Injuries in recreational curling include head injuries and may be prevented by using proper footwear.

INTRODUCTION: Our study examines a recreational curling population to describe patterns of injury occurrence, estimate risk of injury and to gauge attitudes towards equipment-based prevention strategies. METHODS: In a retrospective case series, we queried the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national injury surveillance database, for curling injuries entered between 1993 and 2011. Kingston General Hospital and Hotel Dieu Hospital provide the two Kingston, Ontario, sites for emergency department (ED) care and participate in CHIRPP. Each retrieved entry underwent a chart review. A secondary survey was mailed to select individuals who had experienced curling injuries to solicit details on their injury and attitudes towards equipment to prevent injury. We used descriptive statistics for rates and proportions. RESULTS: Over 90% of acute curling injuries resulted from a fall, and 31.7% were head impacts. We found that acute injuries requiring ED presentation occur at a rate of approximately 0.17 per 1000 athlete-exposures (95% CI: 0.12-0.22). The secondary survey was completed by 54% of potential respondents. Of survey respondents, 41.3% attributed their fall to a lack of proper footwear and 73.5% of respondents agreed with mandatory sport-specific footwear as a prevention strategy, but only 8% agreed with mandatory helmet wear. CONCLUSION: Although curling injuries requiring medical care are not common, head injuries make up a large proportion. Mandated use of appropriate footwear appears to be the most effective prevention strategy, as well as the measure deemed most acceptable by players.

TITRE: Les traumatismes crâniens font partie des blessures associées au curling récréatif qui peuvent être évitées en portant des chaussures appropriées. INTRODUCTION: Notre étude s'intéresse à une population de joueurs de curling et vise à décrire la fréquence des blessures, à estimer le risque de se blesser et à évaluer l'opinion des joueurs à l'égard des stratégies de prévention axées sur l'équipement. MÉTHODOLOGIE: Dans le cadre d'une étude de série de cas rétrospective, nous avons fait des recherches dans le Système canadien hospitalier d'information et de recherche en prévention des traumatismes (SCHIRPT), une base de données nationale pour la surveillance des blessures, en vue d'y repérer les blessures subies au curling répertoriées entre 1993 et 2011. L'Hôpital général de Kingston et l'Hôpital Hôtel-Dieu sont les deux hôpitaux de Kingston (Ontario) qui offrent des services d'urgence et qui font partie du réseau du SCHIRPT. Pour chaque entrée trouvée, nous avons procédé à l'analyse du dossier du patient. Un sondage complémentaire a été envoyé à certaines personnes ayant subi des blessures au curling afin d'en connaître les détails et de savoir ce qu'elles pensent du port d'un équipement comme mesure de prévention. Nous avons utilisé des statistiques descriptives pour les taux et les proportions. RÉSULTATS: Plus de 90 % des blessures graves au curling résultent d'une chute et 31,7 % des cas de blessures graves sont constitués de choc à la tête. Nous avons calculé que le taux de blessures graves qui nécessitent une consultation aux services d'urgence est approximativement de 0,17 pour 1 000 athlètes exposés (intervalle de confiance à 95 % : de 0,12 à 0,22). Le sondage complémentaire a été rempli par 54 % des joueurs blessés ciblés. Parmi eux, 41,3 % attribuent leur chute à l'absence de chaussures appropriées. Concernant les stratégies de prévention, 73,5 % des répondants étaient d'accord avec la suggestion du port obligatoire de chaussures spécialisées, mais seulement 8 % avec celle du port obligatoire du casque. CONCLUSION: Bien que les blessures subies au curling qui nécessitent des soins médicaux ne soient pas courantes, les traumatismes crâniens représentent une proportion importante de ces blessures. Le port obligatoire de chaussures appropriées semble constituer la mesure de prévention la plus efficace et la plus acceptable pour les joueurs.

Patterns of fatal machine rollovers in Canadian agriculture.

