Knee confidence in youth and young adults at risk of post-traumatic osteoarthritis 3-10 years following intra-articular knee injury.

OBJECTIVES: To examine differences in knee confidence between individuals with a history of youth sport-related knee injury and uninjured controls. DESIGN: Historical cohort study. METHODS: Participants include 100 individuals who sustained a youth sport-related intra-articular knee injury 3-10 years previously and 100 age-, sex- and sport-matched uninjured controls. Outcomes included: Knee confidence (Knee Osteoarthritis and Outcome Score); fat mass index (FMI; dual-energy X-ray absorptiometry); and weekly physical activity (modified Godin-Shephard Leisure Time Questionnaire). Mean within-pair differences (95% CI) were calculated for all outcomes. Unadjusted and adjusted (FMI and physical activity) conditional (matched-design) logistic regression (OR 95% CI) examined the association between injury history and knee confidence. RESULTS: Median age of participants was 22 years (range 15-26) and median age at injury was 16 years (range 9-18). Forty-nine percent (95% CI; 39.0, 59.0) of previously injured participants were bothered by knee confidence, compared to 12% (5.5, 18.5) of uninjured participants. Although there was no between group difference in physical activity, injured participants had higher FMI compared to controls (within-pair difference; (95% CI): 1.05kg/m2; (0.53, 1.57)). Logistic regression revealed that injured participants had 5.0 (unadjusted OR; 95% CI; 2.4, 10.2) and 7.5 times (adjusted OR; 95% CI: 2.7, 21.1) greater odds of being bothered by knee confidence than controls. CONCLUSIONS: Knee confidence differs between individuals with a previous youth sport-related knee injury and healthy controls. Knee confidence may be an important consideration for evaluating osteoarthritis risk after knee injury and developing secondary prevention strategies.

Ecological analyses of the associations between injury risk and socioeconomic status, geography and Aboriginal ethnicity in British Columbia, Canada.

BACKGROUND: The current study examines what factors contribute to higher injury risk among Aboriginal peoples, compared to the total British Columbia (BC) population. We explore socioeconomic, geographic, and cultural factors, and combinations of these factors, that contribute to increased injury risk for Aboriginal peoples. This follows from our previously reported findings of improvements in injury risk over time for both the total and Aboriginal populations. DATA AND METHODS: We use provincial population-based linked health care databases of hospital discharge records. We identify three population groups: total BC population, and Aboriginal populations living off-reserve, or on-reserve. For each group we calculate age and gender-standardized relative risks (SRR) of injury-related hospitalization, relative to the total population of BC, for two 5-year time periods (1999-2003, and 2004-2008). We use custom data from the 2001 and 2006 long-form Censuses that described income, education, employment, housing conditions, proportion of urban dwellers, proportion of rural dwellers, and prevalence of Aboriginal ethnicity. We use multivariable linear regression to examine the associations between the census characteristics and SRR of injury. RESULTS: The best-fitting model was an excellent fit (R(2) = 0.905, p < 0.001) among the three population groups within Health Service Delivery Areas of BC. We find indicators in all three categories (socioeconomic, geographic, and cultural) are associated with disparity in injury risk. While the socioeconomic indicators (income, education, housing, employment) were shown to be highly correlated, only living in housing that needs major repair and occupational hazardousness, along with rural residence and Aboriginal ethnicity, remained in the final model. Our data show that cultural density is not associated with injury risk for Aboriginal peoples, and that living off-reserve is associated with reduced injury by improving socioeconomic and geographic conditions (compared to living on-reserve). Finally, our analyses show that Aboriginal status itself is associated with injury risk. CONCLUSIONS: Our findings confirm previous research indicating that geographical differences differentiate injury risk, including for Aboriginal populations, and that socioeconomic determinants are associated with health risks. Our analyses showing that Aboriginal status itself contributes to injury risk is new, but we can only speculate about pathway, and whether the causes are direct or indirect.

Injuries and helmet use related to non-motorized wheeled activities among pediatric patients.

