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Mahant S, Borkhoff CM, Parkin PC, Imsirovic H, Tuna M, Macarthur C, To T, Gill PJ. Sociodemographic Factors and Trends in Bronchiolitis-Related Emergency Department Visit and Hospitalization Rates. JAMA Netw Open 2024; 7:e248976. [PMID: 38683605 PMCID: PMC11059049 DOI: 10.1001/jamanetworkopen.2024.8976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Bronchiolitis is the most common and most cumulatively expensive condition in pediatric hospital care. Few population-based studies have examined health inequalities in bronchiolitis outcomes over time. Objective To examine trends in bronchiolitis-related emergency department (ED) visit and hospitalization rates by sociodemographic factors in a universally funded health care system. Design, Setting, and Participants This repeated cross-sectional cohort study was performed from April 1, 2004, to March 31, 2022, using population-based health administrative data from children younger than 2 years in Ontario, Canada. Main Outcome and Measures Bronchiolitis ED visit and hospitalization rates per 1000 person-years reported for the equity stratifiers of sex, residence location (rural vs urban), and material resources quintile. Trends in annual rates by equity stratifiers were analyzed using joinpoint regression and estimating the average annual percentage change (AAPC) with 95% CI and the absolute difference in AAPC with 95% CI from April 1, 2004, to March 31, 2020. Results Of 2 921 573 children included in the study, 1 422 088 (48.7%) were female and 2 619 139 (89.6%) lived in an urban location. Emergency department visit and hospitalization rates were highest for boys, those with rural residence, and those with least material resources. There were no significant between-group absolute differences in the AAPC in ED visits per 1000 person-years by sex (female vs male; 0.22; 95% CI, -0.92 to 1.35; P = .71), residence (rural vs urban; -0.31; 95% CI -1.70 to 1.09; P = .67), or material resources (quintile 5 vs 1; -1.17; 95% CI, -2.57 to 0.22; P = .10). Similarly, there were no significant between-group absolute differences in the AAPC in hospitalizations per 1000 person-years by sex (female vs male; 0.53; 95% CI, -1.11 to 2.17; P = .53), residence (rural vs urban; -0.62; 95% CI, -2.63 to 1.40; P = .55), or material resources (quintile 5 vs 1; -0.93; 95% CI -3.80 to 1.93; P = .52). Conclusions and Relevance In this population-based cohort study of children in a universally funded health care system, inequalities in bronchiolitis ED visit and hospitalization rates did not improve over time.
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Affiliation(s)
- Sanjay Mahant
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Meltem Tuna
- ICES, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter J. Gill
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Nurse KM, Parkin PC, Keown-Stoneman CDG, Bayoumi I, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. Association Between Family Income and Positive Developmental Screening Using the Infant Toddler Checklist at the 18-Month Health Supervision Visit. J Pediatr 2024; 264:113769. [PMID: 37821023 DOI: 10.1016/j.jpeds.2023.113769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To examine the associations between several potential predictors (child biologic, social, and family factors) and a positive screen for developmental delay using the Infant Toddler Checklist (ITC) at the 18-month health supervision visit in primary care. METHODS This was a cross-sectional study of healthy children attending an 18-month health supervision visit in primary care. Parents completed a standardized questionnaire, addressing child, social, and family characteristics, and the ITC. Logistic regression analyses were used to assess the associations between predictors and a positive ITC. RESULTS Among 2188 participants (45.5% female; mean age, 18.2 months), 285 (13%) had a positive ITC and 1903 (87%) had a negative ITC. The aOR for a positive ITC for male compared with female sex was 2.15 (95% CI, 1.63-2.83; P < .001). The aOR for birthweight was 0.65 per 1 kg increase (95% CI, 0.53-0.80; P < .001). The aOR for a family income of <$40,000 compared with ≥$150,000 was 3.50 (95% CI, 2.22-5.53; P < .001), and the aOR for family income between $40,000-$79,999 compared with ≥$150,000 was 1.88 (95% CI, 1.26-2.80; P = .002). CONCLUSIONS Screening positive on the ITC may identify children at risk for the double jeopardy of developmental delay and social disadvantage and allow clinicians to intervene through monitoring, referral, and resource navigation for both child development and social needs. TRIAL REGISTRATION Clinicaltrials.gov (NCT01869530).
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Affiliation(s)
- Kimberly M Nurse
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Bayoumi
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Department of Pediatrics, Unity Health Toronto, Toronto, Ontario, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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Vanderhout S, Richards DP, Butcher N, Courtney K, Nicholls SG, Fergusson DA, Potter BK, Bhalla M, Nevins P, Fox G, Ly V, Taljaard M, Macarthur C. Prevalence of patient partner authorship and acknowledgment in child health research publications: an umbrella review. J Clin Epidemiol 2023; 164:35-44. [PMID: 37871836 DOI: 10.1016/j.jclinepi.2023.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES Children and families are increasingly involved as equal partners in child health research, however, considerations around authorship have received little attention and there is limited guidance on the topic. Our objective was to determine the frequency and nature of patient partner authorship and/or acknowledgment among articles focused on patient engagement in child health research. STUDY DESIGN AND SETTING In this umbrella review, we searched MEDLINE, Embase, APA PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, and Web of Science for systematic/scoping reviews on patient engagement in child health research. Individual articles included in eligible reviews comprised the sample of articles for analysis and were examined to identify patient partner authorship. Descriptive statistics were used to quantify patient partner authorship and/or acknowledgment and to summarize article characteristics. RESULTS Twelve systematic/scoping reviews met eligibility criteria, from which 230 individual articles were examined. In 16/230 (7%) articles, there was at least one patient partner author, and in 6/230 (3%) articles, patient partners were included as group authors. Within article Acknowledgments sections, patient partners were acknowledged by name in 41/230 (18%) articles, and anonymously or as a group in 98/230 (43%) articles. Patient partner authorship and/or acknowledgment was more frequent among articles published more recently (after 2015) and among articles where patient engagement was explicitly reported in the article. CONCLUSION Patient partners were more likely to be acknowledged than listed as an author on articles on patient engagement in child health research. Understanding patient partner preferences about authorship and acknowledgment, examination of the unique aspects of child and youth authorship and developing supports to empower patient partner authorship are needed.
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Affiliation(s)
- Shelley Vanderhout
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, Ontario L5B 1B8, Canada.
| | - Dawn P Richards
- Patient Partner, Toronto, Ontario, Canada; Five02 Labs Inc., Toronto, Ontario, Canada
| | - Nancy Butcher
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College St, 8th floor, Toronto, Ontario M5T 1R8, Canada
| | - Kim Courtney
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario K1G 5Z3, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario K1G 5Z3, Canada
| | - Manav Bhalla
- University College Dublin School of Medicine, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Pascale Nevins
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada
| | - Grace Fox
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada
| | - Valentina Ly
- University of Ottawa Library Services, 65 University Private, Ottawa, Ontario K1N 6N5, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, Ontario K1G 5Z3, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada
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Vanderhout S, Nevins P, Nicholls SG, Macarthur C, Brehaut JC, Potter BK, Gillies K, Goulao B, Smith M, Hilderley A, Carroll K, Spinewine A, Weijer C, Fergusson DA, Taljaard M. Patient and public involvement in pragmatic trials: online survey of corresponding authors of published trials. CMAJ Open 2023; 11:E826-E837. [PMID: 37726115 PMCID: PMC10516685 DOI: 10.9778/cmajo.20220198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND There are few data on patient and public involvement (PPI) in pragmatic trials. We aimed to describe the prevalence and nature of PPI within pragmatic trials, describe variation in prevalence of PPI by trial characteristics and compare prevalence of PPI reported by trial authors to that reported in trial publications. METHODS We applied a search filter to identify pragmatic trials published from 2014 to 2019 in MEDLINE. We invited the corresponding authors of pragmatic trials to participate in an online survey about their specific trial. RESULTS Of 3163 authors invited, 2585 invitations were delivered, 710 (27.5%) reported on 710 unique trials and completed the survey; 334 (47.0%) conducted PPI. Among those who conducted PPI, for many the aim was to increase the research relevance (86.3%) or quality (76.5%). Most PPI partners were engaged at protocol development stages (79.1%) and contributed to the co-design of interventions (70.9%) or recruitment or retention strategies (60.5%). Patient and public involvement was more common among trials involving children, trials conducted in the United Kingdom, cluster randomized trials, those explicitly labelled as "pragmatic" in the study manuscript, and more recent trials. Less than one-quarter of trials (22.8%) that reported PPI in the survey also reported PPI in the trial manuscript. INTERPRETATION Nearly half of trialists in this survey reported conducting PPI and listed several benefits of doing so, but researchers who did not conduct PPI often cited a lack of requirement for it. Patient and public involvement appears to be significantly underreported in trial publications. Consistent and standardized reporting is needed to promote transparency about PPI methods, outcomes, challenges and benefits.
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Affiliation(s)
- Shelley Vanderhout
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont.
| | - Pascale Nevins
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Stuart G Nicholls
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Colin Macarthur
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Jamie C Brehaut
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Beth K Potter
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Kate Gillies
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Beatriz Goulao
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Maureen Smith
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Alicia Hilderley
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Kelly Carroll
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Anne Spinewine
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Charles Weijer
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Dean A Fergusson
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
| | - Monica Taljaard
- Clinical Epidemiology Program (Vanderhout, Nevins, Nicholls, Brehaut, Carroll, Fergusson, Taljaard), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Vanderhout, Potter, Fergusson, Taljaard), University of Ottawa, Ottawa, Ont.; Child Health Evaluative Sciences (Macarthur), Hospital for Sick Children Research Institute, Toronto, Ont.; Health Services Research Unit (Gillies, Goulao), University of Aberdeen, Aberdeen, UK; Patient Partner (Smith), INFORM RARE Research Network, Ottawa, Ont.; Patient Partner (Hilderley); Louvain Drug Research Institute (Spinewine), Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium; CHU UCL Namur (Spinewine), Godinne, Pharmacy Department, Yvoir, Belgium; Departments of Medicine, Epidemiology & Biostatistics, and Philosophy (Weijer), University of Western Ontario, London, Ont
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Borkhoff SA, Parkin PC, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. Examining the Double Burden of Underweight, Overweight/Obesity and Iron Deficiency among Young Children in a Canadian Primary Care Setting. Nutrients 2023; 15:3635. [PMID: 37630825 PMCID: PMC10458882 DOI: 10.3390/nu15163635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
There is little evidence on the prevalence of the double burden and association between body mass index (BMI) and iron deficiency among young children living in high-income countries. We conducted a cross-sectional study of healthy children, 12-29 months of age, recruited during health supervision visits in Toronto, Canada, and concurrently measured BMI and serum ferritin. The prevalence of a double burden of underweight (zBMI < -2) and iron deficiency or overweight/obesity (zBMI > 2) and iron deficiency was calculated. Regression models examined BMI and serum ferritin as continuous and categorical variables, adjusted for covariates. We found the following in terms of prevalence among 1953 children (mean age 18.3 months): underweight 2.6%, overweight/obesity 4.9%, iron deficiency 13.8%, iron-deficiency anemia 5.4%, underweight and iron deficiency 0.4%, overweight/obesity and iron deficiency 1.0%. The change in median serum ferritin for each unit of zBMI was -1.31 µg/L (95% CI -1.93, -0.68, p < 0.001). Compared with normal weight, we found no association between underweight and iron deficiency; meanwhile, overweight/obesity was associated with a higher odds of iron deficiency (OR 2.15, 95% CI 1.22, 3.78, p = 0.008). A double burden of overweight/obesity and iron deficiency occurs in about 1.0% of young children in this high-income setting. For risk stratification and targeted screening in young children, overweight/obesity should be added to the list of important risk factors.