INTRODUCTION: Our objectives were to examine the activities and circumstances associated with agricultural machine-related rollover fatalities. METHODS: We identified agricultural machine rollover fatalities recorded by the Canadian Agricultural Injury Surveillance Program (CAISP) in 1990-2005. We determined sideways and backwards rollovers by year, age and sex of the victims, agricultural season, machine type, and the activity, circumstances and location of the injury event. RESULTS: The annual rate of rollover fatalities in Canada was 9.1 per 100,000 farm operations. Rollover fatalities decreased to 30% of baseline over the 16-year study period (p = .004). Fatal rollovers most often occurred among men aged 50-69 years and 60-79 years for sideways and backwards rollovers, respectively. DISCUSSION: Sideways rollovers occur when driving across an incline or at the edge of a ditch bordering a roadway or field. Backwards rollovers occur when driving up an incline, towing or extracting stuck machines, pulling stumps or trees, and towing implements or logs. Primary prevention programs for rollover injuries should target these identified patterns of injury.

Identifying predictors of medically-attended injuries to young children: do child or parent behavioural attributes matter?

OBJECTIVE: To investigate whether one can differentiate injured and uninjured young children based on child behavioural attributes or indices of caregiver supervision. METHOD: A matched case-control design was used in which case participants were children presenting to an emergency department for treatment for an injury and age/sex matched control participants presented for illness-related reasons. During structured phone interviews about supervision parents reported on general supervisory practices (standardised questionnaire) and specific practices corresponding to time of injury (cases) or the last time their child engaged in the activity that incited their match's injury (controls). Parents also reported on child behavioural attributes that have been linked to child risk taking in prior research (inhibitory control, sensation seeking). RESULTS: Results revealed no group differences in child behavioural attributes; however, the control group received more supervision both in general (OR = 4.82, 95% CI 1.89 to 12.33) and during the specified activity that led to injury in cases (OR = 5.38, 95% CI 2.13 to 13.58). CONCLUSION: These findings confirm past speculation that caregiver supervision influences children's risk of medically-attended injury and highlight the importance of targeting supervision in child-injury prevention interventions.

Prevention of agricultural injuries: an evaluation of an education-based intervention.

OBJECTIVE: To evaluate the effectiveness of an agricultural health and safety program in reducing risks of injury. DESIGN: Cross-sectional survey. SETTING: 50 rural municipalities in the Province of Saskatchewan, Canada. INTERVENTION: The Agricultural Health and Safety Network (AHSN), a mainly educational program that administered 112 farm safety interventions over 19 years. SUBJECTS: 5292 farm people associated with 2392 Saskatchewan farms. Farms and associated farm people were categorized into three groups according to years of participation in the AHSN. IMPACT: self-reported prevalence of: (1) farm safety practices; (2) physical farm hazards. OUTCOME: (1) self-reported agricultural injuries. RESULTS: After adjustment for group imbalances and clustering at the rural municipality level, the prevalence of all impact and outcome measures was not significantly different on farms grouped according to years of AHSN participation. To illustrate, the adjusted relative risk of reporting no rollover protection on tractors among farms with none (0 years) versus high (>8 years) levels of AHSN participation was 0.95 (95% CI 0.69 to 1.30). The adjusted relative risk for agricultural injuries (all types) reported for the year before the survey was 0.99 (95% CI 0.74 to 1.32). CONCLUSIONS: Educational interventions delivered via the AHSN program were not associated with observable differences in farm safety practices, physical farm hazards, or farm-related injury outcomes. There is a need for the agricultural sector to extend the scope of its injury prevention initiatives to include the full public health model of education, engineering, and regulation.

Head injuries in youth soccer players presenting to the emergency department.

BACKGROUND: There has been recent concern about neuropsychological injuries experienced by soccer players, particularly related to the purposeful heading of the ball. There are few population based analyses examining whether this is a legitimate concern. OBJECTIVES: To explore, using an existing injury surveillance system, one of many parts of this issue: acute injuries requiring emergency medical care experienced by youth soccer players. METHODS: Descriptive epidemiological analysis of emergency department injury surveillance data (1996-2001) for youths aged 10-24 years from the Kingston sites of the Canadian Hospital Injury Reporting and Prevention Program. RESULTS: A total of 1714 cases of soccer injury were identified (mean 286 a year); 235 (13.7%) involved diagnoses of injuries to the head. Leading mechanical factors resulting in head injury were contact with other players or persons (153/235; 65.1%) and balls (62/235; 26.4%). Heading was reported in 4/62 (6%) of the ball contact injuries, and attempted heading was reported in 15/153 (9.8%) of the cases involving person to person contact. Unspecified head to head contact between players was reported in 39 cases. CONCLUSIONS: Minor head injuries that result in emergency medical treatment do not happen often in youth soccer, and very few can be attributed to the purposeful heading of the ball. Player contact injuries appear to be a more important injury control concern. This study informs one of many aspects of the soccer heading injury debate.

