Child and youth injury prevention: A public health approach

The effect of intervention programs on road traffic injury prevention among adolescents and young people: a systematic review

Road traffic injuries (RTIs) are a significant cause of death and disability among young people worldwide. Programs that use injury prevention strategies have been shown to effectively reduce the number of injuries. This systematic review aims to present the available evidence on the effectiveness of intervention programs in preventing RTIs among adolescents and young adults. Articles were identified and retrieved from databases including PubMed, Embase, Web of Science, Scopus, Science Direct, Magiran, SID, and Iran Medex. Two reviewers independently screened the articles. Articles published from the first year of publication until January 2018 that met the eligibility criteria were included in the review. These articles covered randomized controlled trials, pretest/post-test interventions, and controlled pretest/post-test interventions aimed at reducing RTIs among adolescents and young people aged 12-26 years. The framework, provided by Murphy and Haddon, were used to categorize the interventions. According to this framework, the interventions were categorized into five groups including education/behavior change, incentive, engineering/technology, legislation/enforcement, and multifaceted programs. The methodological quality of the studies was assessed using the Effective Public Health Practice Project. Of the initial 3165 findings, 13 studies met the inclusion criteria. Eleven of these studies used educational/behavioral approaches, while two employed multifaceted programs. In the educational/behavioral approach, participants' behaviors were considered as outcome variables. Only one of these studies was not successful. Multifaceted interventions were successful in changing behaviors. No studies were found on the effectiveness of other interventions. Eight studies were assessed as having moderate quality. The systematic review shows that educational/behavioral strategies and multifaceted programs are effective in reducing RTIs among young adults and adolescents. However, there is a lack of studies on other potential interventions. The quality of the included studies was moderate, suggesting a need for more rigorous research.

Epidemiology and factors associated with mortality among pediatric major trauma patients in Nova Scotia: A 17-year retrospective analysis

BACKGROUND

Major traumatic injury in the pediatric population requires further evaluation to improve patient outcomes. Relatively few Canadian studies have investigated pediatric trauma using population-based data. Our objectives were to describe the epidemiology of pediatric major trauma in Nova Scotia and identify factors associated with in-hospital mortality.

METHODS

Retrospective cohort study of pediatric major trauma patients (age <18 years) injured in Nova Scotia over a 17-year period (April 2001-March 2018). Data were collected from the Nova Scotia Trauma Registry. Characteristics were compared between patient subgroups using t-tests, chi-square analyses and Fisher's exact test. Temporal trends were evaluated using the Mann-Kendall test. Incidence and mortality rates were mapped using ArcGIS Pro. A multivariate logistic regression model was created to assess for factors associated with in-hospital mortality.

RESULTS

A total of 1258 injuries were observed over the 17-year study period. The incidence of pediatric major trauma was 41.7 per 100,000 person-years. Most patients were male (819/1258; 65.1 %) and resided in urban areas (764/1258; 60.7 %). Blunt trauma accounted for 86.2 % (1084/1258) of injuries, and motor vehicle collisions were the most common cause (448/1258; 35.6 %). Incidence and mortality rates were highest in the 15-17 year age group, with a trend towards increasing incidence among females (p = 0.011). Mortality was 17.2 % (217/1258) of patients; 10.9 % (137/1258) died pre-hospital. No trends were detected in mortality rates. The regression model showed increased odds of in-hospital mortality for every point increase in the ISS (OR 1.05; 95 % CI 1.02 to 1.09) and for every unit decrease in scene GCS (OR 0.63; 95 % CI 0.56-0.71). Rural patients were 2 times more likely to die in-hospital versus urban patients (OR 2.40; 95 % CI 1.01-5.69), and patients injured at home were 6 times more likely to die compared to those injured in other locations (OR 6.19; 95 % CI 1.01-38.11).

CONCLUSION

Pediatric trauma remains a major public health issue in Canada and beyond. Greater efforts are required to expand our understanding of trauma epidemiology and develop targeted injury prevention strategies, especially for rural inhabitants.

Impact of the COVID-19 era on preventative primary care for children 0-5 years old: a scoping review protocol

BACKGROUND

The COVID-19 pandemic has resulted in widespread disruptions to primary healthcare delivery and shifts to virtual care. Reduced in-person paediatric primary care visit rates have been reported. However, the extent to which access to primary preventative care has been impacted remains unclear. The objective of this scoping review is to characterise the utilisation of preventative primary care and its association with child development for children ages 0-5 years old during the COVID-19 era. In addition, we will determine if specific groups of children are at greater risk for reduced access to care.

METHODS

A systematic search will be conducted for studies published between March 11, 2020, and October 2023 in the following databases: MEDLINE (Ovid), Embase (Ovid), Cochrane Library (CENTRAL and CDSR), Web of Science, and CINAHL (EBSCOhost). This scoping review will follow the methodological framework developed by Arksey and O'Malley and updated by the Joanna Briggs Institute (JBI). Studies related to primary preventative care of children aged 0-5 years old conducted in English and in high-income countries will be screened. Studies published before March 11, 2020, in acute care and low-middle-income settings will be excluded. Results will be summarised for appointments attended, delayed, and missed. In addition, we will summarise findings on the impact of COVID-19 on child development. Findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.

DISCUSSION

Further investigation is required to better understand the relationship between attendance of preventative primary care for children and its effects on child development. The findings obtained from this review will offer essential context to guide policy-making and healthcare service planning for the period following the pandemic.

