PRISM :: Browsing by Author "Hagel, Brent"

Browsing by Author "Hagel, Brent"

Now showing 1 - 20 of 20

Embargo
Bicycling Injuries in Children: The Role of the Built Environment
(2024-10-28) Aucoin, Janet; Hagel, Brent; Nettel-Aguirre, Alberto; Winters, Meghan; McCormack, Gavin
Background: Bicycling has many health benefits for children but can result in injuries, some severe. Additionally, children’s perceptions of injury risk decrease participation. The built environment is associated with the risk of bicycling injury in adults, yet less is known about risks for children who have different bicycling behaviours and locations than adults. This dissertation improves understanding of child bicyclist injury risk factors and perceptions in Canada, with an emphasis on the role of the built environment. Methods: We recruited 333 injured child bicyclists (ages 5-17) who presented to pediatric emergency departments in Vancouver, Calgary, and Toronto from May 2018 - October 2021. Using data from participant interviews and in-person site audits of injury/control locations from the injured child’s route, Chapter 3 used a case-crossover study design to examine associations between built environment characteristics and child bicyclist injuries. Chapter 4 used data from the case-crossover study to explore injury circumstances and examine risk factors associated with severe child bicyclist injuries. In 2021, 40 participants also completed a qualitative interview to explore injured child bicyclists’ perceptions of risk factors and safety (Chapter 5). Results: The results in Chapter 3 provided evidence that unpaved off road locations, presence of debris, poor surface quality, surface grade, and construction were risk factors for child bicyclist injuries. In Chapter 4, motor vehicle involvement and intersections were associated with higher odds of severe injury in child bicyclists. In Chapter 5, child bicyclists shared that some of the factors that contribute to perceptions of safety included sharing spaces with motor vehicles, road design, debris, surface quality, and surface grade. Conclusions: This study adds to evidence suggesting built environment supports are important for increasing bicycling safety for Canadian children. There is a critical need to provide child bicyclists with safe spaces where they are physically separated from motor vehicles and to ensure that routes used by child bicyclists are properly maintained.
Open Access
Clinical Prediction of Perinatal Arterial Ischemic Stroke
(2022-06) Srivastava, Ratika; Kirton, Adam; Hill, Michael D; Richer, Lawrence; Samuel, Susan; Hagel, Brent
Perinatal stroke is a well-defined but heterogenous group of disorders involving a focal disruption of cerebral blood flow between 20 weeks gestation and 28 days of life. At a combined incidence of 1:1000 live births, stroke in the perinatal period is more common than at any other time in childhood. Morbidity of perinatal stroke is high, and it is the most common cause of hemiparetic cerebral palsy. Years living with disability are amplified with deficits lasting a lifetime. Perinatal arterial ischemic stroke (PAIS) is the most common type of perinatal stroke. Advances in neuroimaging have allowed for exceptional growth in stroke diagnosis. However, etiology is poorly understood. Many pregnancy, delivery, and fetal risk factors have been considered, but targeted treatment and prevention efforts are still not possible. This thesis reviewed perinatal stroke and developed a diagnostic risk prediction model for PAIS. Pathophysiology, strategies for diagnosis, investigations, management, and outcomes were broken down by perinatal stroke disease, with an additional focus on family mental health and active trials for acute intervention. A diagnostic prediction model was then developed using novel, multisource data and multivariable logistic regression. Clinical pregnancy, delivery, and neonatal risk factors were collected from four registries including the Alberta Perinatal Stroke Project, Canadian Cerebral Palsy Registry, International Pediatric Stroke Study, and Alberta Pregnancy Outcomes and Nutrition study. Variable selection was based on peer-reviewed literature. The final model included nine clinical factors – maternal age, tobacco exposure, substance exposure, pre-eclampsia, chorioamnionitis, intrapartum maternal fever, emergency c-section, low 5-minute Apgar score, and male sex – to predict the risk of PAIS in a term neonate with good discrimination between cases and controls (C-statistic 0.73). This work highlights the lifelong effects of perinatal stroke on patients and families, and the potential for early perinatal stroke diagnosis. Findings suggest that clinical prediction and early, accurate diagnosis of PAIS may be possible using common clinical variables. Future research is needed to optimize risk prediction by better understanding perinatal stroke pathophysiology, including the role of the placenta, and identifying high-risk groups.