Pediatric farm injuries involving non-working children injured by a farm work hazard: five priorities for primary prevention.

OBJECTIVES: To describe pediatric farm injuries experienced by children who were not engaged in farm work, but were injured by a farm work hazard and to identify priorities for primary prevention. DESIGN: Secondary analysis of data from a novel evaluation of an injury control resource using a retrospective case series. DATA SOURCES: Fatal, hospitalized, and restricted activity farm injuries from Canada and the United States. SUBJECTS: Three hundred and seventy known non-work childhood injuries from a larger case series of 934 injury events covering the full spectrum of pediatric farm injuries. METHODS: Recurrent injury patterns were described by child demographics, external cause of injury, and associated child activities. Factors contributing to pediatric farm injury were described. New priorities for primary prevention were identified. RESULTS: The children involved were mainly resident members of farm families and 233/370 (63.0%) of the children were under the age of 7 years. Leading mechanisms of injury varied by data source but included: bystander and passenger runovers (fatalities); drowning (fatalities); machinery entanglements (hospitalizations); falls from heights (hospitalizations); and animal trauma (hospitalizations, restricted activity injuries). Common activities leading to injury included playing in the worksite (all data sources); being a bystander to or extra rider on farm machinery (all data sources); recreational horseback riding (restricted activity injuries). Five priorities for prevention programs are proposed. CONCLUSIONS: Substantial proportions of pediatric farm injuries are experienced by children who are not engaged in farm work. These injuries occur because farm children are often exposed to an occupational worksite with known hazards. Study findings could lead to more refined and focused pediatric farm injury prevention initiatives.

Evaluation of the North American Guidelines for Children's Agricultural Tasks using a case series of injuries.

OBJECTIVE: To evaluate the potential for the North American Guidelines for Children's Agricultural Tasks (NAGCAT) to prevent the occurrence of pediatric farm injuries. This evaluation focuses upon farm injuries experienced when children were engaged in farm work. DESIGN: Novel outcome evaluation involving primary review of three retrospective case series. SETTING: Fatal, hospitalized, and restricted activity injuries from the United States and Canada. SUBJECTS: Nine hundred and thirty four pediatric farm injury cases. METHODS: The applicability of NAGCAT to each case was rated. For injuries where NAGCAT were applicable, recurrent injury patterns were described and the potential for NAGCAT to prevent their occurrence was assessed. RESULTS: A total of 283 (30.3%) cases involved children engaged in farm work. There was an applicable NAGCAT guideline in 64.9% of the work related cases. Leading individual guidelines applicable to the injury events were: (1) working with large animals; (2) driving a farm tractor; and (3) farm work with an all-terrain vehicle. In the judgment of the research team, 59.6% of these injuries were totally preventable if the principles espoused by NAGCAT had been applied. CONCLUSIONS: NAGCAT are a set of consensus guidelines aimed at the prevention of pediatric farm injuries. The findings suggest that NAGCAT, if applied, would be efficacious in preventing many of the most serious injuries experienced by children engaged in farm work. However, work related injuries represent only a modest portion of pediatric farm injuries. This new information assists in the refinement of NAGCAT as an injury control resource and puts its potential efficacy into context.

Gender differences in the occurrence of farm related injuries.

AIMS: To use national surveillance data in Canada to describe gender differences in the pattern of farm fatalities and severe injuries (those requiring hospitalisation). METHODS: Data from the Canadian Agricultural Injury Surveillance Program (CAISP) included farm work related fatalities from 1990 to 1996 for all Canadian provinces and abstracted information from hospital discharge records from eight provinces for the five fiscal years of 1990 to 1994. Gender differences in fatalities and injuries were examined by comparison of proportions and stratified by sex, injury class (machinery, non-machinery), and age group. RESULTS: Over the six year period of 1990 to 1996 there were approximately 11 times as many agriculture related fatalities for males compared to females (655 and 61, respectively). The most common machinery mechanisms of fatal injuries were roll-over (32%) for males and run-over (45%) for females. Agricultural machinery injuries requiring hospitalisation showed similar patterns, with proportionally more males over age 60 injured. The male:female ratio for non-machinery hospitalisations averaged 3:1. A greater percentage of males were struck by or caught against an object, whereas for females, animal related injuries predominated. CONCLUSIONS: Gender is an important factor to consider in the interpretation of fatal and non-fatal farm injuries. A greater number of males were injured, regardless of how the occurrence of injury was categorised, particularly when farm machinery was involved. As women increasingly participate in all aspects of agricultural production, there is a need to collect, interpret, and disseminate information on agricultural injury that is relevant for both sexes.