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Affiliation(s)
- Sean A. Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON M5G 1E8, Canada; (S.A.B.); (P.C.P.); (C.S.B.); (C.M.)
| | - Patricia C. Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON M5G 1E8, Canada; (S.A.B.); (P.C.P.); (C.S.B.); (C.M.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Catherine S. Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON M5G 1E8, Canada; (S.A.B.); (P.C.P.); (C.S.B.); (C.M.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jonathon L. Maguire
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1A6, Canada
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON M5G 1E8, Canada; (S.A.B.); (P.C.P.); (C.S.B.); (C.M.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Cornelia M. Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON M5G 1E8, Canada; (S.A.B.); (P.C.P.); (C.S.B.); (C.M.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada
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Osmond MH, Legace E, Gill PJ, Correll R, Cowan K, Dawson JE, Duncan R, Fox E, Gupta K, Kolstad AT, Langevin LM, Macarthur C, Macklem R, Olszewska K, Reed N, Zemek R. Partnering With Patients, Caregivers, and Clinicians to Determine Research Priorities for Concussion. JAMA Netw Open 2023; 6:e2316383. [PMID: 37285158 DOI: 10.1001/jamanetworkopen.2023.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Importance Identifying research priorities of patients with concussion, their caregivers, and their clinicians is important to ensure future concussion research reflects the needs of those who will benefit from the research. Objective To prioritize concussion research questions from the perspectives of patients, caregivers, and clinicians. Design, Setting, and Participants This cross-sectional survey study used the standardized James Lind Alliance priority-setting partnership methods (2 online cross-sectional surveys and 1 virtual consensus workshop using modified Delphi and nominal group techniques). Data were collected between October 1, 2020, and May 26, 2022, from people with lived concussion experience (patients and caregivers) and clinicians who treat concussion throughout Canada. Exposures The first survey collected unanswered questions about concussion that were compiled into summary questions and checked against research evidence to ensure they were unanswered. A second priority-setting survey generated a short list of questions, and 24 participants attended a final priority-setting workshop to decide on the top 10 research questions. Main Outcomes and Measures Top 10 concussion research questions. Results The first survey had 249 respondents (159 [64%] who identified as female; mean [SD] age, 45.1 [16.3] years), including 145 with lived experience and 104 clinicians. A total of 1761 concussion research questions and comments were collected and 1515 (86%) were considered in scope. These were combined into 88 summary questions, of which 5 were considered answered following evidence review, 14 were further combined to form new summary questions, and 10 were removed for being submitted by only 1 or 2 respondents. The 59 unanswered questions were circulated in a second survey, which had 989 respondents (764 [77%] who identified as female; mean [SD] age, 43.0 [4.2] years), including 654 people who identified as having lived experience and 327 who identified as clinicians (excluding 8 who did not record type of participant). This resulted in 17 questions short-listed for the final workshop. The top 10 concussion research questions were decided by consensus at the workshop. The main research question themes focused on early and accurate concussion diagnosis, effective symptom management, and prediction of poor outcomes. Conclusions and Relevance This priority-setting partnership identified the top 10 patient-oriented research questions in concussion. These questions can be used to provide direction to the concussion research community and help prioritize funding for research that matters most to patients living with concussion and those who care for them.
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Affiliation(s)
- Martin H Osmond
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Elizabeth Legace
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Peter J Gill
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Rhonda Correll
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Jennifer E Dawson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Randene Duncan
- Patient Partner, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Erin Fox
- Patient Partner, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kanika Gupta
- Patient Partner, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Ash T Kolstad
- Patient Partner, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Alberta Children's Hospital, Calgary, Canada
- currently a graduate student at the University of Calgary, Calgary, Alberta, Canada
| | - Lisa Marie Langevin
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Alberta Children's Hospital, Calgary, Canada
- Department of Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin Macarthur
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Rosemary Macklem
- Patient Partner, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kinga Olszewska
- Patient Partner, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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Vanderhout SM, Bhalla M, Van A, Fergusson DA, Potter BK, Karoly A, Ly V, Macarthur C. The Impact of Patient and Family Engagement in Child Health Research: A Scoping Review. J Pediatr 2023; 253:115-128. [PMID: 36179891 DOI: 10.1016/j.jpeds.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To identify impacts of patient and family engagement in child health research on the research process, research teams, and patient and family partners. STUDY DESIGN A scoping review was conducted using the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Web of Science databases. English-language studies were included if they described ≥1 impact of patient and family engagement on child health research (age <18 years), researchers, or patient and family partners. Data were retrieved by 2 independent extractors. RESULTS Of the 7688 studies identified, 25 were included in our analysis. Impacts of patient and family engagement were mostly on the research process (n = 24 studies; 96%), 11 (44%) determined impacts on the research team, and 17 (68%) reported impacts on patient and family partners. Less than one-half (n = 11; 44%) had a primary purpose of determining the impact of patient engagement, and no study used a specific evaluation tool. CONCLUSIONS Patient and family engagement can strengthen the relevance and feasibility of research and empower researchers and patient partners. Measuring and reporting the impact of engagement is rare. Systematic and standardized evaluation of engagement is needed to understand how, when, and why to engage patients and families.
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Affiliation(s)
- Shelley M Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Manav Bhalla
- Health Sciences Centre, University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Alicia Van
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Valentina Ly
- University of Ottawa Library Services, Ottawa, Ontario, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Mylabathula S, Macarthur C, Mylabathula S, Colantonio A, Guttmann A, Tator CH. Concussion Public Policy in Elementary and High Schools in Ontario, Canada: A Cross-Sectional Survey to Examine Implementation Compliance, Barriers, and Facilitators. J Sch Health 2023; 93:14-24. [PMID: 36004639 PMCID: PMC10087845 DOI: 10.1111/josh.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). METHODS An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. RESULTS One hundred and thirty-five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return-to-learn protocol in place and 90% reported having a return-to-play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty-seven percent of respondents believed that PPM158 improves student well-being. CONCLUSIONS Identified implementation barriers and facilitators can inform concussion policy practices to improve student well-being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools.
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Affiliation(s)
- Swapna Mylabathula
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; Canadian Concussion Centre, Toronto Western Hospital, Toronto, Canada; Krembil Brain InstituteTorontoCanada
| | - Colin Macarthur
- The Hospital for Sick Children Research Institute, Toronto, Canada; The Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
| | - Sandhya Mylabathula
- Faculty of Kinesiology and Physical EducationUniversity of TorontoTorontoCanada
| | - Angela Colantonio
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Department of Occupational Sciences and Occupational Therapy, Dalla Lana School of Public Health, University of TorontoTorontoCanada
| | - Astrid Guttmann
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; The Hospital for Sick Children Research Institute, Toronto, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada; Leong Centre for Healthy Children, University of TorontoTorontoCanada
| | - Charles H. Tator
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; Canadian Concussion Centre, Toronto Western Hospital, Toronto, Canada; Krembil Brain InstituteTorontoCanada
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Schwartz N, Rothman L, Howard A, To T, Macarthur C. Trends in child pedestrian motor vehicle collision injury rates by neighborhood deprivation score in Toronto, Canada. Prev Med Rep 2022; 30:102050. [DOI: 10.1016/j.pmedr.2022.102050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/16/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
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10
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Gingoyon A, Borkhoff CM, Koroshegyi C, Mamak E, Birken CS, Maguire JL, Fehlings D, Macarthur C, Parkin PC. Chronic Iron Deficiency and Cognitive Function in Early Childhood. Pediatrics 2022; 150:190098. [PMID: 36412051 DOI: 10.1542/peds.2021-055926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A landmark longitudinal study, conducted in Costa Rica in the 1980s, found that children with chronic iron deficiency compared with good iron status in infancy had 8 to 9 points lower cognitive scores, up to 19 years of age. Our objective was to examine this association in a contemporary, high-resource setting. METHODS This was a prospective observational study of children aged 12 to 40 months screened with hemoglobin and serum ferritin. All parents received diet advice; children received oral iron according to iron status. After 4 months, children were grouped as: chronic iron deficiency (iron deficiency anemia at baseline or persistent nonanemic iron deficiency) or iron sufficiency (IS) (IS at baseline or resolved nonanemic iron deficiency). Outcomes measured at 4 and 12 months included the Early Learning Composite (from the Mullen Scales of Early Learning) and serum ferritin. RESULTS Of 1478 children screened, 116 were included (41 chronic, 75 sufficient). Using multivariable analyses, the mean between-group differences in the Early Learning Composite at 4 months was -6.4 points (95% confidence interval [CI]: -12.4 to -0.3, P = .04) and at 12 months was -7.4 points (95% CI: -14.0 to -0.8, P = .03). The mean between-group differences in serum ferritin at 4 months was 14.3 μg/L (95% CI: 1.3-27.4, P = .03) and was not significantly different at 12 months. CONCLUSIONS Children with chronic iron deficiency, compared with children with IS, demonstrated improved iron status, but cognitive scores 6 to 7 points lower 4 and 12 months after intervention. Future research may examine outcomes of a screening strategy on the basis of early detection of iron deficiency using serum ferritin.
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Affiliation(s)
| | - Cornelia M Borkhoff
- Dalla Lana School of Public Health.,Institute of Health Policy, Management and Evaluation.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Eva Mamak
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S Birken
- Dalla Lana School of Public Health.,Institute of Health Policy, Management and Evaluation.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Dalla Lana School of Public Health.,Institute of Health Policy, Management and Evaluation.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Dalla Lana School of Public Health.,Institute of Health Policy, Management and Evaluation.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Colin Macarthur
- Institute of Health Policy, Management and Evaluation.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Dalla Lana School of Public Health.,Institute of Health Policy, Management and Evaluation.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Medicine and the Pediatric Outcomes Research Team.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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11
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Walsh CM, Jones NL, McCreath GA, Connan V, Pires L, Abuloghod L, Buchanan F, Macarthur C. Codevelopment and usability testing of Patient Engagement 101: a Patient-Oriented Research Curriculum in Child Health e-learning module for health care professionals, researchers and trainees. CMAJ Open 2022; 10:E872-E881. [PMID: 36195343 PMCID: PMC9544233 DOI: 10.9778/cmajo.20210336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patient and family engagement is thought to improve the quality and relevance of child health research. We developed and evaluated the usability of Patient Engagement 101, an e-learning module designed to strengthen the patient-oriented research readiness of health care professionals, researchers, trainees and other stakeholders. METHODS The development of Patient Engagement 101 was co-led by a parent and a researcher and overseen by a diverse multistake-holder steering committee. The module was refined and evaluated using a mixed-methods usability testing approach with 2 iterative cycles of semistructured interviews, observations and questionnaires. We collected module feedback by way of semistructured interviews, the validated System Usability Scale, and satisfaction, knowledge and confidence questionnaires. Thematic coding of transcripts and field notes, informed by team discussions, guided the module revisions. RESULTS Thirty end-users completed usability testing (15 per cycle). In each cycle, we modified the module with respect to its content, learner experience, learner-centred design and aesthetic design. Participants were highly satisfied, and System Usability Scale scores indicated the module had the best imaginable usability. Substantial increases in the participants' knowledge test scores and the confidence to engage in patient-oriented research, but not self-rated knowledge, were observed after module completion. INTERPRETATION Codevelopment with patients and caregivers, and refinement through comprehensive end-user testing, resulted in a training resource with exceptional usability that improved knowledge and confidence to engage in patient-oriented research in child health. Patient Engagement 101 is openly available online, and the methods used to develop and evaluate it may facilitate the creation and evaluation of similar capacity-building resources.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont.
| | - Nicola L Jones
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Graham A McCreath
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Veronik Connan
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Linda Pires
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Lama Abuloghod
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Francine Buchanan
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
| | - Colin Macarthur
- Division of Gastroenterology, Hepatology and Nutrition (Walsh, Jones), Department of Clinical Dietetics (Connan), SickKids Learning Institute (Walsh), SickKids Research Institute (Walsh, Jones, McCreath, Abuloghod, Macarthur) and Canadian Child Health Clinician Scientist Program (Pires), The Hospital for Sick Children (Walsh, Jones, McCreath, Abuloghod, Buchanan, Macarthur); Departments of Paediatrics (Walsh, Jones, Macarthur) and Physiology (Jones), and The Wilson Centre for Research in Education (Walsh), Temerty Faculty of Medicine (Walsh, Jones, Macarthur); Institute of Health Policy, Management, and Evaluation (Walsh, Buchanan), University of Toronto, Toronto, Ont
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12
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Mylabathula S, Macarthur C, Guttmann A, Colantonio A, Tator C. Development of a concussion public policy on prevention, management and education for schools using expert consensus. Inj Prev 2022; 28:453-458. [PMID: 35508363 DOI: 10.1136/injuryprev-2021-044395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/09/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Concussions are a major public health concern, and, thus, specific policies have been developed for implementation targeting vulnerable populations such as school-aged children and youth in the school setting, in whom the majority of concussions are sports related. Currently, concussion policies exist in various jurisdictions, including Canada's first concussion policy for schools, Ontario's PPM158, initiated in 2014. However, these policies are often variable in terms of content and comprehensiveness. Our objective was to develop a consensus for the content of concussion policy for schools. METHODS Following a pilot study in one Ontario school board in 2015, which identified missing elements in existing concussion policy, we employed a modified Delphi method to develop consensus for the content of concussion public policy for schools. We used an integrated knowledge translation approach with participation from a multidisciplinary stakeholder group of 20 experts including principals, school board directors, physicians, policymakers, public health representatives and parents. RESULTS Based on the experts, we created a list of 30 policy recommendations for concussion policy in the school setting. This comprehensive list reflects the diverse perspectives of the experts and addresses the role of parents, teachers, coaches, school administrators, referees, trainers, physicians/nurse practitioners, public health and students. CONCLUSIONS This is the first expert consensus for content of concussion public policy for schools and can be used for policy development or enhancement in schools in other jurisdictions. We provide a comprehensive list of 30 recommendations to guide best practices for policy development and implementation to enhance school-based concussion prevention and management.
