Trends in concussions at Ontario schools prior to and subsequent to the introduction of a concussion policy - an analysis of the Canadian hospitals injury reporting and prevention program from 2009 to 2016

Background: Concussion is a preventable injury that can have long-term health consequences for children and youth. In Ontario, the Policy/Program Memorandum # 158 (PPM) was introduced by the Ministry of Education of Ontario in March 2014. The PPM’s main purpose is to require each school board in the province to create and implement a concussion policy. The purpose of this paper is to examine trends in school-based concussions prior to and subsequent to the introduction of the PPM. Methods: This report examined emergency department (ED) visits in 5 Ontario hospitals that are part of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), and compared trends over time in diagnosed concussions, and suspected concussions identified as “other head injury” in children and youth aged 4–18. Results: From 2009 to 2016 study years, there were 21,094 suspected concussions, including 8934 diagnosed concussions in youth aged 4–18. The average number of diagnosed concussions in the 5 years before the PPM was 89 concussions/month, compared to approximately 117 concussions per month after; a 30% increase in the monthly rate of concussions presenting to the ED. The total number of concussion or head injury-related ED visits remained relatively unchanged but the proportion of diagnosed concussions rose from 31% in 2009 to 53% in 2016. The proportion of diagnosed concussions in females also increased from 38% in 2013 to 46% in 2016. The percent of all diagnosed concussions occurring at schools increased throughout the study reaching almost 50% in 2016 with most injuries taking place at the playground (24%), gymnasium (22%) or sports field (20%). Conclusions: The introduction of the PPM may have contributed to a general increase in concussion awareness and an improvement in concussion identification at the school level in children and youth aged 4–18. Keywords: Concussion, Policy, Emergency department, YouthYork University Librarie

Seasonal Variation in 25(OH)D at Aberdeen (57°N) and Bone Health Indicators- Could Holidays in the Sun and Cod Liver Oil Supplements Alleviate Deficiency?

Vitamin D has been linked with many health outcomes. The aim of this longitudinal study, was to assess predictors of seasonal variation of 25-hydroxy-vitamin D (25(OH)D) (including use of supplements and holidays in sunny destinations) at a northerly latitude in the UK (57°N) in relation to bone health indicators. 365 healthy postmenopausal women (mean age 62.0 y (SD 1.4)) had 25(OH)D measurements by immunoassay, serum C-telopeptide (CTX), estimates of sunlight exposure (badges of polysulphone film), information regarding holidays in sunny destinations, and diet (from food diaries, including use of supplements such as cod liver oil (CLO)) at fixed 3-monthly intervals over 15 months (subject retention 88%) with an additional 25(OH)D assessment in spring 2008. Bone mineral density (BMD) at the lumbar spine (LS) and dual hip was measured in autumn 2006 and spring 2007 (Lunar I-DXA). Deficiency prevalence (25(OH)

Design and development of Taeneb City Guide - from paper maps and guidebooks to electronic guides

This paper reports the design, development and feedback from the initial trial of the Taeneb City Guide project developing tourist information software on Personal Digital Assistant (PDA) handheld computers. Based on the users' requirements for electronic tourists guides already published in the literature, the paper focuses on the three main technology features of the systems, which would give the advantage over the existing paper publication: query-able dynamic map interface, dynamic information content and community review systems and users' forum. The paper also reports the results of an initial trial of a City Guide for Glasgow conducted as part of the EMAC 03 conference

Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease and cancer : a systematic review and meta-analysis

We thank Associate Professor Andrew Grey for helping to resolve discrepancies in data extraction and interpretation for cardiovascular events and cancer events. We thank trialists from 16 studies for clarifying or providing additional information for this review [Andrews 2011, Aveyard 2016, Bennett 2012, de Vos 2014, Finnish Diabetes Prevention Study 2009, Goodwin 2014, Green 2015, Horie 2016, Hunt (FFIT) 2014, Katula 2013, Li (Da Qing) 2014, Logue 2005, Ma 2013, O’Neil 2016, Rejeski (CLIP) 2011, Uusitupa 1993] and also others who provided information, but their trials were later found not to fulfil our inclusion criteria. Funding: The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.Peer reviewedPublisher PD

