of health disparities for Indigenous children requiring surgical care is lacking. We present a systematic review of the literature examining possible disparities in surgical care and outcomes for pediatric patients of Indigenous ethnicity. DATA SOURCES PubMed, Cochrane, MEDLINE, gray literature. METHODS Literature review, using PubMed, Cochrane, MEDLINE, and gray literature was conducted to identify articles published more than 2010-2020 examining children's surgical health service delivery (epidemiology, access, operations provided) and outcomes for pediatric patients of Indigenous ethnicity compared with others. Extracted data included study design, setting, participant race/ethnicity, operations examined, and surgical outcomes. Article quality was assessed using the Newcastle-Ottawa Scales. RESULTS From 411 abstracts, 125 articles were reviewed and 33 included for data abstraction. These were cohort and cross-sectional studies investigating a wide range of patient populations and procedures across the United States, Canada, Australia, and New Zealand. Articles were organized naturally by theme into birth malformations (15 articles), trauma (6 articles), pediatric general surgery/appendicitis (5 articles), pediatric otolaryngology (6 articles), and renal transplant (1 article) surgery. Four articles also described access and resource utilization related to inpatient care. Notable disparities observed included apparent increased prevalence of gastroschisis, rates of traumatic fatality, non accidental injury, and self harm among North American Indigenous children. CONCLUSIONS Indigenous children appear to be vulnerable to a number of health and treatment outcome disparities related to conditions treated by surgeons. Surgeons are thus uniquely poised to act in identifying and eliminating Indigenous ethnicity-based pediatric health disparities.
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Affiliation(s)
- Martha-Conley Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
| | - Sasha Becker
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sydney L Olson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Stacy Tsai
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Arjun Sarkar
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David H Rothstein
- Division of Pediatric Surgery, Department of Surgery, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Fortin M, Atsaidis Z, Hopkins B, St-Louis E, Guadagno E, Friedman D, Poenaru D. Definitive Care for Severely Injured Children in Quebec. Injury 2023; 54:173-182. [PMID: 36008174 DOI: 10.1016/j.injury.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injury is the leading cause of death in children over the age of one in Canada, and remains the most common cause of death in Quebec pediatric patients. Indigenous communities are 3-4 times more likely to be affected by injuries than the national average. In Quebec, health centres can range from 30 to 1000 km away from the closest level I trauma center. METHODS Descriptive analysis and multiple logistic regression were performed for severely injured pediatric trauma patients received at the Montreal Children's Hospital (MCH) over a ten-year period. Outcomes were compared between regional groups in Quebec using forward sortation areas. RESULTS Two hundred and forty four pediatric patients presented to the MCH with major trauma between 2006 and 2016. Of those, 42% of patients resided in Montreal, 42% off-island, and 16% in Northern Quebec. Admission to the Intensive Care Unit (ICU) was required for 60% of off-island patients and 58% of Northern residents. The median length of hospital stay (LOS) was 5 days for off-island and 15 days for Northern patients. Most patients (78% off-island vs. 76% Northern Quebec) were discharged home. The overall mortality was 5%. In multiple regression analysis, residence in Northern Quebec was associated with increased incidence of longer than median length of stay compared to off-island patients (OR 2.78, 95%CI (1.12-7.29)) after adjusting for injury severity, operative intervention, age, and sex. CONCLUSION ICU admission rate was similar among Northern and off-island populations. Patients from Northern Quebec appeared to have longer-than-median hospital length of stay. In-hospital mortality was infrequent and limited to on-island and off-island populations. A further exploration of this data is required to identify the "trauma deserts" and advocate for children involved in trauma in all areas of Quebec.
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Affiliation(s)
- Mélyssa Fortin
- McGill University Faculty of Medicine & Health Sciences, 3605 Rue de la Montagne, Montreal, Quebec, Canada, H3G 2M1
| | - Zoe Atsaidis
- McGill University Faculty of Medicine & Health Sciences, 3605 Rue de la Montagne, Montreal, Quebec, Canada, H3G 2M1
| | - Brent Hopkins
- Department of General Surgery, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4
| | - Etienne St-Louis
- Department of General Surgery, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J
| | - Debbie Friedman
- Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Canadian Hospitals Injury Reporting and Prevention Program, Public Health Agency of Canada, Department of Pediatrics and Department of Pediatric Surgery, Faculty of Medicine and Health Sciences McGill University
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J.