Open Access
Decannulation of Tracheostomy Tubes in Children and the Role of Polysomnogram in Predicting the Presence of Sleep Apnea
(2024-07-05) Platt, Jody Marie; Samuel, Susan; Adeleye, Adetayo; Pendharkar, Sachin; Hagel, Brent
Tracheostomy tubes in children with complex respiratory conditions may eventually be removed. There is variation in practice among pediatric care teams including the use of polysomnography (PSG). This work reviewed global practices of tracheostomy decannulation and described local practice and outcomes. A scoping review was completed using PRISMA guidelines. Data were extracted from 52 articles and fit to the Donabedian Framework for quality assessment including: structure, process and outcome. Decannulations were done at tertiary care centers (51/52, 98%), but articles often lacked information about health care structure like multi-disciplinary care (only 4/52, 8% with information). Airway endoscopy was the most common investigation before decannulation (43/52, 83%) and PSG testing was reported as completed (27/52, 52%) in half of the studies. When Pulmonary physicians were involved, PSG was commonly included (14/23, 61%). Outcomes focused on decannulation success (43/52, 83%), and success was higher when PSG was done. While different approaches exist, common themes emerged. Original tracheostomy indication and the subspecialties of doctors involved may impact decannulation process including PSG use and outcomes considered. A descriptive study was performed using the database from the Complex Airway Clinic (CAC) in Calgary, Alberta and supplemented with electronic medical record data. The approach to decannulation was described and fifty-two children were identified with upper airway obstruction (UAO) (18/52, 35%), upper airway obstruction and craniofacial syndrome (UAO/SYN) (13/52, 25%), long-term ventilation (LTV) (12/52, 23%), and temporary (TEMP) (9/52, 17%). Details of structure, process and outcomes per the Donabedian Framework were abstracted from the medical records. Children attended the multi-disciplinary CAC and most children without a TEMP tracheostomy tube attended the Otolaryngology / Respirology Combined Clinic for decannulation planning (39/43, 91%). Most children without a temporary tracheostomy had a functional airway assessment (FAA) (31/43, 72%). Children with UAO/SYN (7/13, 54%) and LTV (7/12, 58%) had a PSG before decannulation. Decannulation was successful for 51 of 52 children (98%). There were 7 children with a completed PSG before and after decannulation and there was a moderate agreement (k=0.46) observed in obstructive sleep apnea severity between the studies. Further studies with a prospective multi-center design are required to determine the usefulness of pre-decannulation PSG to inform risk of tracheostomy decannulation including residual obstructive sleep apnea. The indication for tracheostomy tube insertion may help to determine the optimal approach to tracheostomy decannulation and protocol development.
Open Access
Develop a comprehensive hypertension prediction model and risk score in population-based data applying conventional statistical and machine learning approaches
(2021-04-01) Chowdhury, Mohammad Ziaul Islam; Chowdhury, Tanvir; Quan, Hude; Leung, Alexander; O'Beirne, Maeve; Sikdar, Khokan; Hagel, Brent; Hu, Xiaoqiong
Hypertension is a common medical condition and is a significant risk factor for heart attack, stroke, kidney disease, and mortality. Developing a risk prediction model for hypertension incidence incorporating its risk factors can help identify high-risk individuals who should be targeted for healthy behavioral changes or medical treatment to prevent hypertension onset. This research aims to develop a robust hypertension prediction model for the general population. More specifically, we aimed to 1) conduct a comprehensive systematic review to identify risk factors and prediction models for hypertension incidence and perform a meta-analysis to evaluate the current model’s predictive performance. 2) develop a risk prediction model for incident hypertension in a Canadian cohort using a traditional modeling approach. 3) develop machine learning algorithms to predict hypertension incidence and compare their predictive performance with a traditional statistical model. We systematically searched MEDLINE, EMBASE, Web of Science, Scopus, and the grey literature for studies predicting the risk of hypertension among the general adult population. We identified 52 studies that presented 117 models, of which 75 were developed using traditional regression-based modeling and 42 using machine learning algorithms. No studies were from Canada where a hypertension prediction model was developed or validated. Meta-analysis showed the overall pooled C-statistics 0.75 [0.73 – 0.77] for the traditional regression-based models and 0.76 [0.72 – 0.79] for the machine learning-based models. The lack of a hypertension prediction model in a Canadian context motivated us to develop a new model. We used the data of 18,322 participants on 29 candidate variables from the large Alberta’s Tomorrow Project (ATP) to develop traditional Cox proportional hazards (PH) model. Age, sex, body mass index (BMI), systolic blood pressure (SBP), diabetes, total physical activity time, and cardiovascular disease were used as significant risk factors in the model. Our model showed good discrimination (Harrel’s C-statistic 0.77) and calibration (Grønnesby and Borgan test, χ^2 statistic = 8.75, p = 0.07; calibration slope 1.006). A risk score table to estimate hypertension risks at 2-, 3-, 5-, and 6-year were derived from the model to favor the model’s clinical implementation and workability. Five machine learning algorithms were also developed to predict hypertension incidence: penalized regression Ridge, Lasso, Elastic Net (EN), random survival forest (RSF), and gradient boosting (GB). The performance of machine learning algorithms was observed, similar to the traditional Cox PH model. Average C-indexes were 0.78, 0.78, 0.78, 0.76, 0.76, for Ridge, Lasso, Elastic Net, RSF, GB, respectively. Important features associated with each machine learning algorithms were also presented. We developed a simple yet practical prediction model to estimate the risk of incident hypertension for the Canadian population that relies on readily available variables. Our results showed little predictive performance difference between machine learning algorithms and the traditional Cox PH model in predicting hypertension incidence. Our newly developed model may help clinicians, and the general population assess their risks of new-onset hypertension and facilitate discussions on preventing this risk more effectively.