Investigating social determinants of child health and their implications in reducing pediatric traumatic injury: A framework and 17-year retrospective case-control study protocol

INTRODUCTION

Traumatic physical injuries are the number one cause of hospitalization and death among children in Canada. The majority of these injuries are preventable. The burden from injury can be reduced through prevention programs tailored to at-risk groups, however, existing research does not provide a strong explanation of how social factors influence a child's risk of injury. We propose a theoretical framework to better understand social factors and injury in children and will examine the association between these social factors and physical traumatic injury in children using large population-wide data.

METHODS AND ANALYSIS

We will examine data from 11,000 children hospitalized for traumatic physical injury and 55,000 matched uninjured children by linking longitudinal administrative and clinical data contained at the Manitoba Centre for Health Policy. We will examine 14 social determinants of child health measures from our theoretical framework, including receipt of income assistance, rural/urban status, socioeconomic status, children in care, child mental disorder, and parental factors (involvement with criminal justice system, education, social housing, immigration status, high residential mobility, mother's age at first birth, maternal Axis I mental disorder, maternal Axis II mental disorder and maternal physical disorder) to identify groups and periods of time when children are at greatest risk for traumatic physical injury. A conditional multivariable logistic regression model will be calculated (including all social determinant measures) to determine odds ratios and adjusted odds ratios (95% confidence interval) for cases (injured) and controls (non-injured).

ETHICS AND DISSEMINATION

Health Information Privacy Committee (HIPC No. 2017/2018-75) and local ethics approval (H2018-123) were obtained. Once social measures have been identified through statistical modelling, we will determine how they fit into a Haddon matrix to identify appropriate areas for intervention. Knowing these risk factors will guide decision-makers and health policy.

Subsequent risky driving behaviors, recidivism and crashes among drivers with a traffic violation: A scoping review

PURPOSE

Drivers who have committed a traffic violation are a particularly high-risk group, yet studies conducted among this group are scarce. We analyzed and synthesized the current literature concerning subsequent risky driving behaviors, recidivism, and crashes among drivers with a traffic violation.

METHODS

We searched PubMed, Education Resources Information Center (ERIC), Academic Search Complete, Web of Science, and Scopus for articles published in English between January 1, 1999, and May 31, 2023. A total of 25 articles met the selection criteria and were included in the final analysis. Two coders independently extracted and analyzed the selected articles to identify common categories across the articles, including study design, study population, type of traffic violation, and study outcomes including subsequent driving behaviors, recidivism, and crash risks.

RESULTS

Of the 25 selected articles, 19 (76%) involved both male and female participants. Fourteen (56%) studies were interventions/evaluation studies, with the other 11 (44%) being observational. Nineteen (76%) studies included alcohol-impaired driving violations, and 23 (92%) studies examined recidivism as an outcome measure. Over half of the observational studies demonstrated that traffic offenders were more likely to commit a subsequent traffic violation or had elevated risk of crashes. Most of the intervention/evaluation studies demonstrated a significant reduction in driving under the influence (DUI) of alcohol among the study participants. However, such positive effects observed during the active intervention period were not always sustained.

CONCLUSIONS

Traffic offenders are a high-risk group for subsequent violations and crashes. Evidence from this review calls for more effective interventions implemented following a traffic violation to prevent recidivism, crashes, and crash-related injuries and deaths.

Factors associated with booster seat use among Indigenous peoples in Canada

OBJECTIVE

Booster seat use among the general population remains relatively low, despite their effectiveness in preventing injury among children when involved in motor vehicle collisions. Given the prevention of injuries that booster seats provide, understanding the factors that hinder or facilitate the use of these seats is critical, particularly in communities that are often overlooked when conducting general population studies. To date, no studies have examined the prevalence and predictors of booster seat use among Indigenous peoples in Canada. The purpose of this study was to examine the use of booster seat use among Indigenous peoples across Canada and the factors that impact their use.

METHODS

Data were collected from a survey of participants from First Nations communities and organizations serving Indigenous peoples nationwide. Hypotheses arising from known predictors of booster seat use across the general population were tested using logistic regression models.

RESULTS

The strongest predictor of booster seat use, even when all other study factors were accounted for, was the reduction of barriers related to the use of booster seats, such as a child's resistance to being placed or staying in the passive safety restraint or a parent, guardian, or other caregiver being unwilling to use or unsure of how to install/setup the booster seat.

CONCLUSION

Most Indigenous participants consistently used booster seats to safely secure children being transported in vehicles. However, this compliance rate is well below that of the general population. Accessibility and affordability of child safety restraints and/or children's refusal to use booster seats, as well as having more than 1 child to secure, were identified as mitigating factors. Access to and the affordability of booster seats, coupled with clear and understandable information on how to use them, are critical components to compliance. Raising awareness among Indigenous peoples communities regarding the importance of using booster seats is imperative. To achieve this, Indigenous peoples must lead discussions to ensure that child safety strategies not only are based on research and best practices but are culturally connected and community driven. Through meaningful collaboration, vehicle-related injuries and mortality among Indigenous children can be significantly reduced.

Follow-up household assessment for child unintentional injuries two years after the intervention: A community-based study from Karachi, Pakistan

BACKGROUND

Unintentional childhood injuries are a growing public health concern, and the home is the most common location for non-fatal injuries in children less than 5 years of age. This study describes the long-term effects of two injury prevention educational interventions for caregivers-an educational pamphlet and an in-home tutorial guide-by comparing the change in the prevalence of home injury hazards before and after the interventions.