INTRODUCTION: Patients presenting to emergency departments (ED) for injuries resulting from recreational activities represent a unique source of information on important directions for injury prevention efforts. We describe the epidemiology of non-motorized wheeled activity-related injury in pediatric patients presenting to Canadian EDs as well as patients' helmet use. METHODS: Data for the years 2004 to 2009 were abstracted from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national ED injury surveillance program in fifteen hospitals. RESULTS: Most of the 28 618 children aged 1 to 16 years injured during non-motorized wheeled activities were injured while cycling, followed by skateboarding. Most injuries occurred among boys. Children injured on scooters tended to be younger whereas skateboarders were the oldest. On average, the number of all injuries decreased by 6% over the time period. Falls were the most common mechanism of injury; 8.3% of patients had head injuries, which were seen more often among cyclists than other wheeled-activity users. Helmet use was greatest among cyclists (62.2%) and lowest among skateboarders (32.9%). Injured patients presenting to EDs in jurisdictions with legislation mandating helmet use had 2.12 greater odds of helmet use and 0.86 lesser odds of head injury compared with those presenting in jurisdictions without helmet laws. CONCLUSION: These results provide further evidence that legislation mandating helmet use may be an effective way of reducing injury among all wheeled-activity users. The small number of patients who presented with helmet use and protective gear (59.4% overall) suggests that this remains an area for intervention.

TITRE: Blessures et port du casque au cours d'activités non motorisées sur roues chez des patients pédiatriques. INTRODUCTION: Les patients qui se présentent aux urgences en raison de traumatismes subis au cours d'activités récréatives constituent une source d'information unique qui peut orienter de manière déterminante les interventions visant à prévenir les blessures. Nous décrivons ici l'épidémiologie des blessures associées aux activités non motorisées sur roues chez les patients pédiatriques se présentant aux urgences au Canada et faisons état du port du casque chez ces patients. MÉTHODOLOGIE: Nous avons extrait les données relatives aux années 2004 à 2009 du Système canadien hospitalier d'information et de recherche en prévention des traumatismes (SCHIRPT), un programme national de surveillance des blessures dans les urgences de 15 hôpitaux. RÉSULTATS: La majorité des 28 618 enfants âgés de 1 à 16 ans qui ont été blessés au cours d'activités non motorisées sur roues l'ont été durant la pratique de la bicyclette, la deuxième cause étant la pratique de la planche à roulettes. Les enfants blessés étaient majoritairement des garçons. Les enfants blessés en trottinette étaient généralement plus jeunes, ceux blessés en planche à roulettes plus âgés. En moyenne, le nombre total de blessures a diminué de 6 % au cours de la période étudiée. Les chutes étaient le mécanisme lésionnel le plus courant, et 8,3 % des patients présentaient un traumatisme crânien, blessure plus fréquente chez les cyclistes que chez les utilisateurs d'autres dispositifs sur roues. Le port du casque était plus répandu chez les cyclistes (62,2 %), les utilisateurs de planche à roulettes affichant le plus faible taux d'utilisation (32,9 %). Les patients blessés qui s'étaient présentés aux urgences dans une région où le port du casque était obligatoire étaient 2,12 fois plus susceptibles de porter un casque et 0,86 fois moins susceptibles de souffrir d'un traumatisme crânien, comparativement aux patients des régions où il n'y avait pas de réglementation sur le port du casque. CONCLUSION: Ces résultats corroborent les études selon lesquelles la réglementation rendant obligatoire le port du casque pourrait être un moyen efficace de réduire les blessures chez tous les utilisateurs de dispositifs à roues non motorisés. Le petit nombre de patients qui portaient un casque et un équipement de protection (59,4 % en tout) laisse penser que cela demeure un champ d'intervention.

The perils of overprotective parenting: fathers' perspectives explored.