Open Access
The effect of a ski-snowboard injury prevention video on safety knowledge and behaviours in school programs
(2018-01-11) Mitra, Tatum; Hagel, Brent; Emery, Carolyn; Nettel-Aguirre, Alberto; Caird, Jeff; Russell, Kelly
Purpose: To implement and evaluate the effects of a skiing and snowboarding injury prevention video on child and adolescent safety knowledge and behaviours. Study Design: Cluster-randomized controlled trial. Background: Skiing and snowboarding are two popular winter activities; however, these sports can lead to injury. Previous studies have found that injuries in snow sports can be prevented and may be associated with poor decisions, actions and human error. Currently, there is no comprehensive injury prevention program found in skiing and snowboarding. Methods: The participants were students in grades 2 through 9 who were a part of the ski and snowboard school programs at a ski area in Southern Alberta. The participants were randomized into either the control or intervention group, based on the school they attended. The control group followed the current standard protocol for the ski and snowboard school programs, including an orientation video, while the intervention group received a video that focuses on safety knowledge and injury prevention. The outcomes were measured through the use of pre- and post-tests (safety knowledge uptake) and the observations of risky behaviours on the ski hill. Results: There was a significant increase in safety knowledge scores for those in the intervention group immediately following exposure to the video intervention (mean change: +1.91 points/15 points) compared with the control group after exposure to the control video (mean change: +0.10 points/15 points). There were 23.31 risky behaviours/100 runs (95% CI: 16.75-29.87) for those in the control group, and 22.95 risky behaviours/100 runs (95% CI: 17.63-28.26) for those in the intervention group. Conclusion: This project demonstrates that a skiing and snowboarding injury prevention video can improve knowledge scores within a school-aged population. The video intervention, however, was not associated with the overall incidence of risky behaviours in this population. Future injury prevention research should investigate how to better translate knowledge to induce behavioural changes and limit risky behaviours in child and adolescent skiers and snowboarders.
Open Access
Effect of Previous Concussion on Sport-Specific Skills in Youth Ice Hockey Players
(2016-01-18) Eliason, Paul; Emery, Carolyn; Meeuwisse, Willem; Hagel, Brent; Nadeau, Luc; Yeates, Keith
Objective: To investigate the effect of previous concussion on sport-specific skill performance in youth ice hockey players. Methods: In total, 596 participants [525 males and 71 females, ages 11-17, representing elite (upper 30% by division of play) and non-elite (lower 70% by division of play)] were recruited from minor ice hockey teams in Calgary, Alberta over three seasons of play (2012-2015). Primary Outcome Measure: On-ice skill performance was based on the Hockey Canada Skills Test (HCST) battery which included forward agility weave, forward and backward speed skate, forward to backward transition agility, and a 6-repeat endurance skate. Results: There were no significant differences in the adjusted odds ratios or the mean scores between those with and without a history of concussion for all HCST components. Conclusions: Youth ice hockey players with a history of concussion have similar HCST performance scores to those that do not.