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Indigenous participation in pediatric Indigenous health research in Canada: a systematic review. Pediatr Res 2022:10.1038/s41390-022-02361-9. [PMID: 36333537 DOI: 10.1038/s41390-022-02361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
For health inequities to be successfully addressed through health research, it is necessary for researchers to strive for genuine engagement with stakeholders. Indigenous people provide critical perspectives in Indigenous health research. The objective of this review was to systematically review the existing pediatric Indigenous health research in Canada to determine the prevalence of Indigenous participation. Embase, MEDLINE, Cochrane Library were searched on April 15, 2017 and updated on July 16, 2020. A total of 798 studies focused on the health of Indigenous children ≤18 in Canada were included, of 17,752 abstracts screened in English and French. A total of 46.1% of articles indicated Indigenous participation, increasing over time. Organization/government was the most common form of Indigenous participation (62.8%) and Indigenous researcher as author was least common (10.9%). Participation by child age, geography and topic area varied. The most common category of topic researched was nutrition, lifestyle and anthropometrics. Indigeneity of researchers was determined by self-identification in the papers and may be an underestimate. Although improving over time, less than half of studies about Indigenous children in Canada included Indigenous participation in their execution. Journals and funding bodies must ensure fulsome participation of Indigenous people in research focused on Indigenous children. IMPACT: Indigenous participation in pediatric Indigenous health research is critical to producing ethical relevant and actionable results. This review describes the status of Indigenous participation in this body of work in Canada. This review highlights areas of concern and strength to improve the practices and ethics of medical researchers in this area, thereby increasing relevance of pediatric Indigenous health research to communities.
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Waldner R, Baydala L, Tremblay M, Pynoo E, Dreise H. Clinical training within an Indigenous community: a qualitative description of pediatric residents’ learning experiences. Paediatr Child Health 2022; 27:403-407. [DOI: 10.1093/pch/pxac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/31/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Indigenous children and families experience inequities across health domains. Calls to action from the Truth and Reconciliation Commission of Canada and the Indigenous Physicians Association of Canada have highlighted the need for medical professionals to better understand these inequities and improve the provision of culturally safe services through collaboration between Indigenous communities and medical residency programs. There are currently no published evaluations of clinical training for Canadian medical residents within Indigenous communities. The current study was conducted at an on-reserve pediatric outreach clinic (Maskwacis Pediatric Outreach Clinic; MPOC).
Methods
From the perspectives of pediatric residents, the researchers explored the impacts of attending MPOC during resident training. Residents completed anonymous surveys over an 18-month period that addressed patient and caregiver encounters, the value of MPOC on resident training, significant pediatric health issues in the community, and limitations of MPOC in contributing to training. Seven residents participated in a focus group that expanded upon survey results.
Results
Thirty-four surveys were completed. Responses reflected an enhanced understanding of social, environmental, and systemic contributors to health issues, and learning regarding the complexity of circumstances that Indigenous children and families face. Focus group results were organized into the impacts of MPOC on (1) residents and (2) patients, with several sub-categories.
Conclusions
Findings suggest that direct clinical exposure to Indigenous child health issues is a valuable educational experience for pediatric residents. The importance of strength-based approaches to educating medical residents regarding the social determinants of health and colonial contexts of Indigenous health disparities is also identified.
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Affiliation(s)
- Richelle Waldner
- Department of Pediatrics, University of Alberta , Edmonton, Alberta , Canada
| | - Lola Baydala
- Department of Pediatrics, University of Alberta , Edmonton, Alberta , Canada
| | - Melissa Tremblay
- Department of Educational Psychology, University of Alberta , Edmonton, Alberta , Canada
| | - Emily Pynoo
- Department of Educational Psychology, University of Alberta , Edmonton, Alberta , Canada
| | - Heather Dreise
- Department of Pediatrics, University of Alberta , Edmonton, Alberta , Canada
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Al-Hajj S, Desapriya E, Pawliuk C, Garis L, Pike I. Interventions for Preventing Residential Fires in Vulnerable Neighbourhoods and Indigenous Communities: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095434. [PMID: 35564830 PMCID: PMC9100970 DOI: 10.3390/ijerph19095434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Samar Al-Hajj
- Department of Epidemiology and Population Health, Faculty of Health Sciences, The American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
- British Columbia Injury Research and Prevention Unit, British Columbia Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (E.D.); (C.P.); (L.G.); (I.P.)
