Amy Schneeberg

Safety, immunogenicity, and tolerability of three influenza vaccines in older adults: results of a randomized, controlled comparison.

To determine if newer influenza vaccines can safely improve seroprotection rates of older adults, we compared three licensed trivalent inactivated vaccines (TIVs) in a randomized, controlled trial with evaluator blinding. Participants were non-frail adults ≥ 65 y old, annually TIV-immunized. Study vaccines included intradermal (IDV), MF59-adjuvanted (ADV) and subunit (TIV) formulations of equal potency and strain composition. Blood was obtained before vaccination (V1) and 21 (V2) and 180 d (V3) afterward and tested by hemagglutination inhibition (HAI) assay. Safety diaries were completed daily by participants and specific tolerability questions were posed regarding injections and symptoms. In total, 911 participants were immunized and 887 (97.4%) completed V3. Groups had similar demographics. General symptom rates post-vaccination were similar among groups. Rates of injection site redness after IDV/ADV/TIV were 75%/13%/13% and rates of pain were 29%/38%/20%, respectively, but each vaccine was well tolerated, with symptoms causing little bother. Baseline antibody titers did not differ significantly among groups but B/Brisbane titers were too high for meaningful response assessments. At V2, seroprotection rates (HAI titer ≥ 40) were highest after ADV, the rate advantage over IDV and TIV being significant at 11.8% and 11.4% for H3N2 and 10.2% and 12.5% for H1N1, respectively. At day 180, seroprotection rates had declined ~25% and no longer differed significantly among groups. While IDV and TIV were also well tolerated, ADV induced modestly higher antibody titers in seniors to influenza A strains at 3 weeks but not 6 months post-vaccination. Immune responses to IDV and TIV were similar in this population.

Construct validity and impact of mode of administration of the PedsQL™ among a pediatric injury population.

BackgroundThe purpose of this study was to determine the construct validity of the PedsQL™ health related quality of life (HRQoL) instrument for use among injured children and to examine the impact of using different modes of administration, including paper and pencil, online and telephone.MethodsTwo hundred thirty-three participants (aged 0 – 16) were recruited from hospital wards and the emergency department of a pediatric hospital in a large urban center in British Columbia, Canada. Data used to evaluate the construct validity of the PedsQL™ were collected from participants at the time of seeking injury treatment (baseline) to capture a retrospective measure of pre injury health, and one month post injury. Data used to compare different modes of administration (n = 44) were collected at baseline. To assess construct validity repeated measures analysis of variance (rANOVA) was used to determine whether the PedsQL™ tool was able to discriminate between patients pre and post injury while investigating possible interaction by category of length of stay in hospital. The impact of different modalities of administering the PedsQL™ on item responses was investigated using Bland-Altman plots.ResultsrANOVA showed significant differences in PedsQL™ total score between baseline and one month post injury (p < .001), and differences in mean total score at one month post injury by category of injury severity (p < .001). There was also significant interaction by category of injury severity for the change in PedsQL™ total score from baseline to one month (p < .001). Pearson’s correlations were highly significant across three modalities of survey administration: paper and pencil, computer and telephone administration (range: .92 to .97, p < .001). Bland-Altman plots showed strong consistency.ConclusionThe PedsQL™ instrument is able to discriminate between pre and post injury HRQoL, as well as HRQoL post injury for injuries of varying severity. These findings are an indication that this instrument has good construct validity for the purpose of evaluating HRQoL of injured children. Data collected via paper-pencil, online and telephone administration were highly consistent. This is important as depending on the setting, clinical or research, different modalities of completing this instrument may be more appropriate.

Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a Measure of Injury Severity.

This research explored whether the pediatric version of the Canadian Triage Acuity Scale (PaedsCTAS) represented a valid alternative indicator for surveillance of injury severity. Every patient presenting in a Canadian emergency department is assigned a CTAS or PaedsCTAS score in order to prioritize access to care and to predict the nature and scope of care that is likely to be required. The five-level PaedsCTAS score ranges from I (resuscitation) to V (non-urgent). A total of 256 children, 0 to 17-years-old, who attended a pediatric hospital for an injury were followed longitudinally. Of these children, 32.4% (n = 83) were hospitalized and 67.6% (n = 173) were treated in the emergency department and released. They completed the PedsQLTM, a validated measure of health related quality of life, at baseline (pre-injury status), one-month, four- to six-months, and 12-months post-injury. In this secondary data analysis, PaedsCTAS was found to be significantly associated with hospitalization and length of stay, sensitive to the differences between PaedsCTAS II and III, and related to physical but not psychosocial HRQoL. The findings suggest that PaedsCTAS may be a useful proxy measure of injury severity to supplement or replace hospitalization status and/or length of stay, currently proxy measures.