Open Access
Effect of reducing the posted speed limit to 30 km per hour on pedestrian motor vehicle collisions in Toronto, Canada - a quasi experimental, pre-post study
(2020-02-10) Fridman, Liraz; Ling, Rebecca; Rothman, Linda; Cloutier, Marie S; Macarthur, Colin; Hagel, Brent; Howard, Andrew
Abstract Background Pedestrian related deaths have recently been on the rise in Canada. The effect of changing posted speeds on the frequency and severity of pedestrian motor vehicle collisions (PMVC) is not well studied using controlled quasi-experimental designs. The objective of this study was to examine the effect of lowering speed limits from 40 km/h to 30 km/h on PMVC on local roads in Toronto, Canada. Methods A 30 km/h speed limit on local roads in Toronto was implemented between January 2015 and December 2016. Streets that remained at a 40 km/h speed limit throughout the study period were selected as comparators. A quasi-experimental, pre-post study with a comparator group was used to evaluate the effect of the intervention on PMVC rates before and after the speed limit change using repeated measures Poisson regression. PMVC data were obtained from police reports for a minimum of two years pre- and post-intervention (2013 to 2018). Results Speed limit reductions from 40 km/h to 30 km/h were associated with a 28% decrease in the PMVC incidence rate in the City of Toronto (IRR = 0.72, 95% CI: 0.58–0.89). A non-significant 7% decrease in PMVC incidence rates were observed on comparator streets that remained at 40 km/h speed limits (IRR = 0.93, 95% CI: 0.70–1.25). Speed limit reduction also influenced injury severity, with a significant 67% decrease in major and fatal injuries in the post intervention period on streets with speed limit reductions (IRR = 0.33, 95% CI: 0.13–0.85) compared with a 31% not statistically significant decrease in major and fatal injuries on comparator streets (IRR = 0.69, 95% CI: 0.37–1.31). The interaction term for group and pre-post comparisons was not statistically significant (p = 0.14) indicating that there was no evidence to suggest a pre-post difference in IRRs between the intervention and comparator streets. Conclusions Declines in the rate of PMVC were observed on roads with posted speed limit reductions from 40 km/h to 30 km/h, although this effect was not statistically greater than reductions on comparator streets.
Open Access
Epidemiologic Analysis of Injury in Five Years of Canadian Professional Rodeo
(American Orthopaedic Society for Sports Medicine, 2002) Butterwick, Dale J.; Hagel, Brent; Nelson, Dexter S.; LeFave, Mark R.; Meeuwisse, Willem H.
Longitudinal studies of rodeo injuries are rare. We prospectively investigated injuries in professional rodeo in Canada over a 5-year period. Our specific interests included injury incidence density in specific rodeo events, risk factors such as past injury, and the incidence of head injury. Of 323 professional rodeos from 1995 through 1999, 63 rodeos provided a convenience sample. These rodeos were selected because the Canadian Professional Rodeo Sport Medicine Team was in attendance at these events, thus providing both competitor health care and data collection. Four hundred fifty-one injuries were reported during 30,564 competitor-exposures. The greatest injury frequency and injury incidence density were in the rough stock events (bull riding, bareback riding, and saddle bronc). Bull riding accounted for the greatest injury frequency (141) and incidence density (32.2 injuries per 1000 competitor-exposures). Bull riding had a relative injury risk of 1.32 when compared with bareback riding; bareback riding had a relative injury risk of 1.39 when compared with saddle bronc riding. Concussions accounted for 8.6% of all reported injuries. Concussions and other head injuries (65) were second only to knee injuries (76) in frequency of injury to specific body parts. This concussion frequency is higher than has previously been reported.
Open Access
Equipment and Concussion in Youth Ice Hockey and Ringette
(2021-06-28) Kolstad, Ashley; Emery, Carolyn; Hagel, Brent; Black, Amanda; Palacios-Derflingher, Luz; Mihalik, Jason
This thesis examined equipment related to concussion prevention in youth ice hockey and ringette players. The first study examined potential equipment-related risk factors for concussion in youth ice hockey players. We considered both a prospective cohort (rate of concussion) and nested case (concussion) control (musculoskeletal injury) design (odds of concussion) for each equipment characteristic. Main results showed significant lower rates and odds of concussion for mouthguard wearers (when compared to non-wearers) and no differences in concussion likelihood for newer and older helmet ages. The second study examined the feasibility and reliability for conducting virtual helmet fit assessments in youth ice hockey and ringette players for future concussion prevention examination. The results indicated high percent agreement (≥80%) for reliability on almost all criteria for virtual assessments and barriers for assessments related to technology (e.g., camera quality) and environment (e.g., lighting). Overall, equipment may be important for concussion prevention and player safety.