- Correspondence:
| | - Ediriweera Desapriya
- British Columbia Injury Research and Prevention Unit, British Columbia Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (E.D.); (C.P.); (L.G.); (I.P.)
| | - Colleen Pawliuk
- British Columbia Injury Research and Prevention Unit, British Columbia Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (E.D.); (C.P.); (L.G.); (I.P.)
| | - Len Garis
- British Columbia Injury Research and Prevention Unit, British Columbia Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (E.D.); (C.P.); (L.G.); (I.P.)
- School of Culture, Media and Society, The University of the Fraser Valley, Abbotsford, BC V2S 7M8, Canada
| | - Ian Pike
- British Columbia Injury Research and Prevention Unit, British Columbia Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (E.D.); (C.P.); (L.G.); (I.P.)
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6H 3V4, Canada
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Ryder C, Mackean T, Hunter K, Rogers K, Holland AJA, Ivers R. Burn Injuries in Hospitalized Australian Children-An Epidemiological Profile. J Burn Care Res 2020; 42:381-389. [PMID: 32910200 DOI: 10.1093/jbcr/iraa159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Globally, First Nations children sustain burns at a higher rate than other children. Little is understood about how health inequities contribute, especially from an Indigenous viewpoint. We analyzed data from the Burns Registry of Australian and New Zealand (BRANZ) for acute burns in children (<16 years) admitted to hospital between October 2009 and July 2018. Descriptive statistics examined equity variables in patient and injury characteristics. Poisson regression was used to describe factors associated with bacterial infection. Indigenous research methods were used throughout. Aboriginal and Torres Strait Islander children represented 10.4% of the study population. Health inequities were present for Aboriginal and Torres Strait Islander children with longer hospital length of stay (9.5 vs 4.6 days), rural residency (61.3% vs 13.9%), lower socioeconomic status (72.2% vs 34.9%), and more flame burns (19.5% vs 10.6%) compared to other Australian children. Streptococcus sp. infection risk was four times greater in Aboriginal and Torres Strait Islander children compared to other Australian children. Flame burns and high percentage total body surface area burns were a risk for Staphylococcus sp. and Streptococcus sp. infection in all children. The epidemiological profile for burn injuries managed in Australian burns centers differs between Aboriginal and Torres Strait Islander children and other children, indicating persistent health inequities. These differences should be considered in the development of injury prevention strategies and the clinical management of burn injuries for Aboriginal and Torres Strait Islander children and their families.
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Affiliation(s)
- Courtney Ryder
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tamara Mackean
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Hunter
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia
| | - Kris Rogers
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Andrew J A Holland
- The University of Sydney School of Medicine, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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McCalman J, Langham E, Benveniste T, Wenitong M, Rutherford K, Britton A, Stewart R, Bainbridge R. Integrating Healthcare Services for Indigenous Australian Students at Boarding Schools: A Mixed-Methods Sequential Explanatory Study. Int J Integr Care 2020; 20:8. [PMID: 32194357 PMCID: PMC7068848 DOI: 10.5334/ijic.4669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/19/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Many Aboriginal and Torres Strait Islander Australian adolescents from remote communities attend boarding schools, requiring integrated healthcare between home and schools. This study explored students' health status, healthcare service use and satisfaction. METHODOLOGY A two-phased mixed-methods explanatory design was implemented. 32 Indigenous primary and 188 secondary boarding school students were asked their health status, psychological distress, use of healthcare services in community and boarding school, and service satisfaction. Results were fed back to students, parents and community members, and education and healthcare staff to elicit further explanation and interpretation. RESULTS In the previous year, 75% of primary and 81% of secondary boarding school students had visited a doctor. More than 90% were satisfied with healthcare services used. Despite 27.1% reporting high psychological distress, students did not perceive distress as reducing their overall health, nor was distress associated with mental healthcare service use. DISCUSSION Despite high levels of service use and satisfaction, this study highlighted the need for improved healthcare integration for Indigenous adolescents between school-based and remote community services. Further research is needed to identify students' expectations and models for healthcare integration. CONCLUSION With resourcing, schools could play a greater role in facilitating access to healthcare.