BACKGROUND: The dominant discourse of popular media appears to paint a disparaging picture of parents deemed overly concerned about their children's safety. Child injury prevention interventions frequently focus on influencing parenting behaviours. Fathers are increasingly involved in childcare, highlighting the need to understand their perspectives on overprotective parenting as it relates to considerations of injury prevention while actively engaged with their children. METHODS: Qualitative interviews were carried out with 32 fathers of children aged 2-7 years in a Canadian urban setting. Interview questions investigated fathers' injury prevention attitudes and practices, and their beliefs regarding overprotection. Data analysis was guided by grounded theory methods. RESULTS: Fathers noted the subjective nature of overprotection, citing family, social and situational factors that shaped their views. Fathers viewed overprotective parents as experiencing excessive fears that were manifested in lack of willingness to risk physical or psychological injury. They described overprotective parenting as including over-involvement in and excessive restriction of children's activities; and expressed concerns that the results of these behaviours would be children lacking self-confidence and crucial life skills. CONCLUSION: Fathers viewed as problematic overprotective parenting behaviours that limit access to opportunities for physical risk taking in an attempt to prevent mostly minor injuries. The injury prevention field may benefit from considering fathers' perspectives when designing programmes to minimize the likelihood that safety initiatives may be perceived as promoting overprotection of children. Framing safety messages in ways that align with fathers' views could involve promoting appropriate protection and encouraging an active lifestyle.

Unintentional injuries in school-aged children and adolescents: lessons from a systematic review of cohort studies.

OBJECTIVES: To critically synthesise current knowledge of the patterns of injuries and risk factors for injury in school-aged children, to summarise the evidence and support effective child injury prevention initiatives. DESIGN: Systematic review. Selection criteria and METHODS: Prospective cohort studies reporting unintentional injuries in healthy children aged 5-18 years were identified by searching 15 electronic databases and additional grey literature sources. A narrative synthesis was conducted of papers meeting quality criteria, with risk factors analysed at individual, family and environmental levels. Limitations of existing evidence were considered. RESULTS: 44 papers from 18 different cohort studies met the inclusion criteria. There were broad and consistent patterns of injury across time and place. Male sex, psychological, behavioural and risk-taking behaviour problems, having a large number of siblings, and a young mother were all associated with increased injury occurrence across more than one cohort and setting. CONCLUSIONS: Descriptive epidemiology and risk factors for injury were derived from prospective cohort studies, but few studies used the full potential of their design. Opportunities to use repeated measures to assess temporal changes in injury occurrence, and the exploration of risk factors, particularly those related to the child's environment, have rarely been undertaken. Few studies were conducted in low/middle-income countries where the burden of injury is greatest. These findings should be considered when planning future research and prevention initiatives.

Fatal and non-fatal fire injuries in England 1995-2004: time trends and inequalities by age, sex and area deprivation.

AIM: To examine time trends and deprivation gradients in fire-related deaths and injuries. METHODS: A cross-sectional study and time trend analysis using data on fire casualties in England between 1995 and 2004 obtained from the Department for Communities and Local Government. Injury rates were calculated assuming a Poisson distribution. Incidence rate ratios (IRRs) were calculated to compare changes in deprivation gradients over time. RESULTS: There were significant reductions in fatal and non-fatal fire injuries in children (fatal injuries IRR chi(2)(1) = 11.18, P < 0.001; non-fatal injuries IRR chi(2)(2) = 61.44, P < 0.001), adults (fatal injuries IRR chi(2)(1) = 15.99, P < 0.001; non-fatal injuries IRR chi(2)(2) = 183.25, P < 0.001) and older people (fatal injuries IRR chi(2)(1) = 56.88, P < 0.001; non-fatal injuries IRR chi(2)(2) = 54.09, P < 0.001) between 1995 and 2004. Adult and child fire deaths were most commonly caused by smokers' materials (e.g. cigarettes, cigars and tobacco), and cigarette lighters and matches, respectively. Cooking appliances caused most non-fatal fire injuries. Injury rates increased with increasing levels of deprivation and deprivation gradients did not change over 10 years. CONCLUSIONS: Fire prevention interventions should promote the safe use of cooking and heating appliances and the responsible use of smokers' materials, lighters and matches, and should target those at greater risk of fire, including the socially disadvantaged.

