Minh T. Do

Mechanisms of Team-Sport-Related Brain Injuries in Children 5 to 19 Years Old: Opportunities for Prevention

Background There is a gap in knowledge about the mechanisms of sports-related brain injuries. The objective of this study was to determine the mechanisms of brain injuries among children and youth participating in team sports. Methods We conducted a retrospective case series of brain injuries suffered by children participating in team sports. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database was searched for brain injury cases among 5–19 year-olds playing ice hockey, soccer, American football (football), basketball, baseball, or rugby between 1990 and 2009. Mechanisms of injury were classified as “struck by player,” “struck by object,” “struck by sport implement,” “struck surface,” and “other.” A descriptive analysis was performed. Results There were 12,799 brain injuries related to six team sports (16.2% of all brain injuries registered in CHIRPP). Males represented 81% of injuries and the mean age was 13.2 years. Ice hockey accounted for the greatest number of brain injuries (44.3%), followed by soccer (19.0%) and football (12.9%). In ice hockey, rugby, and basketball, striking another player was the most common injury mechanism. Football, basketball, and soccer also demonstrated high proportions of injuries due to contact with an object (e.g., post) among younger players. In baseball, a common mechanism in the 5–9 year-old group was being hit with a bat as a result of standing too close to the batter (26.1% males, 28.3% females). Interpretation Many sports-related brain injury mechanisms are preventable. The results suggest that further efforts aimed at universal rule changes, safer playing environments, and the education of coaches, players, and parents should be targeted in maximizing prevention of sport-related brain injury using a multifaceted approach.

Chlorination Disinfection By-products and Pancreatic Cancer Risk

Chlorination disinfection by-products (CDBPs) are produced during the treatment of water with chlorine to remove bacterial contamination. CDBPs have been associated with an increased risk of bladder cancer. There is also some evidence that they may increase the risk of pancreatic cancer. We report results from a population-based case–control study of 486 incident cases of pancreatic cancer and 3,596 age- and sex-matched controls. Exposure to chlorination by-products was estimated by linking lifetime residential histories to two different databases containing information on CDBP levels in municipal water supplies. Logistic regression analysis found no evidence of increased pancreatic cancer risk at higher CDBP concentrations (all odds ratios < 1.3). Null findings were also obtained assuming a latency period for pancreatic cancer induction of 3, 8, or 13 years.

Maternal exposure to ambient air pollution and risk of early childhood cancers: A population-based study in Ontario, Canada

BACKGROUND There are increasing concerns regarding the role of exposure to ambient air pollution during pregnancy in the development of early childhood cancers. OBJECTIVE This population based study examined whether prenatal and early life (<1year of age) exposures to ambient air pollutants, including nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters ≤2.5μm (PM2.5), were associated with selected common early childhood cancers in Canada. METHODS 2,350,898 singleton live births occurring between 1988 and 2012 were identified in the province of Ontario, Canada. We assigned temporally varying satellite-derived estimates of PM2.5 and land-use regression model estimates of NO2 to maternal residences during pregnancy. Incident cases of 13 subtypes of pediatric cancers among children up to age 6 until 2013 were ascertained through administrative health data linkages. Associations of trimester-specific, overall pregnancy and first year of life exposures were evaluated using Cox proportional hazards models, adjusting for potential confounders. RESULTS A total of 2044 childhood cancers were identified. Exposure to PM2.5, per interquartile range increase, over the entire pregnancy, and during the first trimester was associated with an increased risk of astrocytoma (hazard ratio (HR) per 3.9μg/m3=1.38 (95% CI: 1.01, 1.88) and, HR per 4.0μg/m3=1.40 (95% CI: 1.05-1.86), respectively). We also found a positive association between first trimester NO2 and acute lymphoblastic leukemia (ALL) (HR=1.20 (95% CI: 1.02-1.41) per IQR (13.3ppb)). CONCLUSIONS In this population-based study in the largest province of Canada, results suggest an association between exposure to ambient air pollution during pregnancy, especially in the first trimester and an increased risk of astrocytoma and ALL. Further studies are required to replicate the findings of this study with adjustment for important individual-level confounders.

Concussion management by paediatricians: A national survey of Canadian paediatricians

Abstract Objective: To assess the use of concussion/mild traumatic brain injury (mTBI) guidelines, criteria used in the initiation of return-to-play (RTP) and management of RTP for brain injured children and youth by Canadian paediatricians. Methods: A cross-sectional survey was mailed through the Canadian Paediatric Surveillance Program to ∼2600 paediatric specialists and sub-specialists. Results: Of 809 respondents (31%), 503 encountered newly diagnosed paediatric concussion/mTBI within the past 12 months, reporting ∼6900 cases. Of the respondents, 96.7% (95% CI = 94.7–98.6%) reported using one or more of the presented concussion/mTBI guidelines in the management of their patients. The most frequently reported criteria (>50%) used to determine asymptomatic status were: free from all concussion symptoms, by patient report (92%), by proxy report (76%), normal physical examination (65%), in school full-time, with usual school performance (53%). Most respondents (84.9%) did not initiate RTP immediately after their patients became asymptomatic. The median time waiting before initiating RTP was 7 days. The median duration of the RTP sequence was 7 days, with considerable variation reported. Conclusions: Canadian paediatricians frequently encounter patients with concussion/mTBI. Their concussion/mTBI care appears to be consistent with current guidelines, but also shows practice variation, particularly when current guidelines become less proscriptive.