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Ellis MJ, Boles S, Derksen V, Dawyduk B, Amadu A, Stelmack K, Kowalchuk M, Russell K. Evaluation of a pilot paediatric concussion telemedicine programme for northern communities in Manitoba. Int J Circumpolar Health 2020; 78:1573163. [PMID: 30714513 PMCID: PMC6366439 DOI: 10.1080/22423982.2019.1573163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Pediatric concussion patients living in northern communities in Canada can face unique challenges accessing primary and specialized healthcare. In this study we report the clinical characteristics, healthcare utilization, outcomes and estimated cost avoidance associated with a pilot pediatric concussion telemedicine program established between a multi-disciplinary pediatric concussion program in Winnipeg, Manitoba and a hospital in Thompson, Manitoba. From October 1st- July 1st, 2018, 20 patients were evaluated; mean age 13.1 years, 15 (75%) males and 14 (70%) self-identified as Indigenous. Injury mechanisms included hockey (50%), falls (35%) and assaults (15%). Median time from referral to initial consultation was 2.0 days. After screening by the neurosurgeon, 90% of patients underwent initial consultation via real-time videoconferencing with 80% managed exclusively through telemedicine. At the end of the study, 90% met the criteria for clinical recovery, one remained in treatment and one was discharged to a headache neurologist. Sixty-six telemedicine encounters were completed including 57 videoconferencing appointments and 9 telephone follow-ups representing an estimated cost avoidance of $40,972.94. This study suggests telemedicine may be a useful approach to assist pediatric concussion programs with delivering timely, safe and cost-effective care to patients living in medically underserviced remote and northern communities in Canada.
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Affiliation(s)
- Michael J Ellis
- a Department of Surgery , University of Manitoba , Canada.,b Pediatrics and Child Health , University of Manitoba , Canada.,c Section of Neurosurgery , University of Manitoba , Canada.,d Pan Am Concussion Program , Winnipeg , Manitoba , Canada.,e Childrens Hospital Research Institute of Manitoba , Winnipeg , Manitoba , Canada.,f Canada North Concussion Network , Winnipeg , Manitoba , Canada
| | - Susan Boles
- g MBTelehealth, Manitoba eHealth , Winnipeg , Manitoba , Canada
| | - Vickie Derksen
- d Pan Am Concussion Program , Winnipeg , Manitoba , Canada
| | | | - Adam Amadu
- h Thompson General Hospital , Thompson , MB , Canada
| | - Karen Stelmack
- g MBTelehealth, Manitoba eHealth , Winnipeg , Manitoba , Canada
| | | | - Kelly Russell
- b Pediatrics and Child Health , University of Manitoba , Canada.,e Childrens Hospital Research Institute of Manitoba , Winnipeg , Manitoba , Canada.,f Canada North Concussion Network , Winnipeg , Manitoba , Canada
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Pu H, Li B, Luo D, Wang S, Wang Z, Zhao W, Zheng L, Duan P. Impact of urbanization factors on mortality due to unintentional injuries using panel data regression model and spatial-temporal analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:2945-2954. [PMID: 31838677 DOI: 10.1007/s11356-019-07128-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Unintentional injuries pose a great risk for human health in China. Few studies have focused on unintentional injuries at national level from urbanization perspective. The panel data of mortality rate of transportation accidents (TA), fall and drowning and sinking (DS) is investigated, and urbanization development index is collected. Global Moran's I and linear regression of panel data are applied to determine the spatial distribution and spatial influencing factors of unintentional injuries. The results are the following: (1) The unintentional injury such as TA, fall, and DS shows clear non-uniformity of spatial distribution and relative immobility through time. (2) A 10,000 tons increase in SO2 emission amount (SO2 EA) and emission of smoke and dust (ESD) can result in 15.7 and 12.5 increases in TA death in eastern region, respectively. Meanwhile, A 10,000 tons increase in NOx emission amount can cause 15.1 increase in TA death in western region. For every 100 billion yuan increase in GDP, the fall death can reduce by 8.4 in central region. One bed increase in number of hospital beds per 10,000 population (NHBP) is favorable for decreasing in fall death by 16.7 in eastern region. However, increase in number of workers enjoying industrial injury (NEWII) does not reduce the fall death in eastern region. (3) For every 1 ten thousand people increase in number of students in ordinary high schools (NSOHS) is conductive to reducing DS death by 7.8 in the western region. Our findings show that there exist spatial differences for urbanization influencing TA, fall, and DS death in eastern, western, and central regions. This study is expected to provide a reference for unintentional injuries control in those three regions.