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Affiliation(s)
- Swapna Mylabathula
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Colin Macarthur
- The Hospital for Sick Children, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Angela Colantonio
- The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Sciences & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Charles Tator
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
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13
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Gill PJ, Bayliss A, Sozer A, Buchanan F, Breen-Reid K, De Castris-Garcia K, Green M, Quinlan M, Wong N, Frappier S, Cowan K, Chan C, Arafeh D, Anwar MR, Macarthur C, Parkin PC, Cohen E, Mahant S. Patient, Caregiver, and Clinician Participation in Prioritization of Research Questions in Pediatric Hospital Medicine. JAMA Netw Open 2022; 5:e229085. [PMID: 35471568 PMCID: PMC9044112 DOI: 10.1001/jamanetworkopen.2022.9085] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE The research agenda in pediatric hospital medicine has seldom considered the perspectives of young people, parents and caregivers, and health care professionals. Their perspectives may be useful in identifying questions on topics for research. OBJECTIVE To prioritize unanswered research questions in pediatric hospital medicine from the perspectives of young people, parents/caregivers, and health care professionals. DESIGN, SETTING, AND PARTICIPANTS Between August 4, 2020, and August 19, 2021, two online surveys and a virtual workshop were conducted, using modified Delphi technique and nominal group technique. Young people, parents/caregivers, and health care professionals with experiences in pediatric hospital medicine in Canada were included. INTERVENTIONS The established James Lind Alliance Priority Setting Partnership method was used. In phase 1, a survey collected unanswered questions regarding pediatric hospital medicine via 3 open-ended questions. Survey responses were used to develop summary questions that went through an evidence-checking process. Unanswered questions were brought to a phase 2 interim prioritization survey. The top 10 unanswered research questions in pediatric hospital medicine were established at the final priority setting workshop. MAIN OUTCOMES AND MEASURES Survey responses, top 10 research questions. RESULTS The phase 1 survey was completed by 188 participants (148 of 167 [89%] females; 17 of 167 [10%] males; mean [SD] age, 39.5 [12.4] years) and generated 495 unanswered research questions and comments, of which 58 were deemed out of scope. The remaining 437 responses were grouped into themes (eg, communication, shared decision-making, health service delivery, and health service management) and then refined to 75 unanswered research questions. Of these 75, only 4 questions had sufficient evidence. To make the number of questions in phase 2 manageable, 21 questions submitted by only 1 respondent were eliminated. Fifty unanswered research questions were included in the phase 2 survey, which was completed by 201 participants (165 of 186 [89%] females; 19 of 186 [10%] males; mean [SD] age, 40.0 [11.0] years). A short list of 16 questions-the top 10 questions from patient partners (youths, parents/caregivers) and clinicians-was presented at the final priority setting workshop and the top 10 questions were prioritized. The top 10 questions focused on the care of special inpatient populations (eg, children with medical complexity), communication, shared decision-making, support strategies in the hospital, mental health supports, shortening length of stay, and supporting Indigenous patients, parents/caregivers, and families. CONCLUSIONS AND RELEVANCE This patient-oriented pediatric hospital medicine priority setting partnership identified the most important unanswered research questions focused on the care of children in the hospital. These questions provide a possible roadmap for research on areas deemed important to young people, parents/caregivers, and clinicians.
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Affiliation(s)
- Peter J. Gill
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Pediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Aubrey Sozer
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francine Buchanan
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Research Family Advisory Committee, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Breen-Reid
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Mairead Green
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Michelle Quinlan
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Noel Wong
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelley Frappier
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | | | - Carol Chan
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Dana Arafeh
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Rashid Anwar
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Colin Macarthur
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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14
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Macarthur C, Cohen E, Adams S, Buchanan F, Saunders NR, Friedman JN. From Philanthropy to Clinical Care through Research: Impact of the Norman Saunders Complex Care Initiative. Children 2022; 9:children9030395. [PMID: 35327767 PMCID: PMC8946877 DOI: 10.3390/children9030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Norman Saunders was a respected academic community paediatrician who was passionate about the care of children with medical complexity. Following his untimely death at age 60, patients, friends, and colleagues raised funds to create the Norman Saunders Complex Care Initiative (NSCCI). Dr. Saunders’s vision was a comprehensive, coordinated, and integrated clinical program for children with medical complexity that was informed by research evidence. The objective of this review was to evaluate the impact of targeted philanthropic funding on research, clinical care, and policy. Since 2006, NSCCI funds have been used to support interdisciplinary and innovative research. Funded projects have reflected a breadth of research questions (clinical care, training, health system delivery, social determinants), disciplines, and methods, and the research results have informed and helped build an internationally renowned clinical program in complex care. Philanthropic funding was the foundation for the NSCCI, which over the last 15 years has built research and clinical capacity, catalysed clinical and research networks, helped train paediatric residents, influenced policy, and improved the health and well-being of children with medical complexity and their families across Canada, and beyond.
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Affiliation(s)
- Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
- Correspondence: ; Tel.: +1-416-813-7654 (ext. 309313)
| | - Eyal Cohen
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
- Complex Care Program, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Sherri Adams
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Complex Care Program, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Francine Buchanan
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
| | - Natasha R. Saunders
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Jeremy N. Friedman
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON M5G 0A4, Canada; (E.C.); (S.A.); (F.B.); (N.R.S.); (J.N.F.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Complex Care Program, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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15
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Rothman L, Schwartz N, Cloutier MS, Winters M, Macarthur C, Hagel BE, Macpherson AK, El Amiri N, Fuselli P, Howard AW. Child pedestrian and cyclist injuries, and the built and social environment across Canadian cities: the Child Active Transportation Safety and the Environment Study (CHASE). Inj Prev 2022; 28:311-317. [PMID: 35058306 PMCID: PMC9340017 DOI: 10.1136/injuryprev-2021-044459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/31/2021] [Indexed: 12/02/2022]
Abstract
Introduction Traffic injury is a leading and preventable cause of child death and disability, with child pedestrians and cyclists particularly vulnerable. Examining built environment correlates of child pedestrian and cyclist motor vehicle collisions (PCMVC) in different settings is needed to promote an evidence-based approach to road safety. Methods We conducted a cross-sectional study across multiple urban/suburban environments in Canada (Calgary, Toronto, Montreal, Laval, Peel Region). All public elementary schools were included (n=1030). We examined the role of land use/social environments, road environments and traffic safety interventions on the rates of child PCMVC within 1000 m of schools. Multivariable negative binomial regression was conducted for all cities and by individual city. In a subset of schools (n=389), we examined associations when controlling for active school transportation (AST). Results Mean PCMVC rate per school ranged from 0.13 collisions/year in Peel to 0.35 in Montreal. Child PCMVC were correlated with land use, social and road environments and traffic safety interventions. In fully adjusted models, social and land use features remained the most important correlates. New immigrant population had the largest positive association with child PCMVC (incidence rate ratio (IRR): 1.26, 95% CI 1.06 to 1.50), while old housing (pre-1960) density was most protective (IRR: 0.83, 95% CI 0.77 to 0.90). AST was associated with PCMVC, but it had no effect on the relationships between PCMVC and other social/environmental correlates. Conclusion The built environment and social factors influence rates of child PCMVC. Opportunities to reduce child PCMVC exist through modifications to city design and road environments and implementing traffic safety interventions.
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Affiliation(s)
- Linda Rothman
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, SickKids Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Schwartz
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Marie-Soleil Cloutier
- Centre Urbanisation Culture Société, Institut National de la Recherche Scientifique, Montreal, Québec, Canada
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children, SickKids Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brent E Hagel
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Alison K Macpherson
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Nisrine El Amiri
- Child Health Evaluative Sciences, The Hospital for Sick Children, SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Andrew William Howard
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Orthopaedic Surgery, Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
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16
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Walsh CM, Jones NL, McCreath GA, Connan V, Pires L, Chen AQH, Karoly A, Macarthur C. Co-development and Usability Testing of Research 101: A Patient-Oriented Research Curriculum in Child Health (PORCCH) E-Learning Module for Patients and Families. Front Pediatr 2022; 10:849959. [PMID: 35874594 PMCID: PMC9297034 DOI: 10.3389/fped.2022.849959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Engaging patients and families as research partners increases the relevance, quality, and impact of child health research. However, those interested in research engagement may feel underequipped to meaningfully partner. We sought to co-develop an online learning (e-learning) module, "Research 101," to support capacity-development in patient-oriented child health research amongst patients and families. METHODS Module co-development was co-led by a parent and researcher, with guidance from a diverse, multi-stakeholder steering committee. A mixed-methods usability testing approach, with three iterative cycles of semi-structured interviews, observations, and questionnaires, was used to refine and evaluate the e-learning module. Module feedback was collected during testing and a post-module interview, and with the validated System Usability Scale (SUS), and satisfaction, knowledge, and self-efficacy questionnaires. Transcripts and field notes were analyzed through team discussion and thematic coding to inform module revisions. RESULTS Thirty participants fully tested Research 101, and another 15 completed confirmatory usability testing (32 caregivers, 6 patients, and 7 clinician-researchers). Module modifications pertaining to learner-centered design, content, aesthetic design, and learner experience were made in each cycle. SUS scores indicated the overall usability of the final version was "excellent." Participants' knowledge of patient-oriented research and self-efficacy to engage in research improved significantly after completing Research 101 (p < 0.01). CONCLUSIONS Co-development and usability testing facilitated the creation of an engaging and effective resource to support the scaling up of patient-oriented child health research capacity. The methods and findings of this study may help guide the integration of co-development and usability testing in creating similar resources.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the SickKids Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicola L Jones
- Division of Gastroenterology, Hepatology and Nutrition and the SickKids Research Institute, The Hospital for Sick Children, Department of Paediatrics and Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Graham A McCreath
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Veronik Connan
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda Pires
- Canadian Child Health Clinician Scientist Program, Toronto, ON, Canada
| | - Autumn Q H Chen
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Aliza Karoly
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Colin Macarthur
- SickKids Research Institute, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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17
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Rothman L, Ling R, Hagel BE, Macarthur C, Macpherson AK, Buliung R, Fuselli P, Howard AW. Pilot study to evaluate school safety zone built environment interventions. Inj Prev 2021; 28:243-248. [PMID: 34462331 PMCID: PMC9132849 DOI: 10.1136/injuryprev-2021-044299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND School safety zones were created in 2017 under the City of Toronto's Vision Zero Road Safety Plan. This pilot study examined the effect of built environment interventions on driver speeds, active school transportation (AST) and dangerous driving. METHODS Interventions were implemented at 34 schools and 45 matched controls (2017-2019). Drivers travelling over the speed limit of >30 km/hour and 85th percentile speeds were measured using pneumatic speed tubes at school frontages. Observers examined AST and dangerous driving at school arrival times. Repeated measures beta and multiple regression analyses were used to study the intervention effects. RESULTS Most schools had posted speed limits of 40 km/hour (58%) or ≥50 km/hour (23%). A decrease in drivers travelling over the speed limit was observed at intervention schools post-intervention (from 44% to 40%; OR 0.79, 95% CI 0.66 to 0.96). Seventy-one per cent of drivers travelled >30 km/hour and the 85th percentile speed was 47 km/hour at intervention schools, with no change in either postintervention. There were no changes in speed metrics in the controls. AST increased by 5% (OR 1.22, 95% CI 0.97 to 1.54) at intervention schools. Reductions in dangerous driving were observed at all schools. CONCLUSIONS Posted speed limits were >30 km/hour at most schools and high proportions of drivers were travelling above the speed limits. There were reductions in drivers exceeding the speed limit and in dangerous driving, and modest increased AST post intervention. Bolder interventions to slow traffic are required to effectively reduce speeding around schools, which may increase safe AST.