METHODS

This was a pre- (June and July 2010) and post-study with short-term follow-up (November-December 2010) and long-term follow-up (November 2012- January 2013). Neighborhood one included households that received only educational pamphlets after completing a baseline assessment; neighborhood two included households that received an in-home tutorial guide after completing the baseline assessment and receiving the educational pamphlet. The main outcome of this study was the reduction in home injury hazards for children under 5 years of age.

RESULTS

A total of 312 households participated in the long-term phase to compare the effect of the interventions. Between the short-term to long-term follow-up, injury hazards significantly reduced in neighborhood two compared to neighborhood one. These included fall hazards (walker use) (IRR 0.24 [95% CI 0.08-0.71]), drowning hazards (open bucket of water in the courtyard and uncovered water pool) (IRR 0.45 [95% CI 0.85-0.98] and IRR 0.46 [95% CI 0.76-0.94]), burn hazards (iron, water heater within reach of child) (IRR 0.56 [95% CI 0.33-0.78] and IRR 0.58 [95% CI 0.32-0.91]), poisoning hazards (shampoo/soap and medicine within reach of child) (IRR 0.53 [95% CI 0.44-0.77] and IRR 0.7 [95% CI 0.44-0.98]) and breakable objects within reach of child (IRR 0.62 [95% CI: 0.39-0.99]).

CONCLUSION

An injury prevention tutorial to caretakers of children supplemented with pamphlets could significantly decrease the incidence of falls, drowning, burns, poisoning, and cut injury hazards for children under 5 years of age in their homes in a low-resource setting. This intervention has the potential to be integrated in existing public health programs, such as Lady Health Visitors (LHVs), to disseminate injury prevention information in routine home health visits.

Knowledge and Attitudes around First Aid and Basic Life Support of Kindergarten and Elementary School Teachers and Parents in Taif City, Saudi Arabia

BACKGROUND

The foremost cause of children's (1-19 year) death is inadvertent injuries. While most of these accidental harms occur at home and school, rapid and suitable parental and teacher intervention is required to increase the chances of a child's survival. Therefore, both parents and teachers of the children in kindergarten and elementary school must be knowledgeable in first aid practice and basic life support (BLS) training.

OBJECTIVES

In the current study, our ambition is to evaluate the orientation level, knowledge, and attitudes around first aid and BLS training of kindergarten and elementary school teachers and parents in the city of Taif, Makkah region.

METHODS

A cross-sectional study in Taif, Saudi Arabia, targeted kindergarten and elementary school teachers and parents of students enrolled at these levels. There were 648 participants included in this study. The researchers assessed teachers' and parents' knowledge and attitudes around first aid and BLS using a validated, self-administered online questionnaire.

RESULTS

The study included 648 participants, including 248 (38.3%) teachers and 400 (61.7%) parents. The socio-demographic analysis showed that 412 (63.6%) are females and 233 (36.5%) are between the ages of 36 and 45 years. Approximately 142 (21.9%) participants reported previous training in the cardiopulmonary resuscitation (CPR) program, though more than half of them (53.5%) had outdated certificates (more than 2 years). The mean total knowledge for our study was 4.6 ± 1.4, with 22.4% of the participants being educated about first aid support and expressing a fair level of CPR foundations. Only a small percentage (2.3%) of the participants exposed a good and adequate theoretical level of knowledge around CPR skills and performance, while most of the contributors unveiled a poor level of knowledge (over 75%). There were no statistically significant differences between parents and teachers (p > 0.05). Finally, numerous participants (85%) appreciated training in the CPR program, and the most common motive was a "wish to avoid unnecessary death".

CONCLUSIONS

We concluded that a sizable portion of the contributors expressed a lack of proficiency in the fundamental CPR training knowledge and skills, pointing to an alarming public concern. Promisingly, a sizable percentage of participants expressed motivated attitudes toward CPR training. Therefore, additional study and data are required to effectively combat injury, with an emphasis on investigating causes and risk factors, burden and socioeconomic health determinants, community awareness level and desire to contribute, and accessibility for disseminating specific intervention strategies.

Injuries among Canadian children and youth: an analysis using the 2019 Canadian Health Survey on Children and Youth

This work provides an overview of injury patterns in Canadian children and youth aged 1 to 17 years. Self-reported data from the 2019 Canadian Health Survey on Children and Youth were used to calculate estimates for the percentage of Canadian children and youth who experienced a head injury or concussion, broken bone or fracture, or serious cut or puncture within the last 12 months, overall and by sex and age group. Head injuries and concussions (4.0%) were the most commonly reported, but the least likely to be seen by a medical professional. Injuries most frequently occurred while engaging in sports, physical activity or playing.

The Effect of the Covid-19 pandemic on emergency service home service calls due to home accidents in children aged 0-6 in Sakarya, Türkiye?

Background and Aim

The contribution of global pandemics to the emergence of home accidents is unknown. The study aims to retrospectively examine the effect of the Covid-19 Pandemic on Emergency Service Home Service Calls Due to Home Accidents in Children aged 0-6.

Methods

Data are reported in two sections. The descriptive part is a retrospective analysis of patients admitted to Sakarya Training and Research Hospital Pediatric Emergency and Adult Emergency Unit between March 16, 2019 and January 31, 2020 (non-COVID-19era) and March 16, 2020 and January 31, 2021 (COVID-19era). The second part of the study, the comparative part, presents mean data for 2019-2020 (non-COVID-19era) and 2020-2021 (COVID-19era) from the same center and the same period. These data will then be compared.