A population-based study of potential brain injuries requiring emergency care.

BACKGROUND: Brain injury is an important health concern, yet there are few population-based analyses on which to base prevention initiatives. This study aimed, first, to calculate rates of potential brain injury within a defined Canadian population and, second, to describe the external causes, natures and disposition from the emergency department of these injuries. METHODS: We studied all cases of blunt head injury that resulted in a visit to an emergency department for all residents of Greater Kingston during 1998. We used data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) and augmented this by examining all records of emergency or inpatient care received at all hospitals in the area. RESULTS: In 202 (27%) of 760 cases of head injury, there was potential for brain injury. Annual rates of potential brain injury were 16 and 7 per 10,000 population for males and females respectively. CT was performed on 114 (56%) of 202 cases, of which 60 (53%) demonstrated an intracranial pathology, with 11 (10%) showing a diffuse axonal injury pattern on the initial scan. Falls from heights accounted for 14 (47%) of 30 injuries observed in children aged 0-9 years. Individuals aged 10-44 years sustained 32 (63%) of 51 motor vehicle injuries, 15 (88%) of 17 bicycle injuries, 22 (100%) of 22 sports injuries and 8 (89%) of 9 fight-related injuries. Falls accounted for 15 (71%) of 21 injuries among adults aged 65 years or more. INTERPRETATION: The results indicate the relative importance of several external causes of injury. The findings from our geographically distinct population are useful in establishing rational priorities for the prevention of brain injury.

Surveillance of hospitalized farm injuries in Canada.

OBJECTIVE: To provide an overview of hospital admissions for the treatment of farm injuries. DESIGN: descriptive analysis of data from the Canadian Agricultural Injury Surveillance Program (CAISP). POPULATION: persons experiencing a farm injury requiring hospitalization, April 1991 to March 1995. Access to hospital separation data was negotiated within Canadian provinces. Individual cases were verified by medical records personnel and supplemental data describing injury circumstances were obtained. ANALYSIS: descriptive analyses characterizing farm injuries by: persons involved, mechanisms, primary diagnoses, and agents of injury. RESULTS: Data from 8/10 Canadian provinces representing 98% of the farm population were obtained. A total of 8,263 farm injuries were verified. Adults aged 60 years and older were over-represented in these injuries. Leading external causes of agricultural machinery injury included entanglements, being pinned/struck by machinery, falls, and runovers. Non-machinery causes included falls from heights, animal related trauma, and being struck/by against objects. Leading diagnoses varied by age group, but included: limb fractures/open wounds, intracranial injuries, skull fractures, and spinal/ truncal fractures. CONCLUSIONS: CAISP is a new agricultural injury surveillance program in Canada. Data from this system are actively used to inform prevention initiatives, and to indicate priorities for etiological and experimental research in the Canadian agricultural setting.

Prognostic value of the Quebec Classification of Whiplash-Associated Disorders.