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Affiliation(s)
- Linda Rothman
- School of Occupational and Public Health, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada .,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Ling
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Brent E Hagel
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alison K Macpherson
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Ron Buliung
- Department of Geography, Geomatics and Environment, University of Toronto-Mississauga, Toronto, Ontario, Canada
| | | | - Andrew William Howard
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Parkin PC, Borkhoff CM, Macarthur C, Abdullah K, Birken CS, Fehlings D, Koroshegyi C, Maguire JL, Mamak E, Mamdani M, Thorpe KE, Zlotkin SH, Zuo F, Malhi T, Thompson J, Kowal C, Mason D, Thompson L, Barozzino T, Campbell D, Chisamore B, Danayan K, Do A, Jacobson S, Kadar P, Lau E, Naymark S, Peer M, Perlmutar M, Persaud N, Saunderson J, Sgro M, Wong P, Zajdman M. Randomized Trial of Oral Iron and Diet Advice versus Diet Advice Alone in Young Children with Nonanemic Iron Deficiency. J Pediatr 2021; 233:233-240.e1. [PMID: 33548262 DOI: 10.1016/j.jpeds.2021.01.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/08/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the effects of 2 treatment options on neurodevelopmental and laboratory outcomes in young children with nonanemic iron deficiency. STUDY DESIGN A blinded, placebo-controlled, randomized trial of children 1-3 years with nonanemic iron deficiency (hemoglobin ≥110 g/L, serum ferritin <14 μg/L) was conducted in 8 primary care practices in Toronto, Canada. Interventions included ferrous sulfate or placebo for 4 months; all parents received diet advice. The primary outcome was the Early Learning Composite (ELC) using the Mullen Scales of Early Learning (mean 100, SD 15). Secondary outcomes included serum ferritin. Measurements were obtained at baseline and 4 and 12 months. Sample size was calculated to detect a between-group difference of 6-7 points in ELC. RESULTS At enrollment (n = 60), mean age was 24.2 (SD 7.4) months and mean serum ferritin was 10.0 (SD 2.4) μg/L. For ELC, the mean between-group difference at 4 months was 1.1 (95% CI -4.2 to 6.5) and at 12 months was 4.1 (95% CI -1.9 to 10.1). For serum ferritin, at 4 months, the mean between-group difference was 16.9 μg/L (95% CI 6.5 to 27.2), and no child randomized to ferrous sulfate had a serum ferritin <14 μg/L (0% vs 31%, P = .003). CONCLUSIONS For young children with nonanemic iron deficiency, treatment options include oral iron and/or diet advice. We remain uncertain about which option is superior with respect to cognitive outcomes; however, adding ferrous sulfate to diet advice resulted in superior serum ferritin outcomes after 4 months. Shared decision-making between practitioners and parents may be considered when selecting either option. TRIAL REGISTRATION Clinicaltrials.gov: NCT01481766.
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Affiliation(s)
- Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kawsari Abdullah
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Jonathon L Maguire
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada; Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Eva Mamak
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Stanley H Zlotkin
- Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Munk School of Global Affairs, University of Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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Macarthur C, Walsh CM, Buchanan F, Karoly A, Pires L, McCreath G, Jones NL. Development of the patient-oriented research curriculum in child health (PORCCH). Res Involv Engagem 2021; 7:27. [PMID: 33971980 PMCID: PMC8111753 DOI: 10.1186/s40900-021-00276-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Canadian Institutes for Health Research launched a national 'Strategy for Patient-Oriented Research' (SPOR) in 2011. Patient-oriented research is defined as a continuum of research that engages patients as partners, focuses on patient-identified priorities, and improves patient outcomes. Capacity development is a core element of SPOR. Barriers to patient-oriented research include unfamiliarity with the research process for patients and families and unfamiliarity with the methods of patient and family engagement for researchers. METHODS The aim of the Patient-Oriented Research Curriculum in Child Health (PORCCH) is to build capacity in patient-oriented research in child health among patients and families, researchers, healthcare professionals, decision-makers, and trainees through a curriculum delivered via a series of interactive online modules (e-learning). A multi-disciplinary, multi-stakeholder steering committee, which included patients and families, guided the development of the curriculum and provided feedback on individual modules. The content, design, and development of each module were co-led by a parent and researcher in an equal partnership. RESULTS PORCCH consists of a series of five modules. All modules are interactive and include video vignettes and knowledge comprehension questions. Access to the modules is free and each module takes approximately 30 min to complete. The five modules are: Research 101 (an Introduction to Patient-Oriented Research, parts 1 and 2), Patient Engagement 101 (an Introduction to Patient Engagement in Child Health Research, parts 1 and 2), and Research Ethics 101. CONCLUSIONS PORCCH was developed specifically to overcome recognized barriers to the engagement of patients and families in child health research. The aim of the curriculum is to build capacity in patient-oriented research in child health. The goal is for PORCCH to be a useful resource for all stakeholders involved in patient-oriented research: patients and families, researchers, healthcare professionals, decision-makers, and trainees.
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Affiliation(s)
- Colin Macarthur
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada.
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Catharine M Walsh
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Canada
- The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Francine Buchanan
- Family Advisor, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Aliza Karoly
- Family Advisor, Hospital for Sick Children, Toronto, Canada
| | - Linda Pires
- Canadian Child Health Clinician Scientist Program, Toronto, Canada
| | - Graham McCreath
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Nicola L Jones
- SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
- SickKids Learning Institute, Hospital for Sick Children, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
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Bayoumi I, Birken CS, Nurse KM, Parkin PC, Maguire JL, Macarthur C, Randall Simpson JA, Borkhoff CM. Screening for marginal food security in young children in primary care. BMC Pediatr 2021; 21:196. [PMID: 33892660 PMCID: PMC8063438 DOI: 10.1186/s12887-021-02674-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/16/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Household food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP® FI question using the 2-item Hunger Vital Sign™ as the criterion measure in a primary care population of healthy children ages 18 months to 5 years. RESULTS The sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP® question "I have difficulty buying food I want to feed my child because food is expensive" had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign™. CONCLUSION The single NutriSTEP® question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits. TRIAL REGISTRATION TARGet Kids! practice-based research network (Registered June 5, 2013 at www.clinicaltrials.gov ; NCT01869530); www.targetkids.ca.
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Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine, Queen's University, 220 Bagot St., P.O. Bag 8888, Kingston, ON, K7L5E9, Canada.
- Centre for Studies in Primary Care, Queen's University, Kingston, ON, Canada.
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kimberly M Nurse
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Janis A Randall Simpson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
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21
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Kingsnorth S, Lindsay S, Maxwell J, Hamdani Y, Colantonio A, Zhu J, Bayley MT, Macarthur C. Bridging Pediatric and Adult Rehabilitation Services for Young Adults With Childhood-Onset Disabilities: Evaluation of the LIFEspan Model of Transitional Care. Front Pediatr 2021; 9:728640. [PMID: 34631624 PMCID: PMC8493497 DOI: 10.3389/fped.2021.728640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022] Open
Abstract
Background: LIFEspan ("Living Independently and Fully Engaged") is a linked transition service model for youth and young adults with childhood-onset disabilities offered via an inter-agency partnership between two rehabilitation hospitals (one pediatric and one adult) in Toronto, Canada. Objective: The objective was to evaluate healthcare outcomes (continuity of care and healthcare utilization) for clients enrolled in LIFEspan. Methods: A prospective, longitudinal, observational mixed-method study design was used. The intervention group comprised youth with Acquired Brain Injury (ABI) and Cerebral Palsy (CP) enrolled in LIFEspan. A prospective comparison group comprised youth with Spina Bifida (SB) who received standard care. A retrospective comparison group comprised historical, disability-matched clients (with ABI and CP) discharged prior to model introduction. Medical charts were audited to determine continuity of care, i.e., whether study participants had at least one visit to an adult provider within 1 year post-discharge from the pediatric hospital. Secondary outcomes related to healthcare utilization were obtained from population-based, health service administrative datasets. Data were collected over a 3-year period: 2 years pre and 1 year post pediatric discharge. Rates were estimated per person-year. Fisher's Exact Test was used to examine differences between groups on the primary outcome, while repeated measures GEE Poisson regression was used to estimate rate ratios (post vs. pre) with 95% confidence intervals for the secondary outcomes. Results: Prospective enrolment comprised 30 ABI, 48 CP, and 21 SB participants. Retrospective enrolment comprised 15 ABI and 18 CP participants. LIFEspan participants demonstrated significantly greater continuity of care (45% had engagement with adult services in the year following discharge at 18 years), compared to the prospective SB group (14%). Healthcare utilization data were inconsistent with no significant changes in frequency of physician office visits, emergency department visits, or hospitalizations for clients enrolled in LIFEspan in the year following discharge, compared to the 2 years prior to discharge. Conclusion: Introduction of the LIFEspan model increased continuity of care, with successful transfer from pediatric to adult services for clients enrolled. Data on longer-term follow-up are recommended for greater understanding of the degree of adult engagement and influence of LIFEspan on healthcare utilization following transfer.
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Affiliation(s)
- Shauna Kingsnorth
- Bloorview Research Institute, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Joanne Maxwell
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Bloorview Research Institute, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Canada Research Chair (Tier 1) in Traumatic Brain Injury in Underserved Populations, Canada Research Chair Program, Ottawa, ON, Canada
| | - Jingqin Zhu
- The Hospital for Sick Children, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Mark Theodore Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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22
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Fridman L, Rothman L, Howard AW, Hagel BE, Macarthur C. Methodological considerations in MVC epidemiological research. Inj Prev 2020; 27:155-160. [PMID: 33199349 PMCID: PMC8005794 DOI: 10.1136/injuryprev-2020-043987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/02/2022]
Abstract
Background The global burden of MVC injuries and deaths among vulnerable road users, has led to the implementation of prevention programmes and policies at the local and national level. MVC epidemiological research is key to quantifying MVC burden, identifying risk factors and evaluating interventions. There are, however, several methodological considerations in MVC epidemiological research. Methods This manuscript collates and describes methodological considerations in MVC epidemiological research, using examples drawn from published studies, with a focus on the vulnerable road user population of children and adolescents. Results Methodological considerations in MVC epidemiological research include the availability and quality of data to measure counts and calculate event rates and challenges in evaluation related to study design, measurement and statistical analysis. Recommendations include innovative data collection (eg, naturalistic design, stepped-wedge clinical trials), combining data sources for a more comprehensive representation of collision events, and the use of machine learning/artificial intelligence for large data sets. Conclusions MVC epidemiological research can be challenging at all levels: data capture and quality, study design, measurement and analysis. Addressing these challenges using innovative data collection and analysis methods is required.
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Affiliation(s)
- Liraz Fridman
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Linda Rothman
- School of Occupational and Public Health Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - Andrew William Howard
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brent E Hagel
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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23
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Cloutier MS, Beaulieu E, Fridman L, Macpherson AK, Hagel BE, Howard AW, Churchill T, Fuselli P, Macarthur C, Rothman L. State-of-the-art review: preventing child and youth pedestrian motor vehicle collisions: critical issues and future directions. Inj Prev 2020; 27:77-84. [PMID: 33148798 PMCID: PMC7848053 DOI: 10.1136/injuryprev-2020-043829] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 11/08/2022]
Abstract
Aim To undertake a comprehensive review of the best available evidence related to risk factors for child pedestrian motor vehicle collision (PMVC), as well as identification of established and emerging prevention strategies. Methods Articles on risk factors were identified through a search of English language publications listed in Medline, Embase, Transport, SafetyLit, Web of Science, CINHAL, Scopus and PsycINFO within the last 30 years (~1989 onwards). Results This state-of-the-art review uses the road safety Safe System approach as a new lens to examine three risk factor domains affecting child pedestrian safety (built environment, drivers and vehicles) and four cross-cutting critical issues (reliable collision and exposure data, evaluation of interventions, evidence-based policy and intersectoral collaboration). Conclusions Research conducted over the past 30 years has reported extensively on child PMVC risk factors. The challenge facing us now is how to move these findings into action and intervene to reduce the child PMVC injury and fatality rates worldwide.