Injuries in the North - analysis of 20 years of surveillance data collected by the Canadian Hospitals Injury Reporting and Prevention Program

Background Injury is a major public health concern, particularly for Canadians living in Arctic regions where the harsh physical and social conditions pose additional challenges. Surveillance data collected over the past 2 decades through the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) provide insights into the burden of injuries in certain parts of Canada. Objectives This study aims to summarize and compare patterns of injuries in the Northwest Territories (NWT) and Nunavut to other southern communities across Canada. Methods Analysis was based on CHIRPP data covering the period 1991–2010. Proportionate injury ratio (PIR) and its 95% confidence interval were used to summarize and compare the injury experience of Canadians living in the Arctic regions to other CHIRPP sites across Canada. Results Between 1991 and 2010, there were 65,116 reported injuries. Approximately 83% of the cases were unintentional in nature; however, significantly higher proportions were observed for assaults and maltreatment (PIR=2.80, 95% CI: 2.72–2.88) among Canadians living in northern communities. Significantly higher proportions were also observed for crushing/amputations (PIR=2.28, 95% CI: 2.14–2.44), poison/toxic effects (PIR=1.21, 95% CI: 1.15–1.28), drowning/asphyxiations (PIR=1.52, 95% CI: 1.33–1.74) and frostbites (PIR=7.39, 95% CI: 6.60–8.28). The use of all-terrain vehicles or snowmobiles also resulted in significantly higher proportions of injuries (PIR=1.93, 95% CI: 1.79–2.09). Conclusions This study contributes to the limited literature describing injuries in northern communities where the harsh physical and social climates pose additional challenges. Excesses in the proportions identified in this study could be useful in identifying strategies needed to minimize injury risks in northern communities within Canada.

Effect modification of perinatal exposure to air pollution and childhood asthma incidence

Perinatal exposure to ambient air pollution has been associated with childhood asthma incidence; however, less is known regarding the potential effect modifiers in this association. We examined whether maternal and infant characteristics modified the association between perinatal exposure to air pollution and development of childhood asthma. 761 172 births occurring between 2006 and 2012 were identified in the province of Ontario, Canada. Associations between exposure to ambient air pollutants and childhood asthma incidence (up to age 6 years) were estimated using Cox regression models. 110 981 children with asthma were identified. In models adjusted for postnatal exposures, second-trimester exposures to particulate matter with a 50% cut-off aerodynamic diameter ≤2.5 μm (hazard ratio (HR) per interquartile range (IQR) increase 1.07, 95% CI 1.06–1.09) and nitrogen dioxide (HR per IQR increase 1.06, 95% CI 1.03–1.08) were associated with childhood asthma development. Enhanced impacts were found among children born to mothers with asthma, who smoked during pregnancy or lived in urban areas during pregnancy, males and children born preterm or of low birthweight. Prenatal exposure to air pollution may have a differential impact on the risk of asthma development, according to maternal and infant characteristics. Maternal asthma enhances the effect of air pollution during pregnancy on the risk of developing asthma in children http://ow.ly/eeWp30hSsIb

0388 An update of mortality and cancer incidence among Ontario uranium miners exposed to radon progeny

Objectives Underground uranium mining and milling was conducted in Northern Ontario from 1955 to 1996. The Ontario uranium miner’s cohort was created to study the health effects of radon and other occupational exposures. Study objectives include providing updated estimates of cancer incidence and mortality for miners exposed to radon daughters, a project funded by the Canadian Nuclear Safety Commission. Method The cohort of mine and mill workers was created using data from the National Dose Registry (Canada’s ionising radiation exposure registry), and the Ontario Mining Master File (containing work history information collected during annual chest x-rays) data. The cohort consists of men who worked for at least one week between 1954 and 2004. Follow-up was recently extended from 1986 to 2007 for mortality and included follow-up for cancer incidence from 1969–2005. Standardised mortality ratios (SMRs), standardised incidence ratios (SIRs) and their 95% confidence intervals (CIs) will be calculated based on Canadian national reference rates. Results The final cohort consisted of 28 546 miners. The mean age of the miners at entry into the study was 28.8 years. Miners in the cohort had a mean cumulative exposure of 21.0 WLM over an average of 5.3 years of total exposure. Between 1954 and 2007, a total of 8572 deaths were observed, and of these 2809 were due to cancer, including 1246 lung cancer deaths. There were 4151 incident cancers, including 1285 lung cancers, observed. Conclusions The Ontario uranium miner’s cohort study continues to be a valuable source of assessing uranium miners risk of cancer mortality and incidence.

