Does land use and landscape contribute to self-harm? A sustainability cities framework

Self-harm has become one of the leading causes of mortality in developed countries. The overall rate for suicide in Canada is 11.3 per 100,000 according to Statistics Canada in 2015. Between 2000 and 2007 the lowest rates of suicide in Canada were in Ontario, one of the most urbanized regions in Canada. However, the interaction between land use, landscape and self-harm has not been significantly studied for urban cores. It is thus of relevance to understand the impacts of land-use and landscape on suicidal behavior. This paper takes a spatial analytical approach to assess the occurrence of self-harm along one of the densest urban cores in the country: Toronto. Individual self-harm data was gathered by the National Ambulatory Care System (NACRS) and geocoded into census tract divisions. Toronto’s urban landscape is quantified at spatial level through the calculation of its land use at di erent levels: (i) land use type, (ii) sprawl metrics relating to (a) dispersion and (b) sprawl/mix incidence; (iii) fragmentation metrics of (a) urban fragmentation and (b) density and (iv) demographics of (a) income and (b) age. A stepwise regression is built to understand the most influential factors leading to self-harm from this selection generating an explanatory model.This research was supported by the Canadian Institutes of Health Research Strategic Team Grant in Applied Injury Research # TIR-103946 and the Ontario Neurotrauma Foundation grantinfo:eu-repo/semantics/publishedVersio

Concussions in Sledding Sports and the Unrecognized “Sled Head”: A Systematic Review

Background: Sport-related concussion is a significant public health concern. Little research has been conducted on sport-related concussion and injury prevention strategies in competitive sledding sports like bobsleigh, luge, and skeleton. Athletes have identified “sled head” as a key concern due to its symptom burden.Purpose: To summarize our knowledge of the prevalence of concussion and related symptoms in sledding sports; to utilize Haddon's Matrix to inform and define strategies for injury prevention.Methods: An independent information specialist conducted a search for the known literature on injuries in non-recreational sledding sports, and specifically for concussion via OVID Medline, CINAHL, the Cochrane Database, EMBASE, PsycInfo, PubMed, Scopus, and the Web of Sciences from 1946 to December 2017. After iterative searches of reference sections, a total of 844 articles were assessed for inclusion.Results: Nine articles were included for review. Concussions are a common occurrence in elite sledding sport athletes, affecting 13-18% of all sledding athletes. Significant variance exists between events, indicating a potential effect of the ice track in injury risk. The condition known as “sled head” is discussed and identified as a key point of further investigation. A number of potential injury prevention strategies are discussed.Interpretation: Head injuries and concussions are an important injury for elite sledding sports and a number of avenues exist for prevention. More work is required to delineate the mechanisms, characteristics, natural history and management of “sled head.

New methods for resilient societies: The geographical analysis of injury data

In this paper an empirical assessment of injury patterns is supplied as an example of social endurance -resilient societies can be built by means of geographical analysis of injury data, providing better support for decision makers regarding urban safety. Preventing road traffic collisions with vulnerable road users, such as pedestrians, could help mitigate significant loses and improve infrastructure planning. In this sense, the geographical aspects of injury prevention are of clear spatial analog, and should be tested regarding the carrying capacity of urban areas as well as vulnerability for growing urban regions. The application of open source development tool for spatial analysis research in health studies is addressed. The study aims to create a framework of available open source tools through Python that enable better decision making through a systematic review of existing tools for spatial analysis. Methodologically, spatial autocorrelation indices are tested as well as influential variables are brought forward to establish a better understanding of the incremental concern of injuries in rural areas, in general, and in the Greater Toronto Area, in particular. By using Python Library for Spatial Analysis (PySAL), an integrative vision of assessing a growing epidemiological concern of injuries in Toronto, one of North America's fastest growing economic metropolises is offered. In this sense, this study promotes the use of PySAL and open source toolsets for integrating spatial analysis and geographical analysis for health practitioners. The novelty and capabilities of open source tools through methods such as PySAL allow for a cost efficiency as well as give planning an easier methodological toolbox for advances spatial modelling techniques.info:eu-repo/semantics/publishedVersio

A spatial analytical framework of Toronto using machine learning and spatial regressions

Vaz, E., Cusimano, M. D., Bação, F., Damásio, B., & Penfound, E. (2021). Open data and injuries in urban areas: A spatial analytical framework of Toronto using machine learning and spatial regressions. PLoS ONE, 16(March), 1-17. [e0248285]. https://doi.org/10.1371/journal.pone.0248285Injuries have become devastating and often under-recognized public health concerns. In Canada, injuries are the leading cause of potential years of life lost before the age of 65. The geographical patterns of injury, however, are evident both over space and time, suggesting the possibility of spatial optimization of policies at the neighborhood scale to mitigate injury risk, foster prevention, and control within metropolitan regions. In this paper, Canada’s National Ambulatory Care Reporting System is used to assess unintentional and intentional injuries for Toronto between 2004 and 2010, exploring the spatial relations of injury throughout the city, together with Wellbeing Toronto data. Corroborating with these findings, spatial autocorrelations at global and local levels are performed for the reported over 1.7 million injuries. The sub-categorization for Toronto’s neighborhood further distills the most vulnerable communities throughout the city, registering a robust spatial profile throughout. Individual neighborhoods pave the need for distinct policy profiles for injury prevention. This brings one of the main novelties of this contribution. A comparison of the three regression models is carried out. The findings suggest that the performance of spatial regression models is significantly stronger, showing evidence that spatial regressions should be used for injury research. Wellbeing Toronto data performs reasonably well in assessing unintentional injuries, morbidity, and falls. Less so to understand the dynamics of intentional injuries. The results enable a framework to allow tailor-made injury prevention initiatives at the neighborhood level as a vital source for planning and participatory decision making in the medical field in developed cities such as Toronto.publishersversionpublishe