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Affiliation(s)
- Haixia Pu
- Research Center of the Economy of the Upper Reaches of the Yangtze River and the Key Research Base of Humanities, Ministry Of Education, Chongqing Technology and Business University, Chongqing, 400067, China
- College of Tourism and Land Resources, Chongqing Technology and Business University, Chongqing, 400067, China
- Chongqing Key Laboratory of Spatial Data Mining and Big Data Integration for Ecology and Environment, Chongqing, China
| | - Bin Li
- Research Center of the Economy of the Upper Reaches of the Yangtze River and the Key Research Base of Humanities, Ministry Of Education, Chongqing Technology and Business University, Chongqing, 400067, China
| | - Dongqi Luo
- Research Center of the Economy of the Upper Reaches of the Yangtze River and the Key Research Base of Humanities, Ministry Of Education, Chongqing Technology and Business University, Chongqing, 400067, China.
| | - Shaobin Wang
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
| | - Zhaolin Wang
- Research Center of the Economy of the Upper Reaches of the Yangtze River and the Key Research Base of Humanities, Ministry Of Education, Chongqing Technology and Business University, Chongqing, 400067, China
| | - Wei Zhao
- Research Center of the Economy of the Upper Reaches of the Yangtze River and the Key Research Base of Humanities, Ministry Of Education, Chongqing Technology and Business University, Chongqing, 400067, China
| | - Lingyu Zheng
- Research Center of the Economy of the Upper Reaches of the Yangtze River and the Key Research Base of Humanities, Ministry Of Education, Chongqing Technology and Business University, Chongqing, 400067, China
| | - Ping Duan
- College of Tourism and Geographic Sciences, Yunnan Normal University, Kunming, 650500, Yunnan, China
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Knowledge, Attitudes and Concussion Information Sources Among First Nations in Ontario. Can J Neurol Sci 2018; 45:283-289. [PMID: 29552994 DOI: 10.1017/cjn.2017.299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Hockey is a popular sport played by many First Nation youth. Concussion frequently goes unrecognized and unreported in youth hockey. Unintentional injuries among Indigenous youth occur at rates three to four times the national Canadian average. The study sought to examine knowledge, attitudes and sources of concussion information among First Nations people attending a provincial hockey tournament. METHODS A cross-sectional survey was undertaken. The survey by Mzazik et al. were modified to use in this study. Participants included youth (6-18 years) hockey players (n=75), parents (n=248) and coaches (n=68). The main outcome measure was total knowledge index (TKI) which consisted of the sum of correct responses to 15 multiple choice questions. Additional data gathered included demographics, concussion history, attitudes toward concussion and sources of information. Descriptive statistics included proportion comparisons. Variables were tested using χ 2 and analysis of variance. RESULTS Overall TKI scores (out of a total of 15) were low; players (5.9±2.8), parents (7.5±2.6) and coaches (7.9±2.6). Participants with higher knowledge scores reported more appreciation of the seriousness of concussion. Sources of information about concussion differed by study group, suggesting the need for multiple knowledge translation strategies to reach youth, parents and coaches. CONCLUSIONS Future initiatives are urgently needed to improve education and prevention of concussion in First Nations youth hockey. Collaborating and engaging with communities can help to ensure an Indigenous lens for culturally safe interventions.
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Examining Injury Among Indigenous Young People: A Narrative Scoping Review. J Trauma Nurs 2018. [PMID: 29521778 DOI: 10.1097/jtn.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Indigenous young people of circumpolar developed countries experience a disproportionate incidence of injury compared with non-Indigenous young people. Much has been published about the experience of injury within the general Indigenous population, but literature is limited with regard to Indigenous young people. Trauma nurses, who are important members of the multidisciplinary team that provides injury intervention to Indigenous populations, need to be aware of this literature, as well as subsequent research gaps, to provide effective care to Indigenous young people experiencing injury. The purpose of this study was to provide an updated comprehensive review of the research-based evidence related to all-cause injury for Indigenous young people. An exploratory scoping review was conducted with a narrative synthesis. To locate literature, 7 electronic databases were searched from 2003 to 2017. Criteria were applied to all located articles to determine inclusion and then data were extracted from each study's findings. A total of 15 studies were included in this review that met the inclusion criteria. Themes derived from the knowledge synthesis process are as follows: incidence rates, mechanisms of injury, risk factors, and gaps in research. A strong epidemiological focus has emerged from the research found in this review of injury among Indigenous young people. The results of this review serve as a starting point for trauma nurses to successfully assess, build trusting relationships with, and further research injury among Indigenous young people.
