Child pedestrian and cyclist injuries, and the built and social environment across Canadian cities: the Child Active Transportation Safety and the Environment Study (CHASE).

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.

Supracondylar Humerus Fractures in Older Children: Success of Closed Reduction and Percutaneous Pinning.

BACKGROUND: The incidence of supracondylar humerus (SCH) fracture declines and fracture types change as children grow. Optimal treatment method is unclear in older children. The aim of the study was to determine if fracture type and configuration of distal humerus fractures changes as patients approach skeletal maturity, and to assess the success of closed reduction and percutaneous pin (CRPP) in extra-articular SCH fractures in this transitional age group. METHODS: Inclusion criteria for this retrospective review were (1) distal humerus fractures with extension types 2 and 3, flexion type, T-type; (2) surgically managed, and (3) modified Sauvegrain score ≥1. Reviewed parameters included fracture type and configuration, grade of skeletal maturity, fixation technique, and loss of reduction. Primary analysis was to determine the distribution of fracture type and configuration with age or grade of skeletal maturity. Secondary analysis was used to determine the factors affecting treatment success of CRPP in extra-articular fractures. RESULTS: A total of 142 patients were included (58 males and 84 females). Fracture types revealed significant changes with increased age (P=0.031) and skeletal maturity grade (P<0.005). Skeletal maturity was a better predictor of changing fracture type than chronological age. T-type fractures were only seen in patients with modified Sauvegrain score ≥6 and flexion-type fractures were only seen in patients with modified Sauvegrain score ≤4. Loss of reduction rate after CRPP was 5%. The success of CRPP was not affected by age, sex, modified Sauvegrain score, fracture type, direction of displacement, coronal fracture pattern, number of pins or medial pin use. Fracture obliquity in the sagittal plane (P=0.05), suboptimal pin spread (P<0.01), and lack of bicolumnar fixation (P<0.01) were found as statistically significant factors associated with failed CRPP. CONCLUSION: The distribution of fracture type changed with increased age and skeletal maturity. CRPP of extra-articular fractures in older children is a reliable option regardless of the stage of skeletal maturity. Determinants of a good outcome include optimal pinning technique with adequate pin spread at the fracture site and bicolumnar fixation. LEVEL OF EVIDENCE: Level IV-retrospective case series.

Community of practice: an effective mechanism to strengthen capacity in climate change and health.

SETTING: Climate change is one of the greatest threats to global health in the twenty-first century and has recently been declared a health emergency. The lack of effective dissemination of emerging evidence on climate change health risks, effects, and innovative interventions to health professionals presents one of the greatest challenges to climate action today. INTERVENTION: To identify and address the knowledge gaps at the intersection of health and climate change, the Canadian Coalition for Global Health Research (CCGHR) established a Working Group on Climate Change and Health (WGCCH). WGCCH is evolving organically into a community of practice (CoP) that aims to elevate knowledge brokering on climate change and health and expand to global multi-, inter-, and transdisciplinary realms. OUTCOMES: To date, the WGCCH established a regular webinar series to share expert knowledge from around the world on intersections between climate change and health, developed short summaries on climate change impacts on broad health challenges, supported young professional training, and enhanced climate health research capacity and skills through collegial network development and other collaborative projects that emerged from CoP activities. IMPLICATIONS: This paper proposes that WGCCH may serve as an example of an effective strategy to address the lack of opportunities for collaborative engagement and mutual learning between health researchers and practitioners, other disciplines, and the general public. Our experiences and lessons learned provide opportunities to learn from the growing pains and successes of an emerging climate change and health-focused CoP.

RéSUMé: LIEU: Le changement climatique est l'une des plus grandes menaces pour la santé mondiale au 21e siècle et a récemment été déclaré une urgence sanitaire. Le manque de diffusion efficace des données obtenues concernant les risques pour la santé liés au changement climatique, les impacts et les interventions innovantes auprès des professionnels de la santé constitue aujourd'hui l'un des plus grands défis de l'action climatique. INTERVENTION: Pour identifier et combler les lacunes de connaissances communes à la santé et aux changements climatiques, la Coalition canadienne pour la recherche en santé mondiale (CCRSM) a créé un groupe de travail sur les changements climatiques et la santé (WGCCH). WGCCH évolue organiquement vers une communauté de pratiques (CoP) qui vise à élever le niveau de développement de connaissances liant les changements climatiques à la santé et à s'étendre aux domaines mondiaux multi, inter et transdisciplinaires. RéSULTATS: À ce jour, le WGCCH a lancé une série de webinaires réguliers pour diffuser les connaissances d'experts du monde entier sur les liens entre les changements climatiques et la santé, a élaboré de courts exposés sur les impacts des changements climatiques sur les grands défis de santé, a soutenu la formation de jeunes professionnels et a amélioré la capacité et les compétences en matière de recherche en santé climatique à travers le développement d'un réseau universitaire et d'autres projets de collaboration dont ont émergé des activités de la CoP. IMPLICATIONS: Cet article propose que le WGCCH puisse servir d'exemple d'une stratégie efficace pour remédier au manque d'opportunités d'engagement collaboratif et d'apprentissage mutuel entre les chercheurs et les praticiens de la santé, d'autres disciplines et le grand public. Nos expériences et leçons apprises offrent des occasions de tirer des leçons des peines et des succès croissants d'une CoP axée sur le changement climatique et la santé.

Democracy and Mobility: A preliminary analysis of global adherence to non-pharmaceutical interventions for COVID-19.

In the absence of vaccines or therapeutics, and with cases of COVID-19 continuing to grow each day, most countries are relying on non-pharmaceutical interventions (NPIs) to reduce the spread of SARS-CoV-2. The goal of NPIs - decreasing mobility in order to decrease contact - comes with competing socioeconomic costs and incentives that are not well-understood. Using Google's Community Mobility data, we visualized changes in mobility and explored the effect of economic, social, and governmental factors on mobility via regression. We found decreases in mobility for all movement categories except in residential areas; these changes corresponded strongly with country-specific outbreak trajectory. Mobility increased with GDP per capita, though this relationship varied among movement categories. Finally, countries with more authoritarian governments were more responsive with respect to mobility changes as local case counts increased; however, these countries were also less likely to report mobility data to Google. These preliminary findings suggest that country-specific outbreak trajectory, GDP per capita, and democracy index may be important indicators in assessing a given population's adherence to NPIs.