Pros and Cons of 19 Sport-Related Concussion Educational Resources in Canada: Avenues for Better Care and Prevention

Objective: The goal of this research was to assess the effectiveness of available concussion educational resources in Canada, the means used to disseminate this knowledge and the impact of these educational resources on players' concussion prevention knowledge.Methods: We assessed concussion knowledge before and after exposure to one or more of 19 resources introduced through a national program aimed to increase awareness and knowledge of concussion. The effectiveness of the mode of delivery was measured by changes in concussion knowledge scores (CKS) between pre and pro scores.Measures: Concussion knowledge scores (CKS) were calculated for pre- and post- exposure to concussion educational resources and used as a measure of both, the effectiveness of each resource as well as the effectiveness of the delivery method. The effectiveness of each educational resource was also measured by the respondents' rating of each concussion educational resource.Results: Respondents in post-survey had higher CKS than those in pre-survey. Two out of the 19 newly developed concussion educational resources were effective in improving the resource users' CKS. Linear regression showed that using more resources further increased CKS. Four out of six modes of delivery enhanced respondents' concussion knowledge.Conclusion: Our findings demonstrate that the newly developed Canadian concussion educational resources were effective at improving users' concussion knowledge. Our data demonstrates that using three or more resources further enhanced the users' concussion knowledge. Future research, however, is critical to assess whether concussion prevention knowledge is sufficient to reduce injuries and factors influencing it

Patterns of Urban Violent Injury: A Spatio-Temporal Analysis

Injury related to violent acts is a problem in every society. Although some authors have examined the geography of violent crime, few have focused on the spatio-temporal patterns of violent injury and none have used an ambulance dataset to explore the spatial characteristics of injury. The purpose of this study was to describe the combined spatial and temporal characteristics of violent injury in a large urban centre.Using a geomatics framework and geographic information systems software, we studied 4,587 ambulance dispatches and 10,693 emergency room admissions for violent injury occurrences among adults (aged 18–64) in Toronto, Canada, during 2002 and 2004, using population-based datasets. We created kernel density and choropleth maps for 24-hour periods and four-hour daily time periods and compared location of ambulance dispatches and patient residences with local land use and socioeconomic characteristics. We used multivariate regressions to control for confounding factors. We found the locations of violent injury and the residence locations of those injured were both closely related to each other and clearly clustered in certain parts of the city characterised by high numbers of bars, social housing units, and homeless shelters, as well as lower household incomes. The night and early morning showed a distinctive peak in injuries and a shift in the location of injuries to a “nightlife” district. The locational pattern of patient residences remained unchanged during those times.Our results demonstrate that there is a distinctive spatio-temporal pattern in violent injury reflected in the ambulance data. People injured in this urban centre more commonly live in areas of social deprivation. During the day, locations of injury and locations of residences are similar. However, later at night, the injury location of highest density shifts to a “nightlife” district, whereas the residence locations of those most at risk of injury do not change

Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity Meta-Analysis of Randomized and Observational Studies

ObjectivesThe purpose of this study was to assess the effects of off-pump coronary bypass surgery (OPCAB) on mortality and morbidity.BackgroundDespite its potential for reducing morbidity and mortality, OPCAB’s role in clinical practice remains controversial.MethodsA meta-analysis of 37 randomized controlled trials (RCTs) (n=3,449) and 22 risk-adjusted (logistic regression or propensity-score) observational studies (n=293,617) was performed. Two reviewers performed literature searches (MEDLINE, EMBASE, PubMed, reference lists), quality assessment, and data extraction. Treatment effects were calculated as odds ratios (ORs) with 95% confidence intervals (CIs).ResultsIn RCTs, OPCAB was associated with reduced atrial fibrillation (OR 0.59; 95% CI 0.46 to 0.77) and trends toward reduced 30-day mortality (OR 0.91 95% CI 0.45 to 1.83), stroke (OR 0.52; 95% CI 0.25 to 1.05), and myocardial infarction (OR 0.79; 95% CI 0.50 to 1.25). Observational studies showed OPCAB to be associated with reduced 30-day mortality (OR 0.72; 95% CI 0.66 to 0.78), stroke (OR 0.62; 95% CI 0.55 to 0.69), infarction (OR 0.66; 95% CI 0.50 to 0.88), and atrial fibrillation (OR 0.78; 95% CI 0.74 to 0.82). At one to two years, OPCAB was associated with trends toward reduced mortality, but also increased repeat revascularization (RCT: OR 1.75, 95% CI 0.78 to 3.94; Observational: OR 1.35, 95% CI 0.76 to 2.39).ConclusionsRandomized controlled trials did not find, aside from atrial fibrillation, the statistically significant reductions in short-term mortality and morbidity demonstrated by observational studies. These discrepancies might be due to differing patient-selection and study methodology. Future studies must focus on improving research methodology, recruiting high-risk patients, and collecting long-term data