Open Access
Evaluation of the Effect of Policy Change on Physical Contacts in Youth Ice Hockey Using Video Analysis
(2016) Krolikowski, Maciej; Emery, Carolyn; Palacios-Derflingher, Luz; Hagel, Brent; Nadeau, Luc
Objective: To determine the association between body checking policy change and the frequency and intensity of physical contacts in Bantam ice hockey players (ages 13-14). Methods: This is a cohort study design. Video-analysis data includes 13 non-elite (lowest 70% by division of play) Bantam (ages 13-14) ice hockey games videotaped in Calgary, Alberta, Canada (2014-15 where body checking was permitted) and Vancouver, British Columbia, Canada (2014-15 where body checking was not permitted). Primary outcome measures include high intensity physical contact (body checking), as well as hooking and slashing behaviours. Results: Lower incidence rates of high intensity physical contact were observed in Bantam ice hockey players in a league where body checking was not permitted [IRR= 0.09 (95% CI; 0.05-0.15)]. Players in a league where body checking was not permitted had significantly higher incidence rates of hooking and slashing behaviours [IRR= 1.81 (95% CI; 1.33-2.47)]. Conclusions: There was a lower incidence of higher intensity physical contacts in Bantam ice hockey players in a league where body checking is not permitted, whereas the incidence of hooking and slashing behaviours were higher. This research will inform the mechanisms explaining injury and will have important national public health implications (reduction of injury) for policy decisions related to rule enforcement in youth ice hockey.
Open Access
Factors Influencing Fine and Gross Motor Development among Children 24 Months of Age: Results from the All Our Families Study
(2017) Dodd, Shawn X.; Tough, Suzanne; Hagel, Brent; Cabaj, Jason; Nettel-Aguirre, Alberto
Objective: The objective of this study was to identify factors influencing fine and gross motor development of Albertan children at 24 months of age. Methods: This is a secondary analysis of data from the All Our Families study, a prospective pregnancy cohort. Multivariable logistic regression was performed to identify factors influencing motor development. Results: Early developmental delays, maternal abuse and maternal postpartum drug use were associated with an increased odds of suboptimal gross motor development at 24 months of age. Pregnancy complications were associated with a reduction in risk for gross motor delays. Early developmental delays, NICU admission and maternal postpartum alcohol consumption were associated with an increased risk for delays in fine motor development at 24 months of age. Conclusion: Delayed motor development at 24 months of age may be mitigated through detection and intervention of early cognitive, social and motor developmental delays.
Open Access
The Feasibility and Impact of a Painted Designs Intervention on School Children’s Physical Activity
(Taylor and Francis Group, 2022-06-16) Wong, Janet B.; McCallum, Kyle S.; Frehlich, Levi; Bridel, William; McDonough, Meghan H.; McCormack, Gavin R.; Fox, Kris; Brunton, Laura; Yardley, Leah; Emery, Carolyn A.; Hagel, Brent
Interventions such as painted designs on school tarmacs may increase children’s physical activity during school hours. This mixed-methods study examined the influence of a painted designs (e.g., traditional games, random circles) intervention on the physical activity experiences of elementary school children. Systematic observations and accelerometer data were collected to evaluate the type and quantity of student physical activity. Interviews were used to explore teacher and student experiences. Observed physical activity was not significantly different between intervention and control schools (t(43) = 0.22, p = 0.83), and children at the intervention schools undertook less physical activity (steps, moderate, vigorous, and combined moderate-to-vigorous activity) as compared with the control school (t = 2.71- 4.35, p < 0.05). Teachers and students commented that the painted designs were confusing but held potential for inclusiveness, physical activity, and learning. Additional resources and instruction may assist in better use of painted designs for physical activity and academic learning.