Results

A total of 9,110 pediatric patients applied to our center during the study period, of which 7,905 patients were in the non-Covid- 19era period and 1,205 patients were in the Covid-19 era. While the rate of hospital admissions decreased by 85% in the Covid-19era compared to the non Covid-19era, when the periods are evaluated within themselves; the forensic report retention rate in the Covid- 19era increased by 180% and the rate of hospitalization increased by 75%, The rate of drug overdose increased by 280% and chemical substance use increased by 325% compared to the non-Covid-19era. However The Covid-19 era, the fall rate decreased by 31% and the burn rate decreased by 17% compared to the non-Covid-19 era.

Conclusions

During the national lockdown period, our pediatric emergency department experienced significantly reduced volumes of children. Despite the decrease in hospital admission rate during the COVID-19 pandemic, there was still a very high increase in poisoning from home accidents. This study can provide a basis for further research on alternative strategies to address the problem of home accidents during the COVID-19 pandemic.

An Examination of Child Pedestrian Rule Compliance at Crosswalks around Parks in Montreal, Canada

This study aims to examine child pedestrian safety around parks by considering four rule-compliance measures: temporal, spatial, velocity and visual search compliance. In this regard, street crossing observations of 731 children were recorded at 17 crosswalks around four parks in Montreal, Canada. Information on child behaviors, road features, and pedestrian-vehicle interactions were gathered in three separate forms. Chi-square tests were used to highlight the individual, situational, behavioral and road environmental characteristics that are associated with pedestrian rule compliance. About half of our sampled children started crossing at the same time as the adults who accompanied them, but more rule violations were observed when the adult initiated the crossing. The child's gender did not have a significant impact on rule compliance. Several variables were positively associated with rule compliance: stopping at the curb before crossing, close parental supervision, and pedestrian countdown signals. Pedestrian-car interaction had a mixed impact on rule compliance. Overall, rule compliance among children was high for each of our indicators, but about two-thirds failed to comply with all four indicators. A few measures, such as longer crossing signals and pedestrian countdown displays at traffic lights, may help to increase rule compliance and, ultimately, provide safer access to parks.

Transforming injury prevention for youth (TrIPY): an intersectionality model for youth injury prevention

Injury is deadly and expensive, and rates are increasing. The cost of injury is not only a financial burden; individuals, families and communities suffer the human costs of physical and emotional injury. For children and youth in Canada, injuries are the leading cause of death and disability. However, the risk of preventable injury is not equal for all youth. The transforming injury prevention for youth (TrIPY) model aims to recognise and remediate these inequities by applying an intersectionality lens to injury prevention programming. TrIPY conceptualises injury prevention programming through an intersectionality lens. The model was developed with diverse youth in mind, and the intended users include injury prevention practitioners, partners, stakeholders, communities and decision-makers. TrIPY was designed using a transformative perspective and built on core concepts within public health, injury prevention, intersectionality, gender analysis, youth risk, health equity, and systems of privilege and oppression. TrIPY helps to analyse intersecting inequities along multiple dimensions, to improve injury prevention programmes for diverse youth with unique identities, skills and lived experiences. The end goal of implementing an intersectionality model within injury prevention is to find out who is being missed in order to address existing inequities concerning youth injury. No matter what a person’s unique social location or lived experience, they will have the opportunity to be included in prevention programming. Developing injury prevention programmes through an intersectionality lens is needed to better understand the factors that interact to influence an individual’s risk for injury. There is a need to explore the unique experiences of youth at the intersection of various identity factors, including gender, race and ethnicity, and socioeconomic status. With this knowledge, prevention programmes can be more culturally responsive, gender transformative, inclusive, accessible and engaging for diverse groups of youth.

Self-reported injuries among Canadian adolescents: rates and key correlates

INTRODUCTION

Injuries sustained by adolescents in Canada represent a costly public health issue. Much of the limited research in this area uses administrative data, which underestimate injury prevalence by ignoring injuries that are not treated by the health care system. Self-reported data provide population-based estimates and include contextual information that can be used to identify injury correlates and possible targets for public health interventions aimed at decreased injury burden.

METHODS

The 2017 wave of the Canadian Community Health Survey was used to calculate the prevalence of self-reported total, intentional and unintentional injuries. We compared injury prevalence according to age, sex, employment status, presence of a mood disorder, presence of an anxiety disorder, smoking and binge drinking. Analyses were performed using logistic regression to identify significantly different injury prevalence estimates across key correlates.

RESULTS

Overall past-12-month injury prevalence among adolescents living in Canada was 31.4% (95% CI: 29.4%-33.5%). Most injuries were unintentional. All provinces had estimates within a few percentage points, except Saskatchewan, which had substantially higher prevalence for both overall and unintentional injury. Smoking and binge drinking were significantly associated with higher injury prevalence in most jurisdictions. Remaining correlates exhibited nonsignificant or inconsistent associations with injury prevalence.

CONCLUSION

The data suggest that injury prevention interventions aimed at reducing alcohol consumption, particularly binge drinking, may be effective in reducing adolescent injury across Canada. Future research is needed to determine how provincial context (such as mental health support for adolescents or programs and policies aimed at reducing substance use) impacts injury rates.

Understanding Infants' In-Home Injuries: Context and Correlates

RATIONALE

Infancy is a time of elevated risk of injury. Past research has focused mostly on the type of injuries, leaving many gaps in knowledge about contextual information that could aid in injury prevention planning.