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Affiliation(s)
- Marie-Soleil Cloutier
- Centre Urbanisation Culture Société, Institut National de la Recherche Scientifique, Montreal, Quebec, Canada
| | - Emilie Beaulieu
- Département de pédiatrie, Faculté de médecine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Liraz Fridman
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Brent E Hagel
- Department of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children' Hospital Research Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Andrew William Howard
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda Rothman
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
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Teachman G, McDonough P, Macarthur C, Gibson BE. Interrogating inclusion with youths who use augmentative and alternative communication. Sociol Health Illn 2020; 42:1108-1122. [PMID: 32274809 DOI: 10.1111/1467-9566.13087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Even as the goal of social inclusion underpins health and social services for disabled youths, those with communication impairments continue to lead narrowly circumscribed lives. In this Canadian study, we combined visual methods and interviews with 13 Canadian youths who use augmentative and alternative communication (AAC) to understand how they make 'practical sense' of discourses of inclusion. Drawing on Bourdieu's theory of practice, we suggest: (i) participants' narratives reveal habitus - a socially constituted set of dispositions - that predispose them to accommodate the devalued social positions and constricted conditions of existence imposed on them; (ii) some forms of 'inclusion' perpetuate symbolic violence, as youths who use AAC internalise, as seemingly 'natural', dominant social norms and values that privilege 'normal' bodies; and (iii) although their practices primarily reproduced the status quo, youths in the study also worked at the margins to create locally produced forms of inclusion that attempted to transform the 'rules of the game'. We argue these results suggest a need for systemic shifts past reified notions of inclusion towards fostering social spaces where alternative ways of being in the world are positively valued.
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Affiliation(s)
- Gail Teachman
- School of Occupational Therapy, Western University, Toronto, ON, Canada
| | - Peggy McDonough
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Barbara E Gibson
- Department of Physical Therapy, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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Vaillancourt C, Charette M, Taljaard M, Thavorn K, Hall E, McLeod B, Fergusson D, Brehaut J, Graham I, Calder L, Ramsay T, Tugwell P, Kelly P, Cheskes S, Saskin R, Plint A, Osmond M, Macarthur C, Straus S, Rochon P, Prud'homme D, Dahrouge S, Marlin S, Stiell IG. Pragmatic Strategy Empowering Paramedics to Assess Low-Risk Trauma Patients With the Canadian C-Spine Rule and Selectively Transport Them Without Immobilization: Protocol for a Stepped-Wedge Cluster Randomized Trial. JMIR Res Protoc 2020; 9:e16966. [PMID: 32348267 PMCID: PMC7296410 DOI: 10.2196/16966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Each year, half a million patients with a potential neck (c-spine) injury are transported to Ontario emergency departments (EDs). Less than 1.0% (1/100) of these patients have a neck bone fracture. Even less (1/200, 0.5%) have a spinal cord injury or nerve damage. Currently, paramedics transport all trauma victims (with or without an injury) by ambulance using a backboard, cervical collar, and head immobilizers. Importantly, prolonged immobilization is often unnecessary; it causes patient discomfort and pain, decreases community access to paramedics, contributes to ED crowding, and is very costly. We therefore developed the Canadian C-Spine Rule (CCR) for alert and stable trauma patients. This decision rule helps ED physicians and triage nurses to safely and selectively remove immobilization, without x-rays and missed injury. We successfully taught Ottawa paramedics to use the CCR in the field in a single-center study. OBJECTIVE This study aimed to improve patient care and health system efficiency and outcomes by allowing paramedics to assess eligible low-risk trauma patients with the CCR and selectively transport them without immobilization to the ED. METHODS We propose a pragmatic stepped-wedge cluster randomized design with health economic evaluation, designed collaboratively with knowledge users. Our 36-month study will consist of a 12-month setup and training period (year 1), followed by the stepped-wedge trial (year 2) and a 12-month period for study completion, analyses, and knowledge translation. A total of 12 Ontario paramedic services of various sizes distributed across the province will be randomly allocated to one of three sequences. Paramedic services in each sequence will cross from the control condition (usual care) to the intervention condition (CCR implementation) at intervals of 3 months until all communities have crossed to the intervention. Data will be collected on all eligible patients in each paramedic service for a total duration of 12 months. A major strength of our design is that each community will have implemented the CCR by the end of the study. RESULTS Interim results are expected in December 2019 and final results in 2020. If this multicenter trial is successful, we expect the Ontario Ministry of Health will recommend that paramedics evaluate all eligible patients with the CCR in the Province of Ontario. CONCLUSIONS We conservatively estimate that in Ontario, more than 60% of all eligible trauma patients (300,000 annually) could be transported safely and comfortably, without c-spine immobilization devices. This will significantly reduce patient pain and discomfort, paramedic intervention times, and ED length of stay, thereby improving access to paramedics and ED care. This could be achieved rapidly and with lower health care costs compared with current practices (possible cost saving of Can $36 [US $25] per immobilization or Can $10,656,000 [US $7,335,231] per year). TRIAL REGISTRATION ClinicalTrials.gov NCT02786966; https://clinicaltrials.gov/ct2/show/NCT02786966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16966.
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Affiliation(s)
- Christian Vaillancourt
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | | | - Elizabeth Hall
- Patient Representative, Owner-Hall Consulting, Director-Helping Hands for India, Kanata, ON, Canada
| | - Brent McLeod
- Paramedic Representative, Hamilton Paramedic Service, Hamilton, ON, Canada
| | | | - Jamie Brehaut
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ian Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lisa Calder
- Medical Care Analytics, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tugwell
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Kelly
- Ottawa Paramedic Service, Ottawa, ON, Canada
| | - Sheldon Cheskes
- Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Amy Plint
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Martin Osmond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Sharon Straus
- Knowledge Translation Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Paula Rochon
- Women's College Research Institute, Toronto, ON, Canada
| | | | | | | | - Ian G Stiell
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Fridman L, Ling R, Rothman L, Cloutier MS, Macarthur C, Hagel B, Howard A. Effect of reducing the posted speed limit to 30 km per hour on pedestrian motor vehicle collisions in Toronto, Canada - a quasi experimental, pre-post study. BMC Public Health 2020; 20:56. [PMID: 32036789 PMCID: PMC7008529 DOI: 10.1186/s12889-019-8139-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023] Open
Abstract
Background Pedestrian related deaths have recently been on the rise in Canada. The effect of changing posted speeds on the frequency and severity of pedestrian motor vehicle collisions (PMVC) is not well studied using controlled quasi-experimental designs. The objective of this study was to examine the effect of lowering speed limits from 40 km/h to 30 km/h on PMVC on local roads in Toronto, Canada. Methods A 30 km/h speed limit on local roads in Toronto was implemented between January 2015 and December 2016. Streets that remained at a 40 km/h speed limit throughout the study period were selected as comparators. A quasi-experimental, pre-post study with a comparator group was used to evaluate the effect of the intervention on PMVC rates before and after the speed limit change using repeated measures Poisson regression. PMVC data were obtained from police reports for a minimum of two years pre- and post-intervention (2013 to 2018). Results Speed limit reductions from 40 km/h to 30 km/h were associated with a 28% decrease in the PMVC incidence rate in the City of Toronto (IRR = 0.72, 95% CI: 0.58–0.89). A non-significant 7% decrease in PMVC incidence rates were observed on comparator streets that remained at 40 km/h speed limits (IRR = 0.93, 95% CI: 0.70–1.25). Speed limit reduction also influenced injury severity, with a significant 67% decrease in major and fatal injuries in the post intervention period on streets with speed limit reductions (IRR = 0.33, 95% CI: 0.13–0.85) compared with a 31% not statistically significant decrease in major and fatal injuries on comparator streets (IRR = 0.69, 95% CI: 0.37–1.31). The interaction term for group and pre-post comparisons was not statistically significant (p = 0.14) indicating that there was no evidence to suggest a pre-post difference in IRRs between the intervention and comparator streets. Conclusions Declines in the rate of PMVC were observed on roads with posted speed limit reductions from 40 km/h to 30 km/h, although this effect was not statistically greater than reductions on comparator streets.
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Affiliation(s)
- Liraz Fridman
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada. .,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada. .,O'Brien Institute for Public Health, Calgary, Alberta, Canada. .,Hospital for Sick Children Research Institute, Toronto, Ontario, Canada. .,Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St, Toronto, ON, M5G0A4, Canada.
| | - Rebecca Ling
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Linda Rothman
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | | | - Colin Macarthur
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Brent Hagel
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Andrew Howard
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Ling R, Rothman L, Cloutier MS, Macarthur C, Howard A. Cyclist-motor vehicle collisions before and after implementation of cycle tracks in Toronto, Canada. Accid Anal Prev 2020; 135:105360. [PMID: 31785479 DOI: 10.1016/j.aap.2019.105360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/30/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cycling, as a mode of active transportation, has numerous health and societal benefits, but carries risks of injury when performed on-road with vehicles. Cycle tracks are dedicated lanes with a physical separation or barrier between bicycles and motor vehicles. Studies on the effectiveness of cycle tracks in urban areas in North America, as well as the area-wide effects of cycle tracks are limited. AIMS Study objectives were to examine the effect of cycle track implementation on cyclist-motor vehicle collisions (CMVC) occurring: (1) on streets treated with new cycle tracks; (2) on streets surrounding new cycle tracks in Toronto, Canada. METHODS Intervention and outcome data were obtained from the City of Toronto. All police-reported CMVC from 2000 to 2016 were mapped. Analyses were restricted to 2 years pre- and 2 years post-track implementation. Rates were calculated for CMVC on streets with cycle tracks (objective 1) and in five defined areas surrounding cycle tracks (objective 2). Zero-Inflated Poisson regression was used to compare changes to CMVC rates before and after cycle track implementation for both objectives. All models controlled for season of collision and cycle track. RESULTS The majority of CMVC on cycle tracks occurred at intersections (75%). The crude CMVC rate increased two-fold after cycle track implementation (IRR = 2.06, 95% CI: 1.51-2.81); however, after accounting for the increase in cycling volumes post-implementation, there was a 38% reduction in the CMVC rate per cyclist-month (IRR = 0.62, 95% CI: 0.44-0.89). On streets between 151 m - 550 m from cycle tracks, there was a significant 35% reduction in CMVC rates per km-month following track implementation (IRR = 0.65, 95% CI: 0.54-0.76). CONCLUSIONS Cycle track implementation was associated with increased safety for cyclists on cycle tracks, after adjusting for cycling volume. In addition, there was a significant reduction in CMVC on streets surrounding cycle tracks between 151 m - 550 m distance from the tracks (a 'safety halo' effect), suggesting an area-wide safety effect of cycle track implementation.
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Affiliation(s)
- Rebecca Ling
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7, Canada.
| | - Linda Rothman
- School of Occupational and Public Health, Ryerson University, 288 Church Street, Toronto, M5B 1Z5, Canada
| | - Marie-Soleil Cloutier
- Institut National de la Recherche Scientifique, 385 Sherbrooke Street E, Montreal, H2X 1E3, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
| | - Andrew Howard
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
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Gunaseelan V, Parkin PC, Wahi G, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. Maternal ethnicity and iron status in early childhood in Toronto, Canada: a cross-sectional study. BMJ Paediatr Open 2020; 4:e000635. [PMID: 32509978 PMCID: PMC7254107 DOI: 10.1136/bmjpo-2020-000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between maternal ethnicity and iron deficiency (ID) in early childhood, and to evaluate whether infant feeding practices linked to ID differ between maternal ethnic groups. METHODS This was a cross-sectional study of healthy children 1-3 years of age. Adjusted multivariable logistic regression analyses were used to evaluate the association between maternal ethnicity and ID (serum ferritin <12 µg/L) and the association between maternal ethnicity and five infant feeding practices (breastfeeding duration; bottle use beyond 15 months; current formula use; daily cow's milk intake >2 cups; meat consumption). RESULTS Of 1851 children included, 12.2% had ID. Compared with the European referent group, we found higher odds of ID among children of South Asian and West Asian/North African maternal ethnicities, and lower odds of ID among children of East Asian maternal ethnicity. Statistically significant covariates associated with higher odds of ID included longer breastfeeding duration and daily cow's milk intake >2 cups. Current infant formula use was associated with lower odds of ID. Children of South Asian maternal ethnicity had higher odds of bottle use beyond 15 months of age and lower odds of meat consumption. CONCLUSIONS We found increased odds of ID among children of South Asian and West Asian/Northern African maternal ethnicities. We found a higher odds of feeding practices linked to ID in children of South Asian maternal ethnicity, but not in children of West Asian/North African maternal ethnicity. Culturally tailored approaches to providing guidance to parents on healthy infant feeding practices may be important to prevent ID in early childhood. TRIAL REGISTRATION NUMBER NCT01869530.