Adapting the Quality Maternal and Newborn Care (QMNC) Framework to evaluate models of antenatal care:A pilot study

<div><p>Background</p><p>Recent evidence indicates that continuity models of maternity care result in improved clinical and psychosocial outcomes, but their causal mechanisms are poorly understood. The recent Lancet Series on Midwifery’s Quality Maternal and Newborn Care Framework describes five components of quality care and their associated characteristics. As an initial step in developing this Framework into an evaluation toolkit, we transformed its components and characteristics into a topic guide to assess stakeholder perceptions and experiences of care provided and received. The main purpose of this study was to assess the feasibility of this process.</p><p>Methods</p><p>We conducted twelve focus groups in two Scottish health board areas with 13 pregnant women, 18 new mothers, 26 midwives and 12 obstetricians who had experience of a range of different models of maternity care. Transcripts were analysed using a six-phase approach of thematic analysis. We mapped the identified themes and sub-themes back to the Framework.</p><p>Results</p><p>The emerging themes and sub-themes demonstrated the feasibility of using the QMNC framework as a data collection tool, and as a lens for analysing the data. Of the four emerging themes, only Organisation Culture / Work Structure’ mapped directly to a single Framework component. The others—‘Relationships’; ‘Information and support’; and ‘Uncertainty’–mapped to between two and five components, illustrating the interconnectedness of the Framework’s components. Some negative sub-themes mirrored positive Framework characteristics of care. Some re-phrasing and re-ordering of the topic guides in later focus groups ensured we could cover all aspects of the Framework adequately.</p><p>Conclusion</p><p>Adapting the Quality Maternal and Newborn Care Framework enabled us to focus on aspects of care which worked well and which didn’t work well for these key stakeholders. Identifying ‘what works for whom and why’ in different models of care is a necessary step in reinforcing and replicating the most effective models of care.</p></div

Epidemiology of sports-related injuries in children and youth presenting to Canadian emergency departments from 2007–2010

BACKGROUND: Although injuries related to sports and recreation represent a significant burden to children and youth, few studies have examined the descriptive epidemiology of sports-related injury since 2005, and some sports such as ringette have not been evaluated to date. The primary purpose of this study was to provide the descriptive epidemiology of sports-related injuries treated in emergency departments for children and youth aged 5 – 19. METHODS: A retrospective data analysis was performed using data from the Canadian Hospitals Injury Reporting and Prevention Program [CHIRPP] from fiscal years (April – March) 2007/08 to 2009/10. CHIRPP is a computerized information system designed by the Public Health Agency of Canada that collects information about injuries to people evaluated in emergency departments across 11 pediatric hospitals and 5 general hospitals in Canada. Thirteen sports or activities were analyzed (baseball, basketball, cycling, football, ice hockey, lacrosse, ringette, rugby, skiing, sledding, snowboarding, soccer, and volleyball). Descriptive statistics, including frequency by sport, age and sex, as well as the percent of concussions within each sport were calculated. RESULTS: Out of a total of 56, 691 reported sports and recreational injuries, soccer accounted for the largest proportion of injuries with 11,941 reported cases over the 3 year time period. Of these, approximately 30% were fractures. The 10 – 14 year age group reported the greatest proportion of injuries in 10 out of the 13 sports analyzed. In addition, males reported a greater number of overall injuries than females in 11 out of the 13 sports analyzed. The largest percentage of concussions was reported in ringette; these injuries accounted for 17.1% of overall injuries within this sport. CONCLUSIONS: Injury prevention programs in Canada should focus on improving evidence-based programs to reduce the burden of injuries in all sports

Nutritional status, growth and disease management in children with single and dual diagnosis of type 1 diabetes mellitus and coeliac disease