METHODS

In this longitudinal study, a participant-event recording method was used in which mothers tracked their infants' home injuries through three motor development stages (sitting up independently, crawling, and walking). A contextual analysis elucidated where injuries occurred, their type and severity, the infant's and parent's behaviors at the time, if the infant had done the risk behavior before and been injured, the level of supervision, and the nature of any safety precautions parents implemented following these injuries.

RESULTS

Injuries occurred as often in play as in nonplay areas and were due to physically-active nonplay activities more so than play activities; mothers were often doing chores. Bumps and bruises were the most common types of injuries. As infants became more mobile, supervision scores declined and injury severity scores increased. Infants had done the risk behavior leading to injury previously about 60% of the time, with higher scores associated with parents implementing fewer preventive actions in response to injury. When mothers did implement a safety precaution, greater injury severity was associated with more modifications to the environment and increased supervision; teaching about safety was infrequent.

CONCLUSION

Implications of these results for injury prevention messaging are discussed.

Sport participation and injury rates in high school students: A Canadian survey of 2029 adolescents

INTRODUCTION

The objective of this study is to examine sport and recreational (S&R) activity participation and injury rates (IR) in high school students (ages 14-19).

METHODS

High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified 'other' or missing; ages 14-19) in Alberta completed a web-based survey during class (October 2018-March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any S&R-related injury, (b) most serious S&R-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from S&R for at least one day.

RESULTS

In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as 'other' or missing] participated in an S&R activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67-39.00), ice hockey (20.46%; 95% CI 14.87-27.47), and soccer (19.42%; 95% CI 15.67-23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98-27.82), basketball (18.32%; 95% CI 14.32-23.14), and badminton (17.84%; 95% CI 13.35-23.43). Of the 1,971 students completing the S&R injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72-50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49-34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47-41.93).

CONCLUSIONS

High school student S&R IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in S&R activities has multiple physical, psychological, and health benefits for adolescents, but some S&R activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.

2020 edition of the Rourke Baby Record: What is new in preventive care of children up to 5 years of age?

OBJECTIVE

To update primary care providers practising well-child and well-baby clinical care on the evidence that contributed to the recommendations of the 2020 edition of the Rourke Baby Record (RBR).

QUALITY OF EVIDENCE

Pediatric preventive care literature was searched from June 2016 to May 2019, primary research studies were reviewed and critically appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and recommendations were updated where there was support from the literature.

MAIN MESSAGE

Notable changes in the 2020 edition of the RBR include the recommendations to limit or avoid consumption of highly processed foods high in dietary sodium, to ensure safe sleep (healthy infants should sleep on their backs and on a firm surface for every sleep, and should sleep in a crib, cradle, or bassinette in the parents' room for the first 6 months of life), to not swaddle infants after they attempt to roll, to inquire about food insecurity, to encourage parents to read and sing to infants and children, to limit screen time for children younger than 2 years of age (although it is accepted for videocalling), to educate parents on risks and harms associated with e-cigarettes and cannabis, to avoid pesticide use, to wash all fruits and vegetables that cannot be peeled, to be aware of the new Canadian Caries Risk Assessment Tool, to note new red flags for cerebral palsy and neurodevelopmental problems, and to pay attention to updated high-risk groups for lead and anemia screening.

CONCLUSION

The RBR endeavours to guide clinicians in providing evidence-informed primary care to Canadian children. The revisions are rigorously considered and are based on appraisal of a growing, albeit still limited, evidence base for pediatric preventive care.

Édition 2020 du Relevé postnatal Rourke

Objectif

Renseigner les fournisseurs de soins de première ligne qui dispensent des soins de médecine préventive durant l’enfance quant aux données ayant servi de fondement aux recommandations de l’édition 2020 du Relevé postnatal Rourke (RBR).

Qualité des données

Une recherche a effectuée parmi les publications sur les soins préventifs en pédiatrie entre les mois de juin 2016 et mai 2019, les principales études de recherche ont été revues et rigoureusement évaluées à l’aide de la méthode GRADE (Grading of Recommendations Assessment, Development and Evaluation) et les recommandations ont été actualisées là où les publications étayaient des changements.

Message principal

Les changements notables de l’édition 2020 du RBR sont les recommandations de limiter ou d’éviter les aliments très transformés et riches en sodium alimentaire, de veiller au sommeil sécuritaire (les nourrissons en bonne santé doivent dormir sur le dos et sur une surface rigide à tous les dodos, et ils doivent dormir dans un moïse, un berceau ou une couchette dans la chambre des parents pendant les 6 premiers mois de vie), de ne pas emmailloter les nourrissons après qu’ils aient tenté de se retourner, de s’informer de l’insécurité alimentaire, d’encourager les parents à lire et à chanter aux nourrissons et aux enfants, de limiter le temps que les enfants de moins de 2 ans passent devant un écran (bien que ce soit accepté pour les appels vidéo), de renseigner les parents sur les risques et les torts associés aux cigarettes électroniques et au cannabis, d’éviter les pesticides, de laver tous les fruits et légumes ne pouvant être pelés, de connaître l’existence du nouvel Outil national d’évaluation du risque de caries, de noter les nouveaux symptômes alarmants de paralysie cérébrale et de problèmes neurodéveloppementaux et de porter attention aux nouveaux groupes à risque élevé pour le dépistage du plomb et de l’anémie.