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Affiliation(s)
- Vinusha Gunaseelan
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada
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29
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Rothman L, Clemens T, Macarthur C. Prevention of unintentional childhood injury: A review of study designs in the published literature 2013-2016. Prev Med Rep 2019; 15:100918. [PMID: 31236322 PMCID: PMC6582059 DOI: 10.1016/j.pmedr.2019.100918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/30/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022] Open
Abstract
The purpose of this review was to examine the range and quality of published injury prevention research, based on study design. Stratified random selection of journals (based on the average annual number of injury prevention publications) was conducted using a published inventory. Hand searches for empirical research articles on unintentional injury prevention in children and youth (0–19 years) over the four-year period 2013 to 2016, inclusive were conducted. Of the 380 studies identified, the majority were descriptive (133, 35%) or observational (163, 43%), with more than three quarters of the published studies using a “hypothesis-generating” study design. Only 12 (3%) studies were randomized controlled trials, and of the 44 experimental studies, 19 (43%) did not include a comparison group. Transportation injuries predominated, knowledge/attitude/behaviour outcomes were common, and the most common intervention approach was education. The majority of publications were from high-income countries. This review of injury prevention research in children and youth showed that descriptive studies predominate in the published literature, and hypothesis-testing study designs are relatively infrequent. The findings suggest a need for the injury field to support and promote rigorous analytic study designs. In other words, to enhance and strengthen the evidence base for injury prevention policy and practice, injury prevention researchers should consider a greater focus on determination of cause and effect and evaluation of the effectiveness of interventions, particularly engineering and legislative interventions.
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Affiliation(s)
- Linda Rothman
- Child Health Evaluative Sciences, Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
| | - Tessa Clemens
- Child Health Evaluative Sciences, Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
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30
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Atalla M, Parkin PC, Bayoumi I, Koroshegyi C, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. 156 A positive screen on the 18-month Infant Toddler Checklist is associated with a later developmental disorder. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marina Atalla
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Imaan Bayoumi
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
| | - Christine Koroshegyi
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Pediatrics, St. Michael’s Hospital, Toronto, ON, Canada
| | - Colin Macarthur
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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31
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Gunaseelan V, Parkin PC, Wahi G, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. 32 The Association Between Maternal Ethnicity and Iron Deficiency in Early Childhood. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vinusha Gunaseelan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON, Canada
| | - Patricia C Parkin
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Gita Wahi
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Pediatrics, St. Michael’s Hospital, Toronto, ON, Canada
| | - Colin Macarthur
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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32
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Rothman L, Macarthur C, Wilton A, Howard AW, Macpherson AK. Recent trends in child and youth emergency department visits because of pedestrian motor vehicle collisions by socioeconomic status in Ontario, Canada. Inj Prev 2019; 25:570-573. [PMID: 30975762 DOI: 10.1136/injuryprev-2018-043090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/01/2019] [Accepted: 02/11/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Children in lower-income households have higher injury rates. Trends in emergency department (ED) visits by children 0-19 years because of pedestrian motor vehicle collisions (PMVCs) in Ontario, Canada (2008-2015) by socioeconomic status were examined. METHODS PMVC ED data were obtained from the Institute for Clinical Evaluative Sciences for children age 0-19 years over the period 2008-2015. Age-adjusted rates were calculated using Ontario census data. Household income quintiles were determined from the Registered Persons Database. Poisson regression was used to model ED visit rates by year, age and income quintile. RESULTS The frequency of child PMVC ED visits in Ontario decreased from 1562 in 2008 to 1281 in 2015. Age-adjusted rates were unchanged over time (IRR 1.00, 95% CI 0.99 to 1.00); however, rate disparities by income status persisted with an IRR of 0.52 (0.50 to 0.55) comparing the highest with the lowest income level. CONCLUSIONS Exposure to traffic may play a role in rate disparities by income status in child PMVC; however, less safe traffic environments in lower income areas may also be strong contributors. These findings highlight the potential impact of roadway safety modifications in lower income areas to mitigate disparities in injury rates by socioeconomic status.
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Affiliation(s)
- Linda Rothman
- CHES, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Alison K Macpherson
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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33
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Rothman L, Cloutier MS, Manaugh K, Howard AW, Macpherson AK, Macarthur C. Spatial distribution of roadway environment features related to child pedestrian safety by census tract income in Toronto, Canada. Inj Prev 2019; 26:229-233. [PMID: 30936120 DOI: 10.1136/injuryprev-2018-043125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Investments in traffic calming infrastructure and other street design features can enhance pedestrian safety as well as contribute to the 'walkability' of neighbourhoods. Pedestrian-motor vehicle collisions (PMVCs) in urban areas, however, remain common and occur more frequently in lower income neighbourhoods. While risk and protective features of roadways related to PMVC have been identified, little research exists examining the distribution of roadway environment features. This study examined the relationship between roadway environment features related to child pedestrian safety and census tract income status in Toronto. METHODS Spatial cluster detection based on 2006 census tract data identified low-income and high-income census tract clusters in Toronto. Police-reported PMVC data involving children between the ages of 5 and 14 years were mapped using geographical information system. Also mapped were roadway environment features (densities of speed humps, crossing guards, local roads, one-way streets and missing sidewalks). Multivariate logistic regression was used to examine the relationship between roadway environment features (independent variables) and cluster income status (dependent variable), controlling for child census tract population. RESULTS There were significantly fewer speed humps and local roads in low-income versus high-income clusters. Child PMVC rates were 5.4 times higher in low-income versus high-income clusters. CONCLUSION Socioeconomic inequities in the distribution of roadway environment features related to child pedestrian safety have policy and process implications related to the safety of child pedestrians in urban neighbourhoods.
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Affiliation(s)
- Linda Rothman
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marie-Soleil Cloutier
- Centre Urbanisation Culture Société, Institut National de la Recherche Scientifique, Montreal, Québec, Canada
| | | | | | | | - Colin Macarthur
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
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34
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Oatley H, Borkhoff CM, Chen S, Macarthur C, Persaud N, Birken CS, Maguire JL, Parkin PC. Screening for Iron Deficiency in Early Childhood Using Serum Ferritin in the Primary Care Setting. Pediatrics 2018; 142:peds.2018-2095. [PMID: 30487142 DOI: 10.1542/peds.2018-2095] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The American Academy of Pediatrics recommends universal screening for anemia using hemoglobin at 12 months. However, hemoglobin lacks diagnostic accuracy for iron deficiency, and the optimal age for screening has not been determined. Our objective was to assess a screening strategy for iron deficiency using serum ferritin. METHODS We conducted a cross-sectional study of children 1 to 3 years old attending a health supervision visit. We examined the relationship between child age and serum ferritin, age and hemoglobin, hemoglobin and serum ferritin, and the prevalence of elevated C-reactive protein (CRP). RESULTS Restricted cubic spline analysis (n = 1735) revealed a nonlinear relationship between age and serum ferritin (P < .0001). A linear spline model revealed that from 12 to 15 months, for each 1-month increase in age, serum ferritin levels decreased by 9% (95% confidence interval [CI]: 5 to 13). From 15 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each month increase in age, serum ferritin increased by 2% (95% CI: 1 to 2). For hemoglobin, from 12 to 24 months, the rate of change was nonsignificant. From 24 to 38 months, for each 1-month increase in age, hemoglobin increased by 20% (95% CI: 9 to 32). Compared with the serum ferritin cutoff of <12 μg/L, the hemoglobin cutoff of <110 g/L had a sensitivity of 25% (95% CI: 19 to 32) and a specificity of 89% (95% CI: 87 to 91). Elevated CRP ≥10 mg/L occurred in 3.3% (95% CI: 2.5 to 4.2). CONCLUSIONS Screening for iron deficiency using serum ferritin at 15 or 18 months may be a promising strategy. For children at low risk for acute inflammation, concurrent measurement of CRP may not be necessary.
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Affiliation(s)
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Shiyi Chen
- Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Colin Macarthur
- Department of Pediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Navindra Persaud
- Joannah & Brian Lawson Centre for Child Nutrition, and.,Departments of Family Medicine and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and.,Joannah & Brian Lawson Centre for Child Nutrition, and
| | - Jonathon L Maguire
- Department of Pediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Joannah & Brian Lawson Centre for Child Nutrition, and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Pediatrics, and
| | - Patricia C Parkin
- Department of Pediatrics, Faculty of Medicine, .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and.,Joannah & Brian Lawson Centre for Child Nutrition, and
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35
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Borkhoff CM, Dai DWH, Jairam JA, Wong PD, Cox KA, Maguire JL, Birken CS, Macarthur C, Parkin PC. Breastfeeding to 12 mo and beyond: nutrition outcomes at 3 to 5 y of age. Am J Clin Nutr 2018; 108:354-362. [PMID: 30101330 DOI: 10.1093/ajcn/nqy124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/14/2018] [Indexed: 02/04/2023] Open
Abstract
Background Little is known about nutrition outcomes in preschoolers associated with breastfeeding duration beyond 12 mo of age. Objective The aim was to examine the association between total breastfeeding duration and nutrition outcomes at 3 to 5 y of age. Design A cross-sectional study in healthy children, ages 3-5 y, recruited from 9 primary care practices in Toronto was conducted through the TARGet Kids! (The Applied Research Group for Kids) research network. Parents completed standardized surveys, including the Nutrition Screening for Every Preschooler (NutriSTEP) used to assess nutrition risk. Results A total of 2987 children were included. Ninety-two percent of children were breastfed, and the mean ± SD breastfeeding duration was 11.4 ± 8.4 mo. The prevalence of nutrition risk (score >20) was 17.0%. We examined breastfeeding duration as a continuous variable. With the use of restricted cubic spline modeling, we confirmed a nonlinear relation between breastfeeding duration and NutriSTEP score, dietary intake and eating behavior subscores, and sugar-sweetened beverage and sweet-savory snack consumption. Segmented linear regression was used to examine this nonlinear relation in a piecewise approach. We found a decreasing trend in NutriSTEP score for children who were breastfed for 0-6 mo (β = -0.14; 95% CI: -0.29, 0.004), a significant decrease in NutriSTEP score for children breastfed for 6-12 mo (β = -0.20; 95% CI: -0.33, -0.07), and no significant change after 12 mo (β = 0.09; 95% CI: -0.07, 0.24) and beyond. The mean ± SD NutriSTEP scores were 17.1 ± 7.4 for no breastfeeding, 15.9 ± 6.5 for breastfeeding >0-6 mo, 13.9 ± 6.2 for >6-12 mo, 13.7 ± 6.3 for >12-18 mo, 14.6 ± 6.7 for >18-24 mo, and 14.3 ± 6.8 for >24-36 mo. Conclusions Breastfeeding for ≤12 mo was associated with decreased nutrition risk and healthier eating behaviors and dietary intake at 3-5 y of age. We found insufficient evidence of additional benefit for breastfeeding beyond 12 mo of age. The TARGet Kids! practice-based research network is registered at www.clinicaltrials.gov as NCT01869530.
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Affiliation(s)
- Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation
| | | | - Jennifer A Jairam
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter D Wong
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Departments of Pediatrics
| | - Kelly Anne Cox
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon L Maguire
- Departments of Pediatrics.,Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation.,Departments of Pediatrics
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation.,Departments of Pediatrics
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation.,Departments of Pediatrics
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36
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Ryckman K, Richmond SA, Anderson LN, Birken CS, Parkin PC, Macarthur C, Maguire JL, Howard AW. Temperament and fracture in preschool-aged children. Paediatr Child Health 2018; 22:195-198. [PMID: 29479213 DOI: 10.1093/pch/pxx049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives Approximately one-half of all children will sustain a fracture before adulthood. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. The purpose of this study was to examine the association between temperament and fracture risk in preschool-aged children. Methods Children aged 3 to 6 years who were diagnosed with a fracture were recruited from the Hospital for Sick Children Fracture Clinic. Using a retrospective case-control study design, the 148 cases were frequency-matched by age and sex to 426 controls from the TARGet Kids primary care paediatric cohort. The Childhood Behaviour Questionnaire, a 36-item caregiver response questionnaire was used to assess three of the following temperament factors: surgency (e.g., high activity level), negative affect (e.g., anger, fear, discomfort) and effortful control (e.g., attentional focusing). Results Unadjusted logistic models demonstrated no association between children with previous fracture and higher scores of surgency (unadjusted odds ratio [OR]=1.06, 95% confidence interval [CI]: 0.84, 1.34), negative affect (unadjusted OR=1.15, 95% CI: 0.93, 1.42) or effortful control (unadjusted OR=0.80, 95% CI: 0.63, 1.03). Further, models adjusted for covariates also demonstrated no significant association with surgency (1.00, 95% CI: 0.78, 1.29), negative affect (1.09, 95% CI: 0.86, 1.37) and effortful control (0.80, 95% CI: 0.61, 1.05). Conclusion None of the three main temperament types identified by the Childhood Behaviour Questionnaire were associated with an increase in fracture risk.
