Anne W. Snowdon

Are we there yet? Canada's progress towards achieving road safety vision 2010 for children travelling in vehicles

This study examines safety seat use among Canadian children and evaluates child safety seat use relative to the national policy for child occupant safety, Road Safety Vision 2010. Using a probability sample, roadside observations of car safety seat use were collected from May to October of 2006 for 13,500 children aged from birth to 9 years in 10,084 vehicles at 182 sites in nine Canadian provinces and one territory. Observations revealed that 89.9% of Canadian children were restrained in some type of restraint. However, only 60.5% of these children were restrained in the correct safety seat. When comparing rates of correct use across provinces, results were not significantly different in provinces with booster seat legislation and those without this legislation. This data may be useful for healthcare practitioners and policy makers to develop interventions aimed at increasing appropriate car safety seat use for children in Canada.

A comparison of booster seat use in Canadian provinces with and without legislation

Background: The use of booster seats continues to be low, despite their effectiveness in reducing injury in motor vehicle collisions. Many jurisdictions have introduced legislation requiring the use of booster seats. To date, there have been no Canadian studies evaluating the effectiveness of legislation on booster seat use. Objectives: To describe restraint use among Canadian children aged 4–8 years, and compare booster seat use between provinces/territories with and without legislation. Methods: The data were obtained from a National Survey of Child Restraint Use/Misuse conducted between June and August 2006. A roadside observation survey was conducted at 182 sites across Canada. Weighted statistical analyses of differences in proportions were conducted, accounting for sampling stratification and clustering by car effects. Results: The roadside survey estimated that 24.6% of children aged 4–8 were restrained in booster seats in provinces with legislation, compared with 16.6% in provinces without (p<0.001). Conclusion: This is the first Canadian national study using direct observation to determine the effect of legislation on booster seat use. Provinces with legislation had higher booster seat use, but overall rates were still disappointingly low. Ongoing surveillance of child safety seat use and evaluation of effective adjuncts to legislation is required in order to see collision-related child deaths and injuries drop in the future.

Reverse innovation: an opportunity for strengthening health systems

BackgroundCanada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada.MethodsAn open call for applications took place over a 4-month period. Applicants were enticed to submit to the competition with a

Child Restraint Use in Canadian Provinces With and Without Legislation in 2010

50,000 prize for the top submission to finance their project. Leaders from a wide cross-section of sectors collectively developed evaluation criteria and graded the submissions. The criteria evaluated: proof of concept, potential value, financial impact, feasibility, and scalability as well as the use of prize money and innovation team.ResultsThe competition received 12 submissions from across Canada that identified potential reverse innovations from 18 unique geographical locations that were considered developing and/or emerging markets. The various submissions addressed health system challenges relating to education, mobile health, aboriginal health, immigrant health, seniors health and women’s health and wellness. Of the original 12 submissions, 5 finalists were chosen and publically profiled, and 1 was chosen to receive the top prize.ConclusionsThe results of this initiative demonstrate that a competition that is targeted to reverse innovation does have the potential to mobilize and stimulate leaders to identify reverse innovations that have the potential for system level impact. The competition also provided important insights into the capacity of Canadian students, health care providers, entrepreneurs, and innovators to propose and implement reverse innovation in the context of the Canadian health system.

Methodology of estimating restraint use in children: Roadside observation or parking lot interview survey

Objectives: When used correctly, child safety seats reduce the risk of injury to a child passenger compared to seat belts. The objectives of this study are to (1) describe restraint use among Canadian children ages 4–8 years in 2010; (2) compare child safety seat use between provinces with new legislation (post-2006), old legislation (pre-2006), and without legislation; and (3) compare child safety seat use rates from 2006 to 2010. Methods: Roadside observational surveys of child restraint use were performed in 2006 and 2010 using a nationally representative stratified sample. Proportions of restraint use, correct use (i.e., child safety seats and booster seats) in 4- to 8-year-old children was examined between 3 groups: provinces with new legislation (i.e., child safety seat legislation that included implementation of specific legislation for booster seat use for child passengers ages 4–8 years), old legislation, and no legislation. Results: There were 4048 children observed as passengers in motor vehicles. In provinces with new legislation, 84 percent (95% confidence interval [CI], 72.2–90.8) of children were restrained compared to 94.9 percent (95% CI, 93.0–96.7) in provinces with old legislation, and 81.8 percent (95% CI, 77.3–86.3) in provinces without legislation. Correct use of child restraint was 54.1 percent (95% CI, 48.0–60.3) in provinces with new legislation, 29.5 percent (95% CI, 25.9–33.2) in provinces with old legislation, and 52.0 percent (43.0–61.0) in provinces without legislation in 2010. Conclusion: The findings from this study suggest that child safety seat legislation has an impact on restraint use in Canada. Despite the increase in rates of child safety seat use in provinces with new legislation and stable rates in provinces with old legislation, use rates remain low. Injury prevention strategies including further surveillance, interventions, and enforcement of restraint use in children are important to decrease motor vehicle related injury and death.