Background: The consequences of subclinical coeliac disease (CD) in Type 1 diabetes mellitus (T1DM) remain unclear. We looked at growth, anthropometry and disease management in children with dual diagnosis (T1DM + CD) before and after CD diagnosis.&lt;p&gt;&lt;/p&gt; Methods: Anthropometry, glycated haemoglobin (HbA1c) and IgA tissue transglutaminase (tTg) were collected prior to, and following CD diagnosis in 23 children with T1DM + CD. This group was matched for demographics, T1DM duration, age at CD diagnosis and at T1DM onset with 23 CD and 44 T1DM controls.&lt;p&gt;&lt;/p&gt; Results: No differences in growth or anthropometry were found between children with T1DM + CD and controls at any time point. Children with T1DM + CD, had higher BMI z-score two years prior to, than at CD diagnosis (p &#60;0.001). BMI z-score change one year prior to CD diagnosis was lower in the T1DM + CD than the T1DM group (p = 0.009). At two years, height velocity and change in BMI z-scores were similar in all groups. No differences were observed in HbA1c between the T1DM + CD and T1DM groups before or after CD diagnosis. More children with T1DM + CD had raised tTg levels one year after CD diagnosis than CD controls (CDx to CDx + 1 yr; T1DM + CD: 100% to 71%, p = 0.180 and CD: 100% to 45%, p &#60; 0.001); by two years there was no difference.&lt;p&gt;&lt;/p&gt; Conclusions: No major nutrition or growth deficits were observed in children with T1DM + CD. CD diagnosis does not impact on T1DM glycaemic control. CD specific serology was comparable to children with single CD, but those with dual diagnosis may need more time to adjust to gluten free diet

Urban Prophets: Creating Graffiti as a Means of Negotiating the Constructs of Urban Public Spaces

For this examination, graffiti and neo-graffiti have been compared to public art in order to reveal the ideological constructions of urban public spaces. How does graffiti interact with the construction of urban public spaces? How is graffiti similar to and different from public art? Which of these art forms better represents the public and city living? By comparing public art to (neo)graffiti in Toronto, Ontario and Los Angeles, California, the gendered, racialized, and class-based exclusions present in R. Florida's (2002) creative cities framework as theorized by authors such as N. Smith (1996), Sharon Zukin (1996), and G. Standing (2011) can be revealed. Urban public spaces are carefully shaped by those in control, the government and corporations, with the intention of creating spaces and citizens within those spaces that can be a functioning part of their neoliberal capitalist system. Graffiti and neo-graffiti act as a visual interruption to this system, which in turn can be thought of as physically represented by public art. In this way (neo)graffiti is created by a minority of citizens with the hopes of reclaiming their right to exist in urban public spaces despite layers of ideological exclusions.For this examination, graffiti and neo-graffiti have been compared to public art in order to reveal the ideological constructions of urban public spaces. How does graffiti interact with the construction of urban public spaces? How is graffiti similar to and different from public art? Which of these art forms better represents the public and city living? By comparing public art (neo)graffiti in Toronto, Ontario and Los Angeles California, the racialized and class-based exclusions present in R. Florida&rsquo;s (2002) creative cities framework theorized by authors such as N. Smith (1996), Sharon Zukin (1996), and G. Standing (2011) can be revealed. Urban public spaces are carefully shaped by those in control (the government and corporations) with the intention of creating spaces and citizens within those spaces that can be a functioning part of their system. Graffiti and neo-graffiti act as a visual interruption to this system as represented by public art. In this way (neo)graffiti is created by a minority of citizens with the hopes of reclaiming their right to exist in urban public spaces despite the layers of exclusions

Review of the quarter's economic trends [January 1977]

There is now ample evidence that the pace of recovery in the major economies slackened during 1976. Published statistics, however, are as yet inadequate to document the full extent of the slowdown or to assert that it was a transient phenomenon. Available evidence would suggest that the growth in the major economies in 1977 may be somewhat slower than had earlier been forecast, and that in the short run further reductions in unemployment and inflation rates may be very difficult to achieve. Several threads may be drawn together in an attempt to justify this interpretation of likely future developments

Econometric forecasts for Scotland

In the first issue (July 1975) of the Fraser of Allander Institute Quarterly Economic Commentary, the special article, by Professor J McGilvray, reviewed the problems associated with constructing regional econometric models to forecast key economic variables. Since that time, a number of forecasts for the Scottish economy have been made in the main text or in special articles of the Quarterly Commentary. Many of these have been underpinned by forecasting relationships which have been estimated for particular sectors of the economy. Up to now we have been unable to produce a set of relationships which could genuinely be described as a 'model' of the Scottish economy. The reason for this is simple, but illustrative of the type of problem discussed by Professor McGilvray. To understand it one must be acquainted with the fundamental differences which exist between national and regional economic models