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Durkalec A, Furgal C, Skinner MW, Sheldon T. Investigating environmental determinants of injury and trauma in the Canadian north. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1536-48. [PMID: 24477214 PMCID: PMC3945552 DOI: 10.3390/ijerph110201536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/10/2014] [Accepted: 01/18/2014] [Indexed: 11/23/2022]
Abstract
Unintentional injury and trauma rates are disproportionately high in Inuit regions, and environmental changes are predicted to exacerbate injury rates. However, there is a major gap in our understanding of the risk factors contributing to land-based injury and trauma in the Arctic. We investigated the role of environmental and other factors in search and rescue (SAR) incidents in a remote Inuit community in northern Canada using a collaborative mixed methods approach. We analyzed SAR records from 1995 to 2010 and conducted key consultant interviews in 2010 and 2011. Data showed an estimated annual SAR incidence rate of 19 individuals per 1,000. Weather and ice conditions were the most frequent contributing factor for cases. In contrast with other studies, intoxication was the least common factor associated with SAR incidents. The incidence rate was six times higher for males than females, while land-users aged 26–35 had the highest incidence rate among age groups. Thirty-four percent of individuals sustained physical health impacts. Results demonstrate that environmental conditions are critical factors contributing to physical health risk in Inuit communities, particularly related to travel on sea ice during winter. Age and gender are important risk factors. This knowledge is vital for informing management of land-based physical health risk given rapidly changing environmental conditions in the Arctic.
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Affiliation(s)
- Agata Durkalec
- Frost Centre for Canadian Studies and Indigenous Studies, Trent University, 1600 West Bank Drive, Peterborough, ON K9J 7B8, Canada.
| | - Chris Furgal
- Indigenous Environmental Studies Program and Health, Environment, and Indigenous Communities Research Group, Trent University, 1600 West Bank Drive, Peterborough, ON K9J 7B8, Canada.
| | - Mark W Skinner
- Geography Department, Trent University, 1600 West Bank Drive, Peterborough, ON K9J 7B8, Canada.
| | - Tom Sheldon
- Environment Division, Nunatsiavut Government, P.O. Box 70, Nain, NL A0P 1L0, Canada.
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Yanchar NL, Warda LJ, Fuselli P. Child and youth injury prevention: A public health approach. Paediatr Child Health 2013; 17:511-2. [PMID: 24179425 DOI: 10.1093/pch/17.9.511] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The majority of child and youth injuries are preventable. This statement provides background, direction and a statement of commitment to the issue of child and youth injury prevention in Canada. It acts as a foundation to build upon by focusing first on definitions, scope and priorities for injury prevention. It also describes the burden and patterns of unintentional injury, and the principles of effective intervention for prevention. A list of resources for obtaining data and evidence-based information is included in the full-text version of this statement (www.cps.ca). This statement can also be used for broad-based injury prevention advocacy.
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The impact of fatal pediatric trauma on aboriginal children. J Pediatr Surg 2013; 48:1065-70. [PMID: 23701784 DOI: 10.1016/j.jpedsurg.2013.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Injuries are the leading cause of death in young people. Our aim is to examine the differences between aboriginal and non-aboriginal pediatric trauma mortality as a means to focus on prevention strategies. METHODS The records for all traumatic pediatric (0-18 years) deaths between 1996 and 2010 were reviewed from the regional Medical Examiner's office. RESULTS The majority of the total 932 pediatric deaths were the result of non-intentional injuries (640) followed by suicide (195), homicide (65), child abuse (15), and undetermined (17). Despite being only 3.3% of the provincial population, Aboriginals represented 30.9% of pediatric trauma fatalities. Aboriginal fatalities occurred most commonly in the home, with males and females equally affected. Road related events were the main causes of injury overall. Up to three-quarters of Aboriginal children who died in a non-pedestrian road related event did not wear an indicated protective device. Pedestrian deaths were over-represented in Aboriginal children. The second most common cause of death was suicide for both non-Aboriginal and Aboriginal children. Almost half of all of the suicides were Aboriginal. Homicide and child abuse had similar proportions for both non-Aboriginal and Aboriginal children. CONCLUSION Pediatric Aboriginal injury prevention should be a priority and tailored for Aboriginal communities.
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