Modeling improvements in booster seat use: a discrete choice conjoint experiment.

OBJECTIVE To compare the differences in Canadian national estimates of correct child restraint use obtained using the standard roadside observation method compared to a detailed parking lot interview. DESIGN A multi-stage stratified survey design was used to conduct roadside observational and interview data collection at 182 randomly selected sites across Canada. For each site, a roadside intersection location and a parking lot location were used for the roadside observational survey and the interview respectively. Weighted estimates of correct restraint use from both locations were compared. RESULTS Estimates of correct restraint use were significantly higher for all children under the age of 9 in the parking lot sample. The largest discrepancy between the two samples was in booster seat aged children (ages 4-8) where 29.1% versus 67.8% of children were observed to be correctly restrained using the roadside and the parking lot methodology respectively. There was a 67% participation refusal rate in the parking lot survey. CONCLUSIONS There are specific advantages and limitations to both survey designs. The purpose of the data collection must be considered when selecting the methodology. Parking lot surveys provide richer data regarding restraint use/misuse. Estimates of correct restraint use must be approached with caution due to the effect of consent bias resulting in over inflation of estimates. Roadside observation is adequate and appropriate for providing national estimates of correct restraint use.

Meeting community needs through leadership and innovation: a case of virtual psychiatric emergency department (ED)

Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.

Towards a Unified Data Management and Decision Support System for Health Care

In this paper, we discuss a telehealth project aimed at delivering mental health crisis interventions to patients in two rural hospitals in Southern Ontario, Canada, by creating a virtual psychiatric emergency department (ED) using telehealth technology. A participatory action research approach was followed as a design framework for this project. A formal process based on Kouzes and Posners five practices of exemplary leadership was crafted and closely followed, given the critical role of leadership necessary for the success of this project. The programme achieved its goal and was well received by patients and staff. ED physicians felt supported by the available psychiatric and mental health nursing expertise. Staff satisfaction with the protocols and processes were high, and ED physicians felt confident in the support they received during the decision-making process for appropriate disposition of the patient.

Design of a patient-centric, service-oriented health care navigation system for a local health integration network

We report on progress in development of a unified data management and decision support system, UDMDSS, for application to injury prevention in health care. Our system is based on a modular architecture which supports real-time web-base desktop and mobile data acquisition, semantic data models and queries, Bayesian statistical analysis, artificial intelligence agent-based techniques to assist in modelling and simulation, subjective logic for conditional reasoning with uncertainty, advanced reporting capabilities and other features. This research work is being conducted within a multi-disciplinary team of researchers and practitioners and has been applied to a Canadian national study on child safety in automobiles and also in the context of patient falls in a hospital.

A numerical investigation into the effect of CRS misuse on the injury potential of children in frontal and side impact crashes

Efficient and timely access to health care services has a profound impact on the well-being of individuals. A local health integration network (LHIN) located in South-western Ontario, Canada, is mandated to plan, identify, integrate, and fund regional health care services through its 88 member agencies. However, for the public, it is difficult to locate the right services at the right time due to the absence of a system-level navigation tool. In this ongoing system design project, we discuss a proposed patient-centric, service-oriented navigation system to be used by the public for accessing the regional health care services funded by the LHIN. We also propose that basic building blocks of service design be incorporated into the unified theory of acceptance and use of technology for developing an evaluative framework for assessing the impact of service design elements on the user’s acceptance and usage of technology such as our web-based health care navigation tool.