STUDY DESIGN: Retrospective cohort. OBJECTIVES: 1) Evaluate the utility of the Québec Classification of Whiplash-Associated Disorders as an initial assessment tool; 2) assess its ability to predict persistence of symptoms at 6, 12, 18, and 24 months postcollision; 3) examine one potential modification to the Classification. SUMMARY OF BACKGROUND DATA: In 1995, a task force from Québec, Canada, developed the Québec Classification of Whiplash-Associated Disorders to assist health care workers in making therapeutic decisions. The Classification was applied to an inception cohort of patients presenting for emergency medical care following their involvement in a rear-end motor vehicle collision. METHODS: All patients (n = 446) presenting to the only two emergency departments serving Kingston, Ontario, between October 1, 1995 and March 31, 1998 were considered for inclusion in the study. Eligible patients (n = 380) were categorized according to the Classification based on signs and symptoms documented in their emergency medical chart. Attempts were made to interview all patients shortly following and again 6 months after their collision. Patients were contacted at 12, 18, and 24 months postinjury only if sufficient time had elapsed between recruitment into and cessation of the study. Data were gathered regarding symptoms, treatments received, effects on usual activities, crash circumstances, and personal factors. Associations between initial Classification grade and the frequency/intensity of follow-up symptoms were quantified via multivariable analyses. RESULTS: The Classification was prognostic in that risk for Whiplash-Associated Disorders at 6, 12, 18, and 24 months increased with increasing grade. Analyses supported modification of the Classification to distinguish between Grade II cases of Whiplash-Associated Disorders with normal or limited range of motion. The greatest risk for long-term symptoms was seen among the group of patients with both point tenderness and limited range of motion. CONCLUSION: The analyses of this study support the use of the Québec Classification of Whiplash-Associated Disorders as a prognostic tool for emergency department settings, and the authors propose a modification of the Classification using a subdivision of the Grade II category.

Socioeconomic differences in childhood injury: a population based epidemiologic study in Ontario, Canada.

OBJECTIVE: To determine whether risks for childhood injury vary according to socioeconomic gradients. DESIGN: Population based, retrospective study. The percentage of individuals living below the poverty line (described ecologically using census data) was the primary measure of socioeconomic status. SETTING: Catchment area of a tertiary medical centre that provides emergency services to all area residents. Area residents aged 0-19 years during 1996 were included. OBSERVATIONS: Injuries that occurred during 1996 were identified by an emergency department based surveillance system. The study population was divided into socioeconomic grades based upon percentages of area residents living below the poverty line. Multiple Poisson regression analyses were used to quantify associations and assess the statistical significance of trends. RESULTS: 5894 childhood injuries were identified among 35380 eligible children; 985 children with missing socioeconomic data were excluded. A consistent relation between poverty and injury was evident. Children in the highest grade (indicating higher poverty levels) experienced injury rates that were 1.67 (95% confidence interval 1.48 to 1.89) higher than those in the lowest grade (adjusted relative risk for grades 1-V: 1.00,1.10,1.22,1.42, 1.67; Ptrend < 0.001). These patterns were observed within age/sex strata; for home, recreational, and fall injuries; and for injuries of minor and moderate severities. CONCLUSIONS: Socioeconomic differences in childhood injury parallel mortality and morbidity gradients identified in adult populations. This study confirms that this health gradient is observable in a population of children using emergency department data. Given the population based nature of this study, these findings are likely to be reflected in other settings. The results suggest the need for targeted injury prevention efforts among children from economically disadvantaged populations, although the exact requirements of the optimal prevention approach remain elusive.

Justification of pulse oximeter costs for paramedic prehospital providers.

OBJECTIVE: To assess the potential cost savings of decreasing prehospital oxygen utilization by using pulse oximetry to identify those patients who do not require supplemental oxygen. METHODS: A prospective, controlled trial was performed comparing rates of oxygen utilization by paramedics with and without access to pulse oximetry. Consecutive patient encounters over a ten-week period were randomized by day of presentation. Pulse oximeters were made available on alternate days. On those days, patients whose oxygen saturations were less than 95% were treated with supplemental oxygen. RESULTS: The use of pulse oximeters incurred a saving of 0.14 "D"-size oxygen cylinders per call. For the authors' service, this translates to a potential saving of $2,324 (C)/vehicle/year. CONCLUSION: For regions with patient demographics similar to the authors', the initial cost of providing paramedics with pulse oximeters may be offset by savings in oxygen consumption. A formula is provided to allow individual ambulance services to calculate the potential savings for their service.

Youth injury data in the Canadian Hospitals Injury Reporting and Prevention Program: do they represent the Canadian experience?