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Affiliation(s)
- Kandace Ryckman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Sarah A Richmond
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Laura N Anderson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Patricia C Parkin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, Ontario
| | - Colin Macarthur
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, Ontario
| | - Jonathon L Maguire
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario.,Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario
| | - Andrew W Howard
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ontario.,Department of Surgery, University of Toronto, Toronto, Ontario
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Aglipay M, Birken CS, Parkin PC, Loeb MB, Thorpe K, Chen Y, Laupacis A, Mamdani M, Macarthur C, Hoch JS, Mazzulli T, Maguire JL. Effect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy Children. JAMA 2017; 318:245-254. [PMID: 28719693 PMCID: PMC5817430 DOI: 10.1001/jama.2017.8708] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Epidemiological studies support a link between low 25-hydroxyvitamin D levels and a higher risk of viral upper respiratory tract infections. However, whether winter supplementation of vitamin D reduces the risk among children is unknown. OBJECTIVE To determine whether high-dose vs standard-dose vitamin D supplementation reduces the incidence of wintertime upper respiratory tract infections in young children. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was conducted during the winter months between September 13, 2011, and June 30, 2015, among children aged 1 through 5 years enrolled in TARGet Kids!, a multisite primary care practice-based research network in Toronto, Ontario, Canada. INTERVENTIONS Three hundred forty-nine participants were randomized to receive 2000 IU/d of vitamin D oral supplementation (high-dose group) vs 354 participants who were randomized to receive 400 IU/d (standard-dose group) for a minimum of 4 months between September and May. MAIN OUTCOME MEASURES The primary outcome was the number of laboratory-confirmed viral upper respiratory tract infections based on parent-collected nasal swabs over the winter months. Secondary outcomes included the number of influenza infections, noninfluenza infections, parent-reported upper respiratory tract illnesses, time to first upper respiratory tract infection, and serum 25-hydroxyvitamin D levels at study termination. RESULTS Among 703 participants who were randomized (mean age, 2.7 years, 57.7% boys), 699 (99.4%) completed the trial. The mean number of laboratory-confirmed upper respiratory tract infections per child was 1.05 (95% CI, 0.91-1.19) for the high-dose group and 1.03 (95% CI, 0.90-1.16) for the standard-dose group, for a between-group difference of 0.02 (95% CI, -0.17 to 0.21) per child. There was no statistically significant difference in number of laboratory-confirmed infections between groups (incidence rate ratio [RR], 0.97; 95% CI, 0.80-1.16). There was also no significant difference in the median time to the first laboratory-confirmed infection: 3.95 months (95% CI, 3.02-5.95 months) for the high-dose group vs 3.29 months (95% CI, 2.66-4.14 months) for the standard-dose group, or number of parent-reported upper respiratory tract illnesses between groups (625 for high-dose vs 600 for standard-dose groups, incidence RR, 1.01; 95% CI, 0.88-1.16). At study termination, serum 25-hydroxyvitamin D levels were 48.7 ng/mL (95% CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95% CI, 35.4-38.2 ng/mL) in the standard-dose group. CONCLUSIONS AND RELEVANCE Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections. These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01419262.
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Affiliation(s)
- Mary Aglipay
- Department of Pediatrics, St Michael’s Hospital, Pediatric Research, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Mark B. Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Thorpe
- The La Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yang Chen
- The La Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Laupacis
- The La Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Muhammad Mamdani
- The La Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Jeffrey S. Hoch
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The La Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Public Health Sciences, University of California, Davis, California
| | - Tony Mazzulli
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Ontario, Canada
| | - Jonathon L. Maguire
- Department of Pediatrics, St Michael’s Hospital, Pediatric Research, Toronto, Ontario, Canada
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The La Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
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Rothman L, Howard A, Buliung R, Macarthur C, Richmond SA, Macpherson A. School environments and social risk factors for child pedestrian-motor vehicle collisions: A case-control study. Accid Anal Prev 2017; 98:252-258. [PMID: 27770691 DOI: 10.1016/j.aap.2016.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Child pedestrian-motor vehicle collisions (PMVCs) have decreased in Canada in the past 20 years. Many believe this trend is explained by the rise in automobile use for all travel. Initiatives to increase walking to school need to consider PMVC risk. Potential risk factors related to walking to school, the built environment and social factors were examined for schools with historically high child PMVC rates. METHODS Child PMVCs (age 4-12 years) from 2000 to 2013 and built environment features were mapped within school attendance boundaries in the City of Toronto, Canada. Case and control schools were in the highest and lowest PMVC quartiles respectively. Observational counts of travel mode to school were conducted. Logistic regression evaluated walking to school, built environment and social risk factors for higher PMVC rates, stratified by geographic location (downtown vs. inner suburbs). RESULTS The mean PMVC rates were 18.8/10,000/year (cases) and 2.5/10,000/year (controls). One-way street density (OR=4.00), school crossing guard presence (OR=3.65) and higher social disadvantage (OR=1.37) were associated with higher PMVCs. Higher residential land use density had a protective effect (OR=0.56). More walking was not a risk factor. While several built environment risk factors were identified for the inner suburbs; only social disadvantage was a risk factor within older urban neighbourhoods. CONCLUSIONS Several modifiable environmental risk factors were identified for child PMVCs. More walking to school was not associated with increased PMVCs after controlling for the environment. School social disadvantage was associated with higher PMVCs with differences by geographic location. These results have important implications for the design of roadways around schools.
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Affiliation(s)
- Linda Rothman
- Faculty of Health-School of Kinesiology & Health Science York University, Norman Bethune College, 4700 Keele St., Room 337 Toronto, ON M3J 1P3, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada.
| | - Andrew Howard
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada.
| | - Ron Buliung
- Department of Geography, University of Toronto Mississauga, 3359 Mississauga Road, SB3104, Mississauga, ON L5L 1C6, Canada.
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada.
| | - Sarah A Richmond
- Faculty of Health-School of Kinesiology & Health Science York University, Norman Bethune College, 4700 Keele St., Room 337 Toronto, ON M3J 1P3, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto M5G 1X8, Canada.
| | - Alison Macpherson
- Faculty of Health-School of Kinesiology & Health Science York University, Norman Bethune College, 4700 Keele St., Room 337 Toronto, ON M3J 1P3, Canada.
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Richmond SA, D'Cruz J, Lokku A, Macpherson A, Howard A, Macarthur C. Trends in unintentional injury mortality in Canadian children 1950-2009 and association with selected population-level interventions. Can J Public Health 2016; 107:e431-e437. [PMID: 28026710 DOI: 10.17269/cjph.107.5315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 09/09/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Sarah A Richmond
- School of Kinesiology and Health Science, York University, Toronto, ON; Department of Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON.
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Cox KA, Parkin PC, Anderson LN, Chen Y, Birken CS, Maguire JL, Macarthur C, Borkhoff CM, Anderson LN, Bayoumi I, Birken CS, Borkhoff CM, Carsley S, Chen Y, Katz-Lavigne M, Kavikondala K, Koroshegyi C, Kowal C, Lee GJ, Maguire JL, Mason D, Omand J, Parkin PC, Persaud N, van den Heuvel M, Wong P, Zabih W, Baker J, Barozzino T, Bonifacio J, Campbell D, Cheema S, Chisamore B, Danayan K, Das P, Derocher MB, Do A, Dorey M, Freeman S, Fung K, Guiang C, Handford C, Hatch H, Jacobson S, Kiran T, Knowles H, Kwok B, Lakhoo S, Lam-Antoniades M, Lau E, Leung FH, Loo J, Mahmoud S, Moodie R, Morinis J, Naymark S, Neelands P, Owen J, Peer M, Perlmutar M, Persaud N, Pinto A, Porepa M, Ramji N, Ramji N, Rosenthal A, Saunderson J, Saxena R, Sgro M, Shepherd S, Smiltnieks B, Taylor C, Weisdors T, Wijayasinghe S, Wong P, Ying E, Young E, Barozzino T, Chisamore B, Feldman M, Ipp M, Abreo K, Dalwadi D, Malhi T, Pugliese A, Smith M, Thompson L. Association Between Meat and Meat-Alternative Consumption and Iron Stores in Early Childhood. Acad Pediatr 2016; 16:783-791. [PMID: 26804490 DOI: 10.1016/j.acap.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 01/04/2016] [Accepted: 01/11/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To prevent iron deficiency, 2014 Canadian recommendations for healthy term infants from 6 to 24 months recommend iron-rich complementary foods such as meat and meat alternatives 2 or more times a day. The purpose of our study was to evaluate the association between meat and meat-alternative consumption and iron status in young children and the association between red meat consumption and iron status among children meeting recommendations. METHODS Healthy children aged 12 to 36 months were recruited. A cross-sectional study was conducted. Meat and meat-alternative consumption was measured using the NutriSTEP questionnaire. Adjusted multivariable regression analyses were used to evaluate an association between meat consumption and serum ferritin, and iron deficiency (serum ferritin <14 μg/L). RESULTS A total of 1043 children were included. Seventy-three percent of children met the recommended daily intake of meat and meat alternatives, and 66% ate red meat in the past 3 days. Eating meat and meat alternatives was not associated with serum ferritin (0.13 μg/L, 95% confidence interval -0.05, 0.31, P = .16), but it was associated with a decreased odds of iron deficiency (odds ratio 0.97, 95% confidence interval 0.94, 0.99, P = .03). Associations between red meat consumption and iron status were not statistically significant. Statistically significant covariates associated with increased odds of iron deficiency included longer breast-feeding duration, daily cow's milk intake of >2 cups, and a higher body mass index z score. CONCLUSIONS Daily cow's milk intake of >2 cups, longer breast-feeding duration, and a higher body mass index z score were modifiable risk factors associated with iron deficiency. Eating meat according to recommendations may be a promising additional target for the prevention of iron deficiency in early childhood.
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Affiliation(s)
- Kelly Anne Cox
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Laura N Anderson
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada
| | - Yang Chen
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario Canada; Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada.
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Rothman L, Howard A, Buliung R, Richmond SA, Macarthur C, Macpherson A. 72 Dangerous student passenger drop-off, pedestrian behaviours and the built environment near schools. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Richmond SA, Williams D, Pike I, Huyer D, Lapointe L, Macarthur C, Howard A. 524 Preventing motor vehicle-related fatalities: a collaborative project to enhance coronial data capture and use. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rothman L, Macpherson A, Buliung R, Richmond S, Macarthur C, Howard A. 403 Child pedestrian collisions, walking to school and the built envrionment: a case control study. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ryckman K, Richmond SA, Anderson L, Birken C, Parkin P, Macarthur C, Maguire J, Howard A. 461 Association between temperament and fracture risk in preschool-age children: a case control study. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rothman L, Howard A, Buliung R, Macarthur C, Macpherson A. Dangerous student car drop-off behaviors and child pedestrian-motor vehicle collisions: An observational study. Traffic Inj Prev 2016; 17:454-459. [PMID: 26759927 DOI: 10.1080/15389588.2015.1116041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The objective of this study was to examine the association between dangerous student car drop-off behaviors and historical child pedestrian-motor vehicle collisions (PMVCs) near elementary schools in Toronto, Canada. METHODS Police-reported child PMVCs during school travel times from 2000 to 2011 were mapped within 200 m of 118 elementary schools. Observers measured dangerous student morning car drop-off behaviors and number of children walking to school during one day in 2011. A composite score of school social disadvantage was obtained from the Toronto District School Board. Built environment and traffic features were mapped and included as covariates. A multivariate Poisson regression was used to model the rates of PMVC/number of children walking and dangerous student car drop-off behaviors, adjusting for the built environment and social disadvantage. RESULTS There were 45 child PMVCs, with 29 (64%) sustaining minor injuries resulting in emergency department visits. The mean collision rate was 2.9/10,000 children walking/year (SD = 6.7). Dangerous drop-off behaviors were observed in 104 schools (88%). In the multivariate analysis, each additional dangerous drop-off behavior was associated with a 45% increase in collision rates (incident rate ratio [IRR] = 1.45, 95% confidence interval [CI], 1.02, 2.07). Higher speed roads (IRR = 1.27, 95% CI, 1.13, 1.44) and social disadvantage (IRR = 2.99, 95% CI, 1.03, 8.68) were associated with higher collision rates. CONCLUSIONS Dangerous student car drop-off behaviors were associated with historical nonfatal child PMVC rates during school travel times near schools. Some caution must be taken in interpreting these results due small number of events and limitations in the data collection, because collision data were collected historically over a 12-year period, whereas driving behavior was only observed on a single day in 2011. Targeted multifaceted intervention approaches related to the built environment, enforcement, and education could address dangerous drop-off behaviors near schools to reduce child PMVCs and promote safe walking to school.