Conclusion

Le RBR s’efforce de guider les cliniciens pour leur permettre de dispenser des soins de première ligne factuels aux enfants canadiens. Les révisions sont rigoureusement étudiées, et sont basées sur l’évaluation d’une base de données probantes croissante, quoique toujours limitée, sur les soins préventifs en pédiatrie.

The Kids Are Alright: Outcome of a Safety Programme for Addressing Childhood Injury in Australia

Globally, injuries are the leading cause of death and represent the highest burden of ongoing disease amongst children 1–16 years of age. Increasingly, prevention programmes are recognising a growing need for intervention strategies that target children. The purpose of this study was to determine the efficacy of the SeeMore Safety Programme, designed to teach children (4–6 years of age) how to make conscious decisions about their own capabilities related to safety and how to manage risk. This retrospective study examined de-identified pre- and post-programme data from a sample of 1027 4 to 6-year-old pre-school children over the four-year period who participated in the SeeMore Safety Programme. Results show a significant improvement in each of the post-test scores and when compared to the pre-test scores (p < 0.001). Children from rural areas, as well as those from areas of greater disadvantage, also showed significant improvement in their pre- and post-test scores (p < 0.001). Overall, the findings highlight that the SeeMore Safety Programme over the four-year period demonstrates an increase in the children’s capacity to recognise and identify danger and safety amongst all children, offering great promise for reducing the burden of injury on children, their families and society.

The Economics of Burn Injuries Among Children Aged 0 to 4 Years in British Columbia

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

Parent-Child Disagreements About Safety During Preadolescence

OBJECTIVES

Much research has examined how parents manage safety issues for young children, however, little is known about how they do so in the preadolescent years when children's demand for autonomy increases. The current study focused on youth in this transition stage (10-13 years) and examined parent-child disagreements about safety, including how parents learn of these, react to these, and resolve these (Aim 1), if the parent-child relationship or sex of the child impacts these processes (Aim 2), and the nature and reasons why children intentionally keep safety-relevant secrets from their parents (Aim 3).

METHODS

A short-term longitudinal design was applied. Parents initially completed questionnaires and, with their child, retrospectively recalled safety disagreements. Over the next month, parents tracked safety disagreements and children tracked secrets they withheld from parents.

RESULTS

The findings revealed significant gender differences: Daughters were more likely than sons to spontaneously disclose safety issues to their parents, and parents were more likely to discuss the issue and provide teaching to daughters than sons. Relationship quality emerged as an important factor, particularly for boys: A positive parent-child relationship predicted increased parental teaching in response to a safety-relevant issue for boys only. Children kept secrets from their parents about safety-relevant information in order to maintain their autonomy and independence.

CONCLUSION

Parent-child disagreements about safety are influenced by the positive nature of the parent-child relationship and differ for sons and daughters.

Bicycle injuries among the paediatric population at an emergency department in Singapore

INTRODUCTION

Bicycles injuries are the leading cause of emergency department visits among all recreational activities and have been established as a significant worldwide public health burden. The purpose of this retrospective study was to describe the epidemiology and patterns of paediatric bicycle-related injuries in Singapore.

METHODS

This was a single-centre retrospective study based on data collected from a trauma registry between 2011 and 2016.

RESULTS

A total of 760 patients presented to the emergency department during this period, of whom 68.2% were male and 39.7% were aged 10-16 years. 50.1% of the patients were Chinese and 25.9% were Malay. The cyclist was the person most commonly injured (65.7%) during the bicycle accident. From 2011 to 2015, the number of bicycle injuries showed a persistent upward trend. Superficial injuries such as abrasions and bruises were the most common injuries sustained (46.1%), followed by fractures. The majority of the patients were discharged from the emergency department. There were no bicycle accident deaths recorded during the study period.

CONCLUSION

Our study demonstrated an increasing number of bicycle injuries among paediatric cyclists in the local setting. Parents, teachers, coaches and other caregivers should be educated regarding the need to use protective equipment and to seek medical care promptly in the case of trauma resulting from bicycle injuries.

Promoting Protective Factors in Environments of Risk for Young Children: An Organizing Framework for Practice, Policy, and Research

Early childhood is an important developmental period, which lays the foundation for future learning, behaviour, physical and mental health and gene expression. The most vulnerable children in society are often referred to and receive services from the child welfare system because of a concern of abuse and neglect and/or a poor developmental trajectory. This paper presents an organizing framework for how the child welfare system, in concert with allied partners, can support interventions for young children and families by acknowledging its crucial role in improving their development and well-being. The framework is informed by research amassed from numerous disciplines, including child welfare, development, neuroscience, neurobiology and epigenetics. Although the notions of protection and well-being are central considerations in child welfare legislation in Ontario, Canada, the operationalization of wellbeing has proven challenging in child welfare practice, policy and research. The framework proposes ten key indicators and priorities for identifying and promoting optimal child development. Findings from the 2013 cycle of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2013), the only provincial source of aggregated child welfare investigation data, are presented to articulate the divide between the environmental context of a population of at-risk children and the conditions that both protect children and increase the likelihood that they will thrive in adulthood. This paper argues there are different points of entry and intervention across sectors and provides a foundation for further discussion on how to promote well-being for society's most vulnerable children.

An interprovincial comparison of unintentional childhood injury rates in Canada for the period 2006-2012

OBJECTIVES

To perform an interprovincial comparison of unintentional population-based injury hospitalization and death rates for Canadian children ages 0-19 years and compare trends between 2006 and 2012.