'Do as we say, not as we do': A cross-sectional survey of injuries in injury prevention professionals

Background As the leading cause of death and among the top causes of hospitalisation in Canadians aged 1–44 years, injury is a major public health concern. Little is known about whether knowledge, training and understanding of the underlying causes and mechanisms of injury would help with ones own prevention efforts. Based on the Theory of Planned Behaviour, we hypothesised that injury prevention professionals would experience fewer injuries than the general population. Methods An online cross-sectional survey was distributed to Canadian injury prevention practitioners, researchers and policy makers to collect information on medically attended injuries. Relative risk of injury in the past 12 months was calculated by comparing the survey data with injury incidence reported by a comparable subgroup of adults from the (Canadian Community Health Survey (CCHS)) from 2009 to 2010. Results We had 408 injury prevention professionals complete the survey: 344 (84.5%) women and 63 (15.5%) men. In the previous 12 months, 86 individuals reported experiencing at least one medically attended injury (21 235 people per 100 000 people); with sports being the most common mechanism (41, 33.6%). Fully 84.8% individuals from our sample believed that working in the field had made them more careful. After accounting for age distribution, education level and employment status, injury prevention professionals were 1.69 (95% CI 1.41 to 2.03) times more likely to be injured in the past year. Interpretation Despite their convictions of increasing their own safety behaviour and that of others, injury prevention professionals’ knowledge and training did not help them prevent their own injuries.

WEIGHTY PROBLEMS: SPORT INJURIES IN OVERWEIGHT OR OBESE ACTIVE CANADIAN ADOLESCENTS

Background Despite the multitude of benefits of sport participation, it is the leading cause of injury requiring medical attention in Canadian youth. Previous research found both increased exposure to sport and body mass index (BMI) are injury risk factors. As a modifiable risk factor, further examination of the association between being obese or overweight and sport injury is warranted, accounting for sport exposure level. Objective To examine the relationship between sport injury and overweight and obese weight, versus normal weight, among a sub-sample of adolescents. It is hypothesized that overweight and obese adolescents will have increased odds of sport injury. Design Cross-sectional analysis of the national population-based Canadian Community Health Survey (2009/10) by Statistics Canada. Setting Canada. Participants Nationally representative sample (n=6163) of Canadian adolescents aged 12–19 years, classified ‘active’ by daily energy expenditure in physical activity minimum 3 METS (Kcal/kg/day). Risk factor assessment BMI was calculated using self-report data. Using Coles Classification System, participants were grouped: normal, overweight, or obese categories. Other variables (sex, ethnicity, daily physical activity, socio-economic status) were included in the multivariable logistic regression analysis to control for confounding. Main outcome measurements Sport injury: an injury in the past 12 months while engaged in sport or exercise. Results Among the sample of active adolescents, 25% (n=1 529) reported a sport injury in the past 12 months. In the final adjusted model, no significant relationship was found between being overweight and sport injury (OR=1.05 95% CI=0.90–1.22). A significantly reduced odds of sport injury was observed among obese adolescents (OR=0.72 95% CI=0.53–0.99) compared to their normal weight counterparts. Conclusions Overweight or obese active adolescents do not appear to be at increased risk of sports injury in this sample. The decreased odds among obese adolescents may be because of differences in intensity of sport participation or type of sporting activity.

Validating injury burden estimates using population birth cohorts and longitudinal cohort studies of injury outcomes: The VIBES-Junior study protocol