OBJECTIVE: Injuries to Canadian youth (11-15 years) identified from a population based health survey (World Health Organization-Health Behaviour in School-Aged Children Survey, or WHO-HBSC) were compared with youth injuries from a national, emergency department based surveillance system. Comparisons focused on external causes of injury, and examined whether similar rankings of injury patterns and hence priorities for intervention were identified by the different systems. SETTING: The Canadian version of the WHO-HBSC was conducted in 1998. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is the national, emergency room based, surveillance program. Two hospitals involved in CHIRPP collectively provide population based data for Kingston, Ontario. METHOD: Numbers of injuries selected for study varied by data source: WHO-HBSC (n=3673); CHIRPP (n=20,133); Kingston CHIRPP (n=1944). WHO-HBSC and Kingston CHIRPP records were coded according to four variables in the draft International Classification of External Causes of Injury. Existing CHIRPP codes were available to compare Kingston and other CHIRPP data by five variables. Males and females in the three datasets were ranked according to the external causes. Data classified by source and sex were compared using Spearman's rank correlation statistic. RESULTS: Rank orders of four variables describing external causes were remarkably similar between the WHO-HBSC and Kingston CHIRPP (p>0.78; p<0.004) for mechanism, object, location, and activity). The Kingston and other CHIRPP data were also similar (p>0.87; p<0.001) for the variables available to describe external causes of injury (including intent). CONCLUSION: The two subsets of the CHIRPP data and the WHO-HBSC data identified similar priorities for injury prevention among young people. These findings indicate that CHIRPP may be representative of general youth injury patterns in Canada. Our study provides a novel and practical model for the validation of injury surveillance programs.

Fatal work-related farm injuries in Canada, 1991-1995. Canadian Agricultural Injury Surveillance Program.

BACKGROUND: Studies from other developed countries have shown that agriculture is among the most dangerous occupational sectors in terms of work-related deaths. The authors describe the occurrence of fatal work-related farm injuries in Canada and compare these rates with those in other Canadian industries. METHODS: The authors present a descriptive, epidemiological analysis of data from the recently established Canadian Agricultural Injury Surveillance Program. The study population comprised Canadians who died from work-related farm injuries between 1991 and 1995. Crude, age-standardized, age-specific and provincial rates of such injuries are presented, as are overall death rates in other Canadian industries. Other factors examined were the people involved, the mechanism of injury, and the place and time of injury. RESULTS: There were 503 deaths from work-related farm injuries during the study period, for an overall annual rate of 11.6 deaths per 100,000 farm population. Modest excesses in this rate were observed in Ontario, Quebec and the Atlantic provinces. High rates were observed among men of all ages and among elderly people. Among the cases that listed the person involved, farm owner-operators accounted for 60.2% of the people killed. There was no substantial increase or decrease in the annual number of deaths over the 5 years of study. The leading mechanisms of fatal injury included tractor rollovers, blind runovers (person not visible by driver), extra-rider runovers, and entanglements in machinery. Compared with other industries, agriculture appears to be the fourth most dangerous in Canada in terms of fatal injury, behind mining, logging and forestry, and construction. INTERPRETATION: Canada now has a national registry for the surveillance of fatal farm injuries. Farming clearly is among the most dangerous occupations in Canada in terms of fatal work-related injuries. Secondary analyses of data from this registry suggest priorities for prevention, continued surveillance and in-depth research.

The injury experience observed in two emergency departments in Kingston, Ontario during 'ice storm 98'.

OBJECTIVES: 1) To describe patterns of unintentional injury presenting for emergency medical care in Kingston, Ontario following the ice storm in January 1998; and 2) to provide recommendations for prevention during such situations. METHODS: Unintentional injuries related to the ice storm that presented at the two emergency departments in Kingston, Ontario were identified and described. RESULTS: A total of 254 injuries were identified. Injuries peaked the day following the onset of the ice storm and again 4-6 days following the storm. Common sources of injury included slips and falls on the ice (56%), activities related to clearing brush or trees (15%), and unintentional carbon monoxide poisonings (9%). CONCLUSIONS: While the number of injuries that presented during the storm and its aftermath was not unusual, the distribution of injuries by type did reflect the irregular nature of environmental conditions. This analysis provides useful information for public officials to use reviewing disaster plans and to generate recommendations for managing future occurrences.

Work-related mortality among older farmers in Canada.