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Affiliation(s)
- Linda Rothman
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada
- b Faculty of Health, School of Kinesiology & Health Science, York University , Toronto , Canada
| | - Andrew Howard
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada
- c Orthopaedic Surgery, The Hospital for Sick Children , Toronto , Canada
- d Department of Surgery , University of Toronto , Toronto , Canada
- e Health Policy Management and Evaluation, University of Toronto , Toronto , Canada
| | - Ron Buliung
- f Department of Geography , University of Toronto Mississauga , Mississauga , Canada
| | - Colin Macarthur
- a Child Health Evaluative Sciences, The Hospital for Sick Children , Toronto , Canada
- e Health Policy Management and Evaluation, University of Toronto , Toronto , Canada
- g Department of Pediatrics , University of Toronto , Toronto , Canada
| | - Alison Macpherson
- b Faculty of Health, School of Kinesiology & Health Science, York University , Toronto , Canada
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Lindsay S, Proulx M, Maxwell J, Hamdani Y, Bayley M, Macarthur C, Colantonio A. Gender and Transition From Pediatric to Adult Health Care Among Youth With Acquired Brain Injury: Experiences in a Transition Model. Arch Phys Med Rehabil 2016; 97:S33-9. [DOI: 10.1016/j.apmr.2014.04.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 11/24/2022]
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Rothman L, Howard A, Buliung R, Macarthur C, Macpherson A. Driving behaviours near schools and child pedestrian-motor vehicle collisions in Toronto, Canada. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv173.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rothman L, Macpherson A, Buliung R, Macarthur C, To T, Larsen K, Howard A. Installation of speed humps and pedestrian-motor vehicle collisions in Toronto, Canada: a quasi-experimental study. BMC Public Health 2015; 15:774. [PMID: 26264227 PMCID: PMC4534084 DOI: 10.1186/s12889-015-2116-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/31/2015] [Indexed: 01/13/2023] Open
Abstract
Background Evidence related to the effectiveness of speed humps on reducing pedestrian-motor vehicle collisions (PMVC) has been conflicting. The purpose of this study was to determine the association between speed hump installation and changes in PMVC rates in Toronto, Canada. Methods Speed humps were mapped along with police-reported pedestrian collisions from 2000–2011 and built environment roadway characteristics. A quasi-experimental study identified collision counts before and after speed hump installation, modeled using repeated measures Poisson regression adjusted for season and roadway characteristics. Stratified analyses were conducted by age group and injury severity. Results There were 27,827 PMVC, with 1344 collisions along 409 roadways with speed humps. PMVC incidence rates/meters of road/month decreased after installation of speed humps (IRR 0.78 95 % CI 0.66, 0.91). Winter, collector roads (versus local), pre-amalgamated city centre and increased land use mix were associated with more collisions. The association between speed humps and PMVC rates decreased more for children (IRR 0.57, 95 % CI 0.41, 0.79) than for adults (IRR 0.80, 95 % CI 0.68, 0.95). Conclusions Speed humps are an easily replicated method of traffic calming which have a significant protective effect on PMVC on the roadways where they are installed, particularly for children. There is a need for an area-wide analysis to determine the effects of the installation of speed humps to ensure that PMVC are not being displaced to surrounding roadways.
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Affiliation(s)
- Linda Rothman
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada, M5G 1E2. .,Faculty of Health-School of Kinesiology & Health Science, York University, Norman Bethune College, 4700 Keele St., Room 339, Toronto, ON, Canada, M3J 1P3.
| | - Alison Macpherson
- Faculty of Health-School of Kinesiology & Health Science, York University, Norman Bethune College, 4700 Keele St., Room 339, Toronto, ON, Canada, M3J 1P3.
| | - Ron Buliung
- Department of Geography, University of Toronto Mississauga, 3359 Mississauga Road N, South Building, Mississauga, ON, Canada, L5L 1C6.
| | - Colin Macarthur
- Research Institute, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada, M5G 1E2.
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada, M5G 1E2.
| | - Kristian Larsen
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada, M5G 1E2. .,Department of Geography, University of Toronto Mississauga, 3359 Mississauga Road N, South Building, Mississauga, ON, Canada, L5L 1C6.
| | - Andrew Howard
- Orthopaedic Surgery, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada, M5G 1E2.
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Rothman L, Perry D, Buliung R, Macarthur C, To T, Macpherson A, Larsen K, Howard A. Do school crossing guards make crossing roads safer? A quasi-experimental study of pedestrian-motor vehicle collisions in Toronto, Canada. BMC Public Health 2015; 15:732. [PMID: 26227508 PMCID: PMC4520271 DOI: 10.1186/s12889-015-2065-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 07/16/2015] [Indexed: 11/24/2022] Open
Abstract
Background The presence of school crossing guards has been associated with more walking and more pedestrian-motor vehicle collisions (PMVCs) in area-level cross-sectional analyses. The objectives of the study were to (1) Determine the effect on PMVC rates of newly implemented crossing guards in Toronto, Canada (2) Determine where collisions were located in relation to crossing guards throughout the city, and whether they occurred during school travel times. Methods School crossing guards with 50 m buffers were mapped along with police-reported child PMVCs from 2000–2011. (1) A quasi-experimental study identified all age collision counts near newly implemented guards before and after implementation, modeled using repeated measures Poisson regression adjusted for season and built environment variables. (2) A retrospective cohort study of all child PMVCS throughout the city to determine the proportions of child PMVCs which occurred during school travel times and at guard locations. Results There were 27,827 PMVCs, with 260 PMVCs at the locations of 58 newly implemented guards. Repeated measures adjusted Poisson regression found PMVCs rates remained unchanged at guard locations after implementation (IRR 1.02, 95 % CI 0.74, 1.39). There were 568 guards citywide with 1850 child PMVCs that occurred at guard locations. The majority of child PMVCs occurred outside school travel times (n = 1155, 62 %) and of those that occurred during school travel times, only 95 (13.7 %) were at a guard location. Conclusions School crossing guards are a simple roadway modification to increase walking to school without apparent detrimental safety effects. Other more permanent interventions are necessary to address the frequency of child PMVCs occurring away from the location of crossing guards, and outside of school travel times.
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Affiliation(s)
- Linda Rothman
- Child Health Evaluative Sciences, Toronto, Canada. .,Faculty of Health-School of Kinesiology & Health Science, York University, Toronto, Canada.
| | - Daniel Perry
- Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada. .,Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK.
| | - Ron Buliung
- Department of Geography, University of Toronto Mississauga, Mississauga, Canada.
| | - Colin Macarthur
- Child Health Evaluative Sciences, Toronto, Canada. .,Department of Pediatrics, University of Toronto, Toronto, Canada. .,Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Teresa To
- Child Health Evaluative Sciences, Toronto, Canada. .,Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Alison Macpherson
- Faculty of Health-School of Kinesiology & Health Science, York University, Toronto, Canada.
| | - Kristian Larsen
- Child Health Evaluative Sciences, Toronto, Canada. .,Department of Geography, University of Toronto Mississauga, Mississauga, Canada.
| | - Andrew Howard
- Child Health Evaluative Sciences, Toronto, Canada. .,Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada. .,Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
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Abdullah K, Thorpe KE, Mamak E, Maguire JL, Birken CS, Fehlings D, Hanley AJ, Macarthur C, Zlotkin SH, Parkin PC. An internal pilot study for a randomized trial aimed at evaluating the effectiveness of iron interventions in children with non-anemic iron deficiency: the OptEC trial. Trials 2015; 16:303. [PMID: 26170014 PMCID: PMC4501099 DOI: 10.1186/s13063-015-0829-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background The OptEC trial aims to evaluate the effectiveness of oral iron in young children with non-anemic iron deficiency (NAID). The initial sample size calculated for the OptEC trial ranged from 112–198 subjects. Given the uncertainty regarding the parameters used to calculate the sample, an internal pilot study was conducted. The objectives of this internal pilot study were to obtain reliable estimate of parameters (standard deviation and design factor) to recalculate the sample size and to assess the adherence rate and reasons for non-adherence in children enrolled in the pilot study. Methods The first 30 subjects enrolled into the OptEC trial constituted the internal pilot study. The primary outcome of the OptEC trial is the Early Learning Composite (ELC). For estimation of the SD of the ELC, descriptive statistics of the 4 month follow-up ELC scores were assessed within each intervention group. The observed SD within each group was then pooled to obtain an estimated SD (S2) of the ELC. Correlation (ρ) between the ELC measured at baseline and follow-up was assessed. Recalculation of the sample size was performed using analysis of covariance (ANCOVA) method which uses the design factor (1- ρ2). Adherence rate was calculated using a parent reported rate of missed doses of the study intervention. Conclusion The new estimate of the SD of the ELC was found to be 17.40 (S2). The design factor was (1- ρ2) = 0.21. Using a significance level of 5 %, power of 80 %, S2 = 17.40 and effect estimate (Δ) ranging from 6–8 points, the new sample size based on ANCOVA method ranged from 32–56 subjects (16–28 per group). Adherence ranged between 14 % and 100 % with 44 % of the children having an adherence rate ≥86 %. Information generated from our internal pilot study was used to update the design of the full and definitive trial, including recalculation of sample size, determination of the adequacy of adherence, and application of strategies to improve adherence. Trial registration ClinicalTrials.gov Identifier: NCT01481766 (date of registration: November 22, 2011). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0829-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kawsari Abdullah
- Division of Pediatric Medicine, Department of Pediatrics, Pediatrics Outcomes Research Team, The Hospital for Sick Children, Room 109708, 10th Floor, 555 University Avenue, M5G 1X8, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6, Toronto, Canada.
| | - Kevin E Thorpe
- The Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada.
| | - Eva Mamak
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, ON, Canada.
| | - Jonathon L Maguire
- Division of Pediatric Medicine, Department of Pediatrics, Pediatrics Outcomes Research Team, The Hospital for Sick Children, Room 109708, 10th Floor, 555 University Avenue, M5G 1X8, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6, Toronto, Canada. .,The Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada. .,Department of Pediatrics, St. Michael's Hospital, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Catherine S Birken
- Division of Pediatric Medicine, Department of Pediatrics, Pediatrics Outcomes Research Team, The Hospital for Sick Children, Room 109708, 10th Floor, 555 University Avenue, M5G 1X8, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, floor 10, room#109832, M5G 0A4, Toronto, ON, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Darcy Fehlings
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada. .,Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, and Bloorview Research Institute, 150 Kilgour Road, M4G 1R8, Toronto, ON, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Anthony J Hanley
- Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada. .,Department of Nutritional Sciences, University of Toronto, FitzGerald Building, 150 College Street, Room 316, M5S 3E2, Toronto, ON, Canada. .,Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Colin Macarthur
- Division of Pediatric Medicine, Department of Pediatrics, Pediatrics Outcomes Research Team, The Hospital for Sick Children, Room 109708, 10th Floor, 555 University Avenue, M5G 1X8, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada. .,Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, M5G 0A4, Toronto, ON, Canada.
| | - Stanley H Zlotkin
- Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, floor 10, room#109832, M5G 0A4, Toronto, ON, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada. .,Department of Nutritional Sciences, University of Toronto, FitzGerald Building, 150 College Street, Room 316, M5S 3E2, Toronto, ON, Canada. .,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, M5G 1X8, Toronto, Canada. .,Centre for Global Child Health, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada.
| | - Patricia C Parkin
- Division of Pediatric Medicine, Department of Pediatrics, Pediatrics Outcomes Research Team, The Hospital for Sick Children, Room 109708, 10th Floor, 555 University Avenue, M5G 1X8, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3M7, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, floor 10, room#109832, M5G 0A4, Toronto, ON, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
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