METHODS

Annual population-based hospitalization rates per 100,000 from unintentional injuries were calculated for children/youth (< 19 years) using data from the Discharge Abstract Database between 2006 and 2012. Annual mortality rates were analyzed using provincial coronial data. The mean annual change in the rate of hospitalizations due to unintentional injuries was reported for each province.

RESULTS

The average annual rate of hospital admissions for unintentional injuries was 305.10 per 100,000 population between 2006 and 2012, and this decreased by - 11.91 over time (p < 0.01, - 15.85; - 7.77). Saskatchewan had the highest average annual morbidity rate (550.76 per 100,000) from all unintentional causes, and Ontario had the lowest average annual rate (238.89 per 100,000). Saskatchewan had the highest average annual rate for all subcauses except for drowning. Ontario was the only province with an average annual injury morbidity rate that was consistently below the Canadian average. The average annual mortality rate from all unintentional injury was highest in Saskatchewan (17.51 per 100,000) and lowest in Ontario (5.99 per 100,000) when compared to Canada (7.97 per 100,000).

CONCLUSION

Injury prevention policies vary considerably among provinces. Although the unintentional injury hospitalization rate is decreasing over time, some subcauses such as choking/suffocation have shown an increase in certain provinces. Evidence-based childhood injury prevention policies, such as playground equipment safety and four-sided pool fencing among others, should be standardized across Canada.

Retrospective evaluation of the BIG score to predict mortality in pediatric blunt trauma

OBJECTIVES

This study's objective was to measure the criterion validity of the BIG score (a new pediatric trauma score composed of the initial base deficit [BD], international normalized ratio [INR], and Glasgow Coma Scale [GCS]) to predict in-hospital mortality among children admitted to the emergency department with blunt trauma requiring an admission to the intensive care unit, knowing that a score <16 identifies children with a high probability of survival.

METHODS

This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016. Participants were all children admitted to the emergency department for a blunt trauma requiring intensive care unit admission or who died in the emergency department. The primary analysis was the association between a BIG score ≥16 and in-hospital mortality.

RESULTS

Twenty-eight children died among the 336 who met the inclusion criteria. Two hundred eighty-four children had information on the three components of the BIG score, and they were included in the primary analysis. A BIG score ≥16 demonstrated a sensitivity of 0.93 (95% confidence interval [CI]: 0.76-0.98) and specificity of 0.83 (95% CI: 0.78-0.87) to identify mortality. Using receiver operating characteristic curves, the area under the curve was higher for the BIG score (0.97; 95% IC: 0.95-0.99) in comparison to the Injury Severity Score (0.78; 95% IC: 0.71-0.85).

CONCLUSION

In this retrospective cohort, the BIG score was an excellent predictor of survival for children admitted to the emergency department following a blunt trauma.

Dental injuries in younger emergency department patients

BACKGROUND

Dental trauma is a relatively common occurrence in childhood, with an impact exceeding that of periodontal diseases. It places a significant burden on the public health system because of its high frequency, impact on quality of life and consumption of resources.

OBJECTIVES

To identify changing trends of dental injury in patients between 0-18 years of age in Canada and provide a detailed assessment of dental injury patterns in patients attending a large pediatric tertiary care hospital.

METHODS

This retrospective study was carried out in two parts. Firstly, data from patients who presented to the emergency departments of the 15 Canadian hospitals involved in the Injury Reporting and Prevention Program (CHIRPP) from 1st January 1990 to 31st December 2013 was collected. Secondly, at the Hospital for Sick Children, charts of patients identified from the aforementioned database from the years 2008, 2012 and 2015 were accessed for additional clinical data.

RESULTS

Based on CHIRPP data there appears to be an increasing incidence in dental injuries presenting to emergency departments nationally. Participation in sports and cycling contributed to the majority of dental injuries. The use of safety equipment such as helmets with a face-grill and mouth-guard was low.

CONCLUSIONS

Our study demonstrates a rising incidence of dental injuries in young patients. Most dental injuries occurred during sports and playground related activities. The low rate of use of safety equipment and playground safety measures suggests that Canadian Standards Association standards for playgrounds could be more effective if strengthened by mandatory legislation.

Injury severity in pediatric all-terrain vehicle-related trauma in Nova Scotia

BACKGROUND/PURPOSE

In 2004-2005, legislation restricting all-terrain vehicle (ATV) use by children and an extensive social marketing campaign intended to reduce pediatric ATV-related morbidity. The frequency, nature, and severity of pediatric ATV-associated trauma were compared before and after such interventions.

METHODS

A retrospective cohort study was performed for all pediatric ATV-related injuries that presented to the provincial level 1 pediatric trauma center from 1998 to 2014. National databases were queried for ATV-related injury hospitalizations (n=258), trauma center emergency department visits (n=342), and admissions (n=136) in Nova Scotia from 2002 to 2014. Admissions between 1998 and 2003 (n=68) and 2006-2014 (n=60) were compared using chi square analysis for age and gender distribution, length of stay, critical care admission, helmet use, mechanism, and severity of injury.

RESULTS

Admissions, trauma center emergency room visits and admissions initially decreased following legislative and social marketing interventions and subsequently gradually increased. Interventions resulted in no significant difference in age or gender distribution, length of hospital stay, critical care admission, helmet use, and mechanism of injury. There was a significantly higher proportion of severe injuries post interventions.

CONCLUSIONS

Legislation and social marketing interventions had a short-term decrease on the frequency of ATV-related injuries and no sustained effect on the frequency, nature, and severity of ATV-related injuries.

