Déterminants de l'accès à un système de traumatologie intégré : une étude de cohorte rétrospective

Peu de données sont disponibles quant à l’accès aux soins dans les systèmes de traumatologie intégrés. Nous avons conduit une étude de cohorte populationnelle rétrospective pour décrire l’accès, identifier ses déterminants et évaluer pour les traumatismes majeurs, l’influence de cet accès sur la mortalité et la durée de séjour hospitalières. Tous les adultes admis pour traumatisme dans un hôpital du Québec entre 2006 et 2011 ont été inclus. L’accès était de 75% pour toute la population et 90% pour les traumatismes majeurs. Le lieu de résidence, mécanisme du traumatisme, nombre de blessures, sévérité du traumatisme et l’âge étaient les déterminants les plus importants de l’accès. La mortalité et la durée de séjour pour les patients n’ayant pas accès au système étaient globalement semblables à celles des patients ayant accès. Le système de traumatologie du Québec semble bien fonctionner en offrant des soins aux patients qui en ont vraiment besoin.Few data are available on access to integrated trauma systems. We therefore conducted a population-based retrospective cohort study to firstly describe access to trauma care, identify its determinants in an integrated trauma system and secondly evaluate among major trauma admissions, the influence of access on hospital mortality and length of stay (LOS). We included all adults admitted to acute care hospitals for trauma in the province of Québec between 2006 and 2011 using an administrative hospital discharge database. Of the 136,653 injury admissions selected, 75% were treated within the trauma system. Among major trauma (n=25,522), 90% had access to specialized trauma care. The region of residence followed by mechanism of injury, number of trauma diagnoses, injury severity and age were the most important determinants of access to trauma care. Mortality and LOS for the small proportion of patients treated in non-designated centers were similar to those of patients treated in trauma centers. These studies provide evidence that the Québec trauma system performs well in its mandate to offer appropriate treatment to victims of injury that require specialized care

State or market? How to effectively decrease alcohol-related crash fatalities and injuries

Background It is estimated that more than 270 000 people die yearly in alcohol-related crashes globally. To tackle this burden, government interventions, such as laws which restrict blood alcohol concentration (BAC) levels and increase penalties for drunk drivers, have been implemented. The introduction of private-sector measures, such as ridesharing, is regarded as alternatives to reduce drunk driving and related sequelae. However, it is unclear whether state and private efforts complement each other to reduce this public health challenge. Methods We conducted interrupted time-series analyses using weekly alcohol-related traffic fatalities and injuries per 1 000 000 population in three urban conglomerates (Santiago, Valparaíso and Concepción) in Chile for the period 2010–2017. We selected cities in which two state interventions—the ‘zero tolerance law’ (ZTL), which decreased BAC, and the ‘Emilia law’ (EL), which increased penalties for drunk drivers—were implemented to decrease alcohol-related crashes, and where Uber ridesharing was launched. Results In Santiago, the ZTL was associated with a 29.1% decrease (95% CI 1.2 to 70.2), the EL with a 41.0% decrease (95% CI 5.5 to 93.2) and Uber with a non-significant 28.0% decrease (95% CI −6.4 to 78.5) in the level of weekly alcohol-related traffic fatalities and injuries per 1 000 000 population series. In Concepción, the EL was associated with a 28.9% reduction (95% CI 4.3 to 62.7) in the level of the same outcome. In Valparaíso, the ZTL had a −0.01 decrease (95% CI −0.02 to −0.00) in the trend of weekly alcohol-related crashes per 1 000 000 population series. Conclusion In Chile, concomitant decreases of alcohol-related crashes were observed after two state interventions were implemented but not with the introduction of Uber. Relationships between public policy interventions, ridesharing and motor vehicle alcohol-related crashes differ between cities and over time, which might reflect differences in specific local characteristics

Who’s Back, Who’s Coming Back, and Who’s Left For Good? Results from Wave 2 of The Public Transit and COVID-19 Survey in Toronto and Vancouver

These are summary results of a research project. Peer-reviewed, multivariable modelling is forthcoming.In May 2020 researchers at the University of Toronto Scarborough surveyed over 3,000 regular transit riders in Toronto and Vancouver on how COVID-19 impacted their travel and their ability to reach essential destinations like healthcare and groceries. This report highlights the key results from a follow up survey of nearly 2,000 of the same respondents. In May 2020, 63% of riders across both cities reported that they had stopped riding transit completely. By March 2021, 70% of those who stopped in May 2020 had returned. About 32% of respondents agree that they will ride transit less than they did before the pandemic began, compared with 56% who disagree and 12% who are unsure. Roughly 41% of respondents owned a vehicle in March 2021, up from 36% in May 2020. This represents a 14% increase. These and related results are summarized and discussed along with qualitative feedback on from riders on why they believe they will or will not use transit after COVID-19.This work was supported by the Ontario Research Fund, Canada Research Chair in Transportation and Health, the City of Vancouver, and the University of Toronto School of Cities

Facing the future of transit ridership: which riders bought a car; who is planning on riding less?