The advocacy in action study a cluster randomized controlled trial to reduce pedestrian injuries in deprived communities.

BACKGROUND: Road traffic-related injury is a major global public health problem. In most countries, pedestrian injuries occur predominantly to the poorest in society. A number of evaluated interventions are effective in reducing these injuries. Very little research has been carried out into the distribution and determinants of the uptake of these interventions. Previous research has shown an association between local political influence and the distribution of traffic calming after adjustment for historical crash patterns. This led to the hypothesis that advocacy could be used to increase local politicians knowledge of pedestrian injury risk and effective interventions, ultimately resulting in improved pedestrian safety. OBJECTIVE: To design an intervention to improve the uptake of pedestrian safety measures in deprived communities. SETTING: Electoral wards in deprived areas of England and Wales with a poor record of pedestrian safety for children and older adults. METHODS: Design mixedmethods study, incorporating a cluster randomized controlled trial. Data mixture of Geographical Information Systems data collision locations, road safety interventions, telephone interviews, and questionnaires. Randomization 239 electoral wards clustered within 57 local authorities. Participants 615 politicians representing intervention and control wards. Intervention a package of tailored information including maps of pedestrian injuries was designed for intervention politicians, and a general information pack for controls. OUTCOME MEASURES: Primary outcome number of road safety interventions 25 months after randomization. Secondary outcomes politicians interest and involvement in injury prevention cost of interventions. Process evaluation use of advocacy pack, facilitators and barriers to involvement, and success.

Evidence into practice: combining the art and science of injury prevention.

OBJECTIVES: To bring together scientific evidence of what works in injury prevention with the knowledge and experience of practitioners, using a case study of smoke alarm installation from England. DESIGN: There is good evidence of strategies to reduce injuries but less is known about the art of translating those strategies to implementation in real-world settings. England's Health Development Agency developed a structured process applicable to many public health fields, which integrates practitioner knowledge into the evidence base and reflects local contexts. The multistep process includes convening structured field meetings with local practitioners and policy makers, which focus on a mapping exercise of strategies, policies, targets, and funding streams related to childhood injury prevention, and barriers and facilitators relating to implementation of specific interventions. SETTING: Meetings were held in six venues across England with 98 participants from a range of professional backgrounds and sectors. RESULTS: The collective knowledge of participants provided many local insights unlikely to emerge in conventional research. Discussion topics covered key partners and sectors to include when planning a program; national policies and programs that could be used to drive the agenda; potential sources of funding; the importance of providing and installing appropriate smoke alarms; targeting of programs; and suggestions for gaining access to hard-to-reach populations. CONCLUSION: This methodology represents an efficient way of gaining insight necessary for successful implementation of evidence based programs. It may be particularly useful in lower and middle income countries, serving to translate evidence into the local contexts and circumstances within which practitioners operate.

Risk factors for unintentional injuries due to falls in children aged 0-6 years: a systematic review.

OBJECTIVE: To identify risk factors for unintentional injuries due to falls in children aged 0-6 years. DESIGN: A systematic review of the literature. METHODS: Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0-6 years and included a comparison group. RESULTS: 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. CONCLUSION: Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0-6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children.

Grandparental impact in young adults' relationships with their closest grandparents: the role of relationship strength and emotional closeness.

This study explored the role that relationship strength, generally, and emotional closeness, more specifically, may play in delimiting the bounds of grandparental influence in young adults' lives. One-hundred and seventy-one college-aged young adults completed a questionnaire evaluating their relationship with the living grandparent to whom they felt most emotionally close or, if they felt close to none of their living grandparents, the grandparent with whom they had the most contact. Participants' perceptions of the strength of this relationship were significantly and positively related to their responses on measures of the extent to which their closest grandparent influenced various aspects of their lives (e.g., their beliefs and values, how much their lives would be missing had they never known the grandparent). In addition, participants whose grandparent-grandchild relationships were emotionally close endorsed a broader range of alternatives on checklist measures of perceived relationship impact than did those whose relationships were more emotionally distant.