LEVEL OF EVIDENCE

Level IV.

Trends in unintentional injury mortality in Canadian children 1950-2009 and association with selected population-level interventions

OBJECTIVES

To examine unintentional injury mortality rates in children (0-19 years) in Canada from 1950 to 2009 against national population-level injury prevention interventions.

METHODS

Injury mortality rates were age and sex adjusted. Changes in trend and level of mortality rates were assessed at pre-specified intervention periods using segmented linear regression analyses for interrupted time series. Maximum likelihood estimation was used with a second order autoregressive error process.

RESULTS

From 1950 to 2009, the overall unintentional injury mortality rate decreased by 86%. Males had consistently higher mortality rates compared to females; however, the standardized rate ratio decreased from 2.37:1 in 1950 to 1.97:1 in 2009. Substantial declines in choking/suffocation deaths were noted in children less than 1 year of age, predominantly during the period 1970-1988 when the Hazardous Products Act and Crib Regulations were implemented. For burns, significant changes in slope were noted comparing 1972-1994 to pre-1971 (introduction of the Hazardous Products Act - Flammability Regulations), where the greatest decline was noted in children ages 1-4 years (Est. = -0.03, 95% CI = -0.02, -0.04). For 15-19 year olds, there was a 408% increase in motor vehicle collision-related mortality rates between 1950 and 1971; however a significant change in slope was noted during the period 1978-1985, compared to 1972-1977 (Est. = -0.10, 95% CI = -0.20, -0.007) across all age groups.

CONCLUSION

While this study is not a cause and effect analysis, there is a strong association with implementation of safety campaigns and legislative changes related to child safety and a dramatic decline in childhood fatalities related to injury.

Time for Lifestyle Medicine to Take Injury Prevention Seriously

Over 2 decades ago, the United States National Academy of Sciences described injuries as “the most under-recognized major public health problem facing the nation.” Our progress since then has been limited. Injuries still account for nearly 1 out of every 10 deaths in the world, and the global burden of injury is projected to increase over the next decade, predominately in low- and middle-income countries. Despite this, injury prevention receives scant attention from legislators, the education system, and, most strikingly, the health care system. The lifestyle medicine community, however, is beginning to focus on injury prevention and will play an increasing role in helping control the burden of injury. Lifestyle medicine practitioners are in a tremendous position to promote injury prevention. Physical activity and positive lifestyle changes can be accompanied with an increased focus on preventing injury. Lifestyle medicine can prevent injuries by supporting legislation, advancing medical advocacy, providing community education, and linking clinical care with injury prevention.

Understanding Barriers for Communicating Injury Prevention Messages and Strategies Moving Forward: Perspectives from Community Stakeholders

OBJECTIVES

The primary objective of this study was to elicit the perspectives of direct care providers on barriers and facilitators to communicating injury prevention messages to parents/caregivers of children under 4 years of age. The secondary objective was to examine characteristics of an injury prevention messaging strategy preferred by direct care providers.

DESIGN AND SAMPLE

This qualitative study was conducted across four regions in Ontario Canada. Fifty-nine direct care providers were purposefully sampled and data interpreted using focus group analysis.

MEASURES

Transcripts were analyzed verbatim using content and discourse analysis.

RESULTS

Several barriers to communicating injury prevention messages were identified encompassing (a) role, (b) parental, (c) social determinants, and (d) evidence impediments. In an effort to offset some of these barriers, participants endorsed the development of a tailored multicomponent injury prevention strategy adopting action-based messages.

CONCLUSION

The results of this study provide an in-depth exploration of direct care providers perceptions that can inform the design of materials and dissemination strategies to help increase and optimize access to injury prevention information. Injury prevention messages should be action-oriented, specifically tailored to the stage of child development, and disseminated through both face-to-face interactions and mobile technology.

Looking over the wall: Using a Haddon Matrix to guide public policy making on the problem of sudden cardiac arrest

Sudden cardiac arrest remains an important health care problem. If survival rates of all regions would equal those of the best performers, literally thousands of lives would be saved. Similar to injury, there is a need for an epidemiology-based approach for planning and execution of countermeasures. In this policy paper, we present the Haddon Matrix as an all-inclusive conceptual framework to assist in this. We advocate for a more community-centred 'public health' approach, with a crucial role for policy-level executives. There is a large potential gain in outcome by implementing 'passive' - not requiring individual action - measures. As happened for injury, 'Cardiac Arrest Academies' should be created to facilitate and coordinate this process.

The importance of child and youth death review

The mandate of a formal child death review (CDR) system is to advance understanding of how and why children die, to improve child health and safety, and to prevent deaths and injuries in the future. Areas in which CDR has provided valuable information and/or intervention include sudden death in infancy, unintentional injuries (the leading cause of death in Canadian children and youth one to 19 years of age), suicide in youth, and deaths due to homicide or child maltreatment. When collected systematically using common definitions, information regarding deaths in children and youth can help with understanding the scope of problems. Information about the context of a death can inform potential prevention or intervention activities. CDR can improve medical and mental health best practices, child welfare policies and procedures, and legislation and education relevant to public health and safety. In the United States, the United Kingdom, Australia and New Zealand, CDR processes are mandated by legislation. In Canada, death review teams have diverse structures and functions, and the CDR system is less well developed. The present statement addresses the need for formal, organized child and youth death review in Canada to help strengthen and systemize injury and death prevention efforts.