Embargo
Investigating the Built Environment’s Influence on Child Active Transportation Injury and Prevalence
(2024-04-11) HubkaRao, Tate; Hagel, Brent; Nettel-Aguirre, Alberto; Cloutier, Marie-Soleil
Background: Motor-vehicle collisions (MVCs) are a leading cause of Canadian child active transportation injuries. Specific built environment features may reduce child injury risk while increasing active transportation prevalence; however, few studies exist evaluating the effectiveness of these features specific to this age group. Further, it is important to understand how built environment features can influence community and school wide child active transportation injuries and prevalence. Methods: Using a modified stepped-wedge trial, Chapters 3 and 4 investigated the influence of installing specific built environment features on traffic speed and volume, active transportation prevalence, and caregiver perceptions of safety. Chapters 5 and 6 used machine learning recursive partitioning trees to predict the number of child active transportation related MVCs, and the proportion of elementary students using active transportation to school, based on the built environment within respective geographical areas. Results: Chapter 3 found traffic calming curbs and in-street signs were associated with a reduction in traffic speed, depending on time-period. No significant changes in traffic volume were found immediately following installation. In-street signs were associated with a reduction of active transportation prevalence in the morning, and an increase in the afternoon. Chapter 4 found traffic calming curb installation was associated with higher proportions of caregiver perceptions of safety. Some respondents showed higher proportions of reported children walking to school at intervention locations. Chapter 5 found built environment features such as signalized intersections were predictive of annual collisions. Chapter 6 showed population density to be important in predicting active transportation prevalence to school. Conclusions: Results of this thesis support calls for a systems approach to road safety. The variability in characteristics of the urban environment that are associated with child active transportation safety and prevalence suggests that no single intervention would be as effective as a more holistic and comprehensive approach. Specific features such as traffic calming curbs and in-street signs, coupled with reductions of major roadways and increases in population density, may, together, have a considerable and lasting effect on improving active transportation safety for Canadian children.
Embargo
Longitudinal Analysis of the Behavioral and Occupational Factors Present in Individuals Living with Inflammatory Bowel Disease during the COVID-19 Pandemic in Calgary, Alberta
(2023-06-08) Caplan, Léa Natacha; Kaplan, Gilaad; Hagel, Brent; Panacionne, Remo
The COVID-19 pandemic caused by the SARS-CoV-2 virus resulted in a public health emergency. Routine behaviours such as shopping were considered high-risk during the pandemic. Research on how people with inflammatory bowel disease (IBD) altered their behaviour during the pandemic is lacking. Therefore, we aimed to understand how the behaviours of persons with IBD were altered during the pandemic, and whether behavioural exposures were associated with COVID-19 disease. At recruitment, 556 participants with a confirmed diagnosis of IBD were administered a self-report, online questionnaire. The primary baseline questionnaire captured demographic and occupational factors as well as the frequency of social behaviours at two time periods: 1. January–March 2020 (i.e., prior to pandemic lockdown), and 2. January–September 2021 (i.e., restriction period). A follow-up questionnaire investigating the same exposures from January–March 2022 (Omicron era) was completed by a subset of 223 participants between September 1st, 2022, and October 20th, 2022. Proportions for high frequency behaviours (daily to once per week) across the three time periods were reported. Multivariable logistic regression was used to analyze behaviours and Omicron-era COVID-19 cases. Behavioural changes were observed across all three time periods. The proportion of highly frequent behaviours dropped for almost all behaviour measures (except for outdoor exercise and online groceries) between January–March 2020 and January–September 2021. The proportion of most behaviours increased between January–September 2021 and January–March 2022 but did not match pre-pandemic levels (except online groceries, outdoor fitness, and travelling). Participants who visited restaurants frequently (i.e., daily to once per week) had 3.24 times the odds of getting COVID-19 compared with those who visited a restaurant infrequently (i.e., less than once per week). Over a two-year period, those with IBD changed their behaviours and lifestyle, perhaps in response to policy and restriction changes in Alberta. Individuals with IBD resorted to lower risk behaviours such as outdoor exercise, and activities with higher risk of exposure (e.g., indoor fitness) did not return to pre-pandemic levels.
Open Access
Pediatric Concussion Health Service Utilization and Follow-Up Care: A Population-Based Epidemiological Study Using Administrative Health Data
(2021-08-19) Wittevrongel, Krystle; Zwicker, Jennifer; Yeates, Keith; Schneider, Kathryn; Hagel, Brent
Concussion is a common injury among children and youth, although population-level incidence and trends related to service use are not well described in the literature. In addition, while treatment and management decisions are led by best practices and clinical guidelines, there is a paucity of studies exploring the individual and contextual factors that impact health service utilization following concussion in the pediatric patient. Thus, the objective of this thesis was to address these gaps and better understand how children and youth are interacting with the health care system following concussion in Alberta. In this thesis, 14-years of system-level linked administrative health data and a defined episode of care (EOC) were used to describe trends in health care utilization following pediatric concussion in Alberta. An increased incidence of concussion and other mild head injury diagnoses was observed across the province. In addition, a shift in care from emergency department (ED) to outpatient physician office (PO) settings and a higher use of the ED by some segments of the population was observed. Findings suggest some children and youth are more likely to receive care following a concussion. In addition, follow-up care increased over time, demonstrating accordance with clinical guidelines. However, rates remained low, indicating a lack of application by provider or adherence by patient. Findings indicate that the likelihood of receiving follow-up care in Alberta was influenced by both individual and contextual factors. Factors related to need (perceived and evaluated) were most strongly associated with health care utilization. The index visit occurring in PO had the strongest positive association with follow-up care, followed by a history of concussion-related EOC. At the same time, patient predisposing and enabling factors also affected utilization. Younger children and youth, females, and those from areas of lower socioeconomic status (SES) or residing in certain geographical areas were less likely to receive follow-up care. Findings suggest that to improve service delivery and targeted treatment in line with clinical guidelines for all children and youth, policies that focus on equitable access are needed.