OBJECTIVE: To describe the frequency and circumstances of work-related, fatal injuries among older farmers in Canada (1991 to 1995). DESIGN: Descriptive, epidemiologic analysis of data from the Canadian Agricultural Injury Surveillance Program. SETTING: Canada. PARTICIPANTS: Farmers aged 60 and older who died from work-related injuries from 1991 through 1995. METHOD: Age-adjusted mortality rates were calculated using the Canadian farm population as a standard for people involved, mechanism of injury, and place and time of injury. MAIN FINDINGS: The 183 work-related fatalities observed produced an overall mortality rate of 32.8 per 100,000 population per year. Higher fatality rates were observed in Quebec and the Atlantic Provinces. Almost all of those who died (98%) were men. Farm owner-operators accounted for 82.8% of the deaths (where the relationship of the person to the farm owner was reported). Leading mechanisms of fatal injury included tractor rollovers, being struck or crushed by objects, and being run over by machinery. Many older farmers appeared to be working alone at the time of injury. CONCLUSIONS: The data suggest that older farmers died while performing tasks common to general farm work, that most were owner-operators, and that many were working alone at the time of death. Innovative ways to reduce work-related injuries in this population must be found.

Suicide mortality and pesticide use among Canadian farmers.

BACKGROUND: An exploratory, case-control study was used to investigate a new hypothesis about suicide among farm operators. This hypothesis suggested a biologically plausible link between exposures to certain pesticides and the occurrence of suicide among farm operators. These analyses were based on data from the Canadian Farm Operator Cohort. METHODS: Canadian male farm operators who committed suicide between 1971-1987 (n = 1,457) were compared with a frequency matched (by age and province) sample of control farm operators (n = 11,656) who were alive at the time of death of individual cases. Comparisons focused on past exposures to pesticides reported to the 1971 Canada Census of Agriculture. RESULTS: Multivariate logistic regression analyses indicated no associations between suicide and (1) acres sprayed with herbicides, (2) acres sprayed with insecticides, and (3) the costs of agricultural chemicals purchased; after controlling for important covariates. There was, however, a suggestive increase in risk for suicide associated with herbicide and insecticide spraying among a subgroup of farm operators who were most likely to be directly exposed to pesticides: OR = 1.71 (95% CI = 1.08-2.71) for 1-48 vs. 0 acres sprayed. Additional risk factors that were identified included seasonal vs. year-round farm work (OR = 1.68; 95% CI = 1.15-2.46); and high levels of paid labor on the farm (e.g., OR = 1.61; 95% CI = 1.24-2.10, for > 13 vs. 0 weeks per year). Factors that were protective included marriage (odds ratio (OR) = 0.69; 95% confidence interval (CI) = 0.58-0.81), having more than one person resident in the farm house (e.g., two vs. one person; OR = 0.62; 95% CI = 0.42-0.92); and higher levels of education (e.g., postsecondary vs. primary; OR = 0.40; 95% CI = 0.17-0.96). CONCLUSIONS: This study does not provide strong support for the main hypothesis under study, that exposure to pesticides is an important risk factor for suicide among farmers. Although secondary to the main hypothesis, a number of other risk factors for suicide were suggested. These have implications for the future study and targeting of suicide prevention programs in rural Canada.

A case-control study of risk factors for playground injuries among children in Kingston and area.

OBJECTIVE: To determine the risk for injury associated with environmental hazards in public playgrounds. SETTING: One hundred and seventeen playgrounds operated by municipalities or school boards in and around Kingston, Ontario, Canada. METHODS: A regional surveillance database was used to identify children presenting to emergency departments who were injured on public playgrounds; each case was individually matched (by sex, age, and month of occurrence) with two controls--one non-playground injury control, and one child seen for non-injury emergency medical care. Exposure data were obtained from an audit of playgrounds conducted using Canadian and US safety guidelines. Exposure variables included the nature of playground hazards, number of hazards, frequency of play, and total family income. No difference in odds ratios (ORs) were found using the two sets of controls, which were therefore combined for subsequent analysis. RESULTS: Multivariate analysis showed strong associations between injuries and the use of inappropriate surface materials under and around equipment (OR 21.0, 95% confidence interval (CI) 3.4 to 128.1), appropriate materials with insufficient depth (OR 18.2, 95% CI 3.3 to 99.9), and inadequate handrails or guardrails (OR 6.7, 95% CI 2.6 to 17.5). CONCLUSION: This study confirms the validity of guidelines for playground safety relating to the type and depth of surface materials and the provision of handrails and guardrails. Compliance with these guidelines is an important means of preventing injury in childhood.