Introduction Traumatic injury is a leading contributor to the global disease burden in children and adolescents, but methods used to estimate burden do not account for differences in patterns of injury and recovery between children and adults. A lack of empirical data on postinjury disability in children has limited capacity to derive valid disability weights and describe the long-term individual and societal impacts of injury in the early part of life. The aim of this study is to establish valid estimates of the burden of non-fatal injury in children and adolescents. Methods and analysis Five longitudinal studies of paediatric injury survivors <18 years at the time of injury (Australia, Canada, UK and USA) and two whole-of-population linked administrative data paediatric studies (Australia and Wales) will be analysed over a 3-year period commencing 2018. Meta-analysis of deidentified patient-level data (n≈2,600) from five injury-specific longitudinal studies (Victorian State Trauma Registry; Victorian Orthopaedic Trauma Outcomes Registry; UK Burden of Injury; British Columbia Children’s Hospital Longitudinal Injury Outcomes; Children’s Health After Injury) and >1 million children from two whole-of-population cohorts (South Australian Early Childhood Data Project and Wales Electronic Cohort for Children). Systematic analysis of pooled injury-specific cohort data using a variety of statistical techniques, and parallel analysis of whole-of-population cohorts, will be used to develop estimated disability weights for years lost due to disability, establish appropriate injury classifications and explore factors influencing recovery. Ethics and dissemination The project was approved by the Monash University Human Research Ethics Committee project number 12 311. Results of this study will be submitted for publication in internationally peer-reviewed journals. The findings from this project have the capacity to improve the validity of paediatric injury burden measurements in future local and global burden of disease studies.

A cross-sectional evaluation examining the use of the Achilles tendinopathy toolkit by physiotherapists in British Columbia, Canada.

Abstract Purpose: To evaluate the awareness and use of the Achilles tendinopathy toolkit (ATT), a knowledge translation (KT) strategy supporting evidence-informed management of midportion Achilles Tendinopathy (AT), by British Columbian physiotherapists (PTs). Secondarily, to assess PTs strategies for AT management by examining the association between exploring the ATT and following best practice in clinical care as recommended by the ATT. Methods: Members of the Physiotherapy Association of British Columbia (BC) completed an online cross-sectional survey collecting information on demographics; awareness and exposure; perceptions, usability and applicability to clinical practice; knowledge; and attitudes. A clinical vignette assessed if respondents adhered to recommendations made by the ATT. Multi-variable logistic regression examined the association between exploring the ATT and following its recommendations. Results: Of 238 participants, 81% (n = 154) were aware of the ATT and of those 53% (n = 81) explored its contents. Time was the most frequent barrier. Bi-variable analyses showed those who explored the ATT had over double the odds of following the best practice (odds ratio = OR = 2.8; 95% confidence interval = 95% CI = 1.3–6.0). This did not remain significant in the final adjusted model (OR = 2.2; 95% CI = 0.9–5.4). Conclusions: Evaluation of KT strategies is critical. This study revealed high awareness and moderate use of the ATT. Future work should consider the impact of toolkits on patient outcomes. Implications for Rehabilitation A toolkit is a novel knowledge translation (KT) strategy designed to provide accessibleevidence-informed resources to facilitate best practice by clinicians. The evaluation of the Achilles tendinopathy toolkit (ATT) revealed favourable findingsregarding the impact of this KT strategy on the knowledge and attitudes of British Columbia(BC) PTs and the possibility of a positive impact on best practice in clinical care. This research suggests toolkits are a feasible and meaningful KT strategy to provide clinicianswith valuable synthesized resources that have the potential to benefit patient outcomes.

Association between Body Composition and Sport Injury in Canadian Adolescents

Purpose: To examine the association between overweight or obesity and sport injury in a population-based sample of Canadian adolescents. Methods: Cross-sectional analyses were performed using the Canadian Community Health Survey (2009–2010), a nationally representative sample (n=12,407) of adolescents aged 12–19 years. Body composition was quantified using BMI, grouping participants into healthy weight, overweight, or obese. The outcome of interest was acute or repetitive strain injury sustained during sport in the previous year. We examined the relationship between sport injury and overweight or obesity compared with healthy weight using multivariate logistic regression, controlling for sex, ethnicity, physical activity, and socio-economic status. We also examined the interaction between physical activity and body composition in a secondary analysis with a subset of active adolescents. Results: No significant relationship was found between being overweight and sport injury (odds ratio [OR]=1.04, 95% CI: 0.92, 1.17); however, a protective effect was seen between obesity and sport injury (OR=0.67, 95% CI: 0.53, 0.84). Secondary analysis revealed that overweight youths with the highest activity level (quartile 4) did have increased odds of sport injury (OR=1.38, 95% CI: 1.04, 1.83), yet obese youths with a moderate activity level (quartile 2) were protected compared with healthy-weight youths (OR=0.46, 95% CI: 0.24, 0.91). Conclusions: Further examination of active adolescents is warranted. Studies should consider sport-specific differences and comprehensive measurement of exposure to sport.