Open Access
Protocol for a rapid scoping review to examine child health and well-being indicator frameworks in OECD countries
(2022-09-26) Roth, Christiane; Zwicker, Jennifer; Hagel, Brent; Boynton, Heather; Crowshoe, Lynden F.J.; Dimitropoulos, Gina; Exner-Cortens, Deneira; Metcalfe, Amy; Russell-Meyhew, Shelly; Schwartz, Kelly Dean; Thomas, Karen; Tough, Suzanne
The purpose of the rapid scoping review is to identify commonly recognized domains/dimension and indicators considered important to the measurement of child health and wellbeing of children and youth to inform the development of a wellbeing indicator framework. Understandings of the concept and importance of health and wellbeing has evolved in the recent decades to encompass wider determinants of health. The concept of wellbeing or quality of life in particular, has become increasingly relevant at the international and national policy levels as a measure for a country’s overall performance. Wellbeing or quality of life indicator frameworks can help monitor health and wellbeing over time in a given jurisdiction and guide the development of cross–sectoral wellbeing policies and strategies to improve overall wellbeing outcomes of the population. This protocol describes our approach to a scoping review, which will gather comprehensive data on how child health and wellbeing is defined and measured across the globe. The protocol is based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist, which will also guide its reporting. The scoping review will include peer-reviewed articles and information from a grey literature search of inter-governmental organizations and official documents of OECD countries. Data will be synthesized to showcase what child health and wellbeing is commonly comprised of (dimensions/domains/components) and which indicators and sources are used to measure the concept.
Open Access
Road safety, health equity, and the built environment: perspectives of transport and injury prevention professionals in five Canadian municipalities
(2023-06-22) McCullogh, Emily; Macpherson, Alison; Hagel, Brent; Giles, Audrey; Fuselli, Pamela; Pike, Ian; Torres, Juan; Richmond, Sarah A.
Abstract Background Concerns regarding health equity (HE) and the built environment (BE) are well established in the Canadian urban context. Transport and injury prevention professionals across sectors, such as transportation and public health, are involved in designing and implementing BE interventions that enhance the safety of vulnerable road users (VRUs). Results from a larger study examining barriers and facilitators to BE change are used to illustrate how transport and injury prevention professionals perceive HE concerns in their work in five Canadian municipalities. Broadening our understanding of how HE influences the professional BE change context is crucial when advocating for modifications that enhance the safety of equity-deserving VRUs and groups who experience marginalization. Methods Interview and focus group data were gathered from transport and injury prevention professionals working in policy/decision-making, transport, police services, public health, non-profit organizations, schools/school boards, community associations, and private sectors across five Canadian urban municipalities: Vancouver, Calgary, Peel Region, Toronto, and Montréal. Data were analyzed using thematic analysis (TA) to illustrate how equity considerations were perceived and applied in participants’ BE change work. Results The results of this study illustrate transport and injury prevention professionals’ awareness of the varying needs of VRUs, as well as the inadequacies of current BEs in the Canadian urban context and consultation processes utilized to guide change. Participants emphasized the importance of equitable community consultation strategies, as well as specific BE changes that would support the health and safety of VRUs. Overall, the results highlight how HE concerns inform transport and injury prevention professionals’ BE change work in the Canadian urban context. Conclusion For professionals working in urban Canadian transport and injury prevention sectors HE concerns influenced their perspectives of the BE and BE change. These results illustrate a growing need for HE to guide BE change work and consultation processes. Further, these results contribute to ongoing efforts in the Canadian urban context to ensure that HE is at the forefront of BE policy change and decision-making, while promoting existing strategies to ensure that the BE, and related decision-making processes, are accessible and informed by a HE lens.