Public transit agencies face a transformed landscape of rider demand and political support as the COVID-19 pandemic recedes. We explore people’s motivations for returning to or avoiding public transit a year into the pandemic. We draw on a March 2021 follow-up survey of over 1,900 people who rode transit regularly prior to the COVID-19 pandemic in Toronto and Vancouver, Canada, and who took part in a prior survey on the topic in May 2020. We investigate how transit demand changes associated with the pandemic relate to changes in automobile ownership and its desirability. We find that pre-COVID frequent transit users between the ages of 18–29, a part of the so-called “Gen Z,” and recent immigrants are more attracted to driving due to the pandemic, with the latter group more likely to have actually purchased a vehicle. Getting COVID-19 or living with someone who did is also a strong and positive predictor of buying a car and anticipating less transit use after the pandemic. Our results suggest that COVID-19 may have increased the attractiveness of auto ownership among transit riders likely to eventually purchase cars anyway (immigrants, twentysomethings), at least in the North American context. We also conclude that getting COVID-19 or living with someone who did is a positive predictor of having bought a car. Future research should consider how having COVID-19 transformed some travelers’ views, values, and behaviour

Suicidality and protective factors among sexual and gender minority youth and adults in Canada: a cross-sectional, population-based study

Abstract Background Sexual and gender minority populations experience elevated risks for suicidality. This study aimed to assess prevalence and disparities in non-fatal suicidality and potential protective factors related to social support and health care access among sexual and gender minority youth and adults and their heterosexual and cisgender counterparts in Canada. The second objective was to examine changes in the prevalence of suicidal ideation and protective factors during the COVID-19 pandemic. Methods Pooled data from the 2015, 2016 and 2019 Canadian Community Health Surveys were used to estimate pre-pandemic prevalence of suicidal ideation, plans and attempts, and protective factors. The study also estimated changes in the prevalence of recent suicidal ideation and protective factors in fall 2020, compared with the same period pre-pandemic. Results The prevalence of suicidality was higher among the sexual minority populations compared with the heterosexual population, and the prevalence was highest among the bisexual population, regardless of sex or age group. The pre-pandemic prevalence of recent suicidal ideation was 14.0% for the bisexual population, 5.2% for the gay/lesbian population, and 2.4% for the heterosexual population. The prevalence of lifetime suicide attempts was 16.6%, 8.6%, and 2.8% respectively. More than 40% of sexual minority populations aged 15–44 years had lifetime suicidal ideation; 64.3% and 36.5% of the gender minority population had lifetime suicidal ideation and suicide attempts. Sexual and gender minority populations had a lower prevalence of protective factors related to social support and health care access. The prevalence of recent suicidal ideation among sexual and gender minority populations increased in fall 2020, and they tended to experience longer wait times for immediate care needed. Conclusions Sexual and gender minority populations had a higher prevalence of suicidality and less social support and health care access compared to the heterosexual and cisgender populations. The pandemic was associated with increased suicidal ideation and limited access to care for these groups. Public health interventions that target modifiable protective factors may help decrease suicidality and reduce health disparities

Child labour and health: a systematic review

ObjectivesThis study aimed to synthesise the available knowledge, identify unexplored areas and discuss general limits of the published evidence. We focused on outcomes commonly hypothesised to be affected by child labour: nutritional status, harmful exposures and injuries.MethodsFour electronic databases (EMBASE, MEDLINE, Scopus, ISI Web of Science) were searched in November 2017. All articles published since 1996, without restrictions on language, were considered for inclusion.ResultsOut of the 1090 abstracts initially identified by the search, 78 articles were selected for inclusion and reviewed. Most of the studies were conducted in Asia and South America, and only a third of them compared working children to a control group of non-working children. Child labour appears to be associated with poor nutritional status, diseases due to harmful exposures, and a higher prevalence of injuries.ConclusionsDespite evidence for a negative relation between child work and health, the cross-sectional design of most studies limits the causal interpretation of existing findings. More rigorous observational studies are needed to confirm and better quantify these associations