The lows of getting high: sentinel surveillance of injuries associated with cannabis and other substance use

ObjectivesCannabis is a widely used illicit substance that has been associated with acute injuries. This study seeks to provide near real-time injury estimates related to cannabis and other substance use from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database.MethodsData from the eCHIRPP database, years 2011 to 2016, were analyzed via data mining, descriptive, logistic regression, and sensitivity analyses. Drug use trends over time for cannabis and/or other substances (alcohol, illicit drugs, and medications) were assessed. Descriptive statistics (intent, external cause, and nature of injury) and proportionate injury ratios (PIR) associated with cannabis use are presented.ResultsCannabis use was observed in 184 cases/100,000 eCHIRPP cases, and related injuries were mostly identified as unintentional (66.8%). Poisoning (68.5%) and intoxication (69.4%) were the external cause and nature of injury most associated with these events, and hospitalization was recorded for 14.3% of cases. Per 100,000 eCHIRPP cases, cannabis was used alone in 72.4 cases, and in combination with alcohol, illicit drugs, or medications in 74.6 cases, 11.3 cases, and 7.9 cases, respectively. Relative to non-use, the PIR of hospitalization was not significant for cannabis-only users of either sex (males: PIR 1.0, 95% CI 0.6–1.7, females: PIR 0.9, 95% CI: 0.5–1.7).ConclusionCannabis use injuries are rare, but can occur when cannabis is used with or without other substances. As Canada considers legislative changes, our finding of cases related to unintentional injury, poisoning, and intoxication suggests areas that might benefit from health literacy efforts.RésuméObjectifsLe cannabis, une substance illicite largement consommée, est associé à des blessures aiguës. Notre étude vise à présenter en quasi temps réel les blessures estimatives liées à la consommation de cannabis et d’autres substances d’après la base de données de la plateforme électronique du Système canadien hospitalier d’information et de recherche en prévention des traumatismes (eSCHIRPT).MéthodeNous avons analysé les données de la base eSCHIRPT pour les années 2011 à 2016 au moyen de techniques de forage de données et d’analyses descriptives, de sensibilité et de régression logistique. Nous avons estimé les tendances de la consommation de cannabis avec ou sans autres substances (alcool, drogues et médicaments) au fil du temps. Nous présentons les statistiques descriptives (intention, cause externe et nature de la blessure) et les rapports proportionnels de blessures (RPB) associés à la consommation de cannabis.RésultatsLa consommation de cannabis a été observée dans 184 pour 100,000 cas dans eSCHIRPT, et les blessures associées étaient principalement non intentionnelles (66,8%). L’empoisonnement (68,5%) et l’intoxication (69,4%) étaient la cause externe et la nature de la blessure les plus souvent associées à ces épisodes, et une hospitalization a été enregistrée dans 14,3% des cas. Pour 100,000 cas dans eSCHIRPT, le cannabis avait été consommé seul dans 72,4 cas, et en combinaison avec de l’alcool, de la drogue ou des médicaments dans 74,6, 11,3 et 7,9 cas, respectivement. Par rapport à la non-consommation, les RPB de l’hospitalization n’étaient pas significatifs pour les consommateurs et consommatrices de cannabis seul (hommes: RPB 1,0, IC de 95%: 0,6–1,7; femmes: RPB 0,9, IC de 95%: 0,5–1,7).ConclusionLes blessures dues à la consommation de cannabis sont rares, mais elles peuvent se produire, que le cannabis soit consommé seul ou avec d’autres substances. Étant donné les modifications législatives envisagées au Canada, nos constatations sur les cas de blessures, d’empoisonnements et d’intoxications involontaires indiquent que des efforts pour renforcer l’information en matière de santé sur ces aspects pourraient être bénéfiques.

Facteurs environnementaux associés au trouble du spectre de l’autisme : étude de délimitation portant sur les années 2003 à 2013

Introduction : Le nombre d’enfants chez lesquels on diagnostique un trouble du spectre de l’autisme (TSA) grimpe rapidement depuis une décennie. L’étiologie de ce trouble est toutefois en grande partie inconnue, même si la contribution de l’environnement est importante par rapport à celle de la génétique. Nous avons procédé à une étude de délimitation pour évaluer en détail l’état actuel des connaissances sur les facteurs environnementaux présents depuis le stade de la préconception jusqu’au début de la vie que l’on associe au TSA et pour dégager les lacunes de la recherche.

At-a-glance - Sentinel surveillance of emergency department presentations for barbecue brush-related injuries: the electronic Canadian Hospitals Injury Reporting and Prevention Program, 2011 to 2017

A barbecue (BBQ) brush is a common household item designed for cleaning grills used for barbecuing. Data from the electronic Canadian Hospitals Injury Reporting and Prevention Program database were analysed to estimate the frequency of injuries related to BBQ brushes as a proportion of all injuries, as well as to describe characteristics associated with such injury events. Between April 1, 2011 and July 17, 2017, BBQ brush injuries were observed at a frequency of 1.5 cases per 100 000 eCHIRPP cases (N = 12). Findings suggest that in addition to risks associated with the ingestion of loose BBQ brush bristles attached to foods, loose bristles could also result in injury via other mechanisms.