Open Access
Setting the Standard: Injury, Concussion, and Performance in Youth Volleyball
(2022-05) Vaandering, Mackenzie; Schneider, Kathryn; Emery, Carolyn; Hagel, Brent; Pasanen, Kati
This thesis contains three projects focused on Canadian youth community volleyball. The first project is a prospective cohort study evaluating injury epidemiology during the 2018 Canadian Youth National Volleyball Tournament. It was found that rates of injury in U14 were higher than U18, with high rates of injury in tournament play. The second project evaluated the test-retest reliability of a series of volleyball performance measures (i.e., modified agility t-test, modified pro agility, spike approach jump height, serve velocity, attack velocity and the Y-balance test). Most measures, excluding serve and attack velocity, were found to be reliable. The third project is a cross-sectional study describing performance scores on these measures. Males were faster on both agility tests, jumped higher, and achieved faster serve velocities than females. In the future, the addition of performance metrics may be beneficial to assess skill development and performance changes with injury prevention programs.
Restricted
Whistleblowing the whistleblower- are head contact penalties a target for injury prevention in youth and university basketball?
(2023-03-08) Fehr, Christy; Emery, Carolyn; West, Stephen; Hagel, Brent; Goulet, Claude
This thesis contains two original data papers, both using video analysis to determine incidence of head contacts (HCs), suspected concussion and injury, and other important factors contributing to injury outcomes in basketball. The first study focuses on male and female university level basketball players competing in the 2019/2020 regular season. Video analysis was used to compare the incidence of suspected concussion, injury, and HCs (both direct, [HC1], and indirect [HC2]). Further, we assessed proportions of these outcomes that occurred by game event, as well as court location and penalization of HCs. Our main finding from this study was males sustained HC1s at a 1.55-fold greater rate than females. Despite illegality of HC in basketball competition, we revealed an astonishingly low proportion of HCs were assessed as a foul by referees. The second study assessed the same research question with the same objectives but was focused on a youth demographic. We divided games into divisions (Division 1 and Division 2) for a more like comparison concerning age and skill level. We found no statistically significant sex differences in our study outcomes in Division 1, however, Division 2 boys sustained HC1s at a 1.42-fold greater rate than females in Division 2. Although most of our rates were not statistically different between sexes, our point estimates do warrant concern regarding our injury outcomes for youth in both Divisions. Common to both studies, the ‘key’ was the most common court location for sustaining HCs. Game events varied by sex within each study, but commonly reported for sustaining HCs was the act of rebounding both offensively and defensively. Overall, these studies highlight potential sex differences that may exist when assessing HCs, suspected concussion and injury, and the need for targeting stricter penalization of HCs in competition.
Open Access
Youth Ice Hockey Related Injury and Concussion: Informing Prevention Through Modifiable Risk Factors
(2021-04-30) Eliason, Paul Hamilton; Emery, Carolyn; Hagel, Brent; Palacios-Derflingher, Luz; Patten, Scott; Kerr, Zachary
Ice hockey is a popular sport in Canada, yet is considered a high-risk sport for injury. To prevent these injuries, potential risk factors must be identified to inform injury prevention strategies. Further, injury prevention strategies that have been implemented should be evaluated to ensure no unintended injury consequences have occurred. In this dissertation, the potential risk factors for injury and prevention strategies in youth ice hockey are reviewed and limitations of the literature are discussed to help inform the next steps for injury prevention. The association between on-ice skill performance and injury is also examined. This will help provide a better understanding of the potentially modifiable risk factors for injury in youth ice hockey and will further aid in the development of targeted interventions. Additionally, the rates of injury and concussion among under-15 (ages 13-14) ice hockey players playing in leagues allowing body checking, but who have varying years of body checking experience is explored. Finally, the association of body checking experience and rates of injury and concussion in under-18 players (ages 15-17) are assessed. These evaluations will provide important evidence for recent and potentially future body checking policy changes in youth ice hockey. Policy permitting body checking continues to be the most relevant modifiable risk factor in youth ice hockey. A faster time on the transition agility (suggesting higher skill) was associated with a higher rate of injury among 11-17-year-olds. Among 13-14-year-olds participating in a body checking league, there were no significant differences in the rates of injury or concussion among players that had no body checking experience and those that had either 1 year or 2+ years of experience. Among 15-17-year-olds, the adjusted rates of injury and concussion were higher among those with more body checking experience (3 years) than those with less experience (2 years). These studies provide further evidence in support of disallowing body checking in younger age groups in youth ice hockey to reduce injury and concussion rates, with no adverse consequences related to less body checking experience when engaged in leagues allowing body checking in older age groups (ages 13-17).