Takuro Ishikawa

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review

Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.

Evaluating the benefits of second-eye cataract surgery among the elderly

&NA; The aim of this systematic review was to synthesize and appraise the evidence of benefits of second‐eye cataract extraction for visual function, patient‐reported quality of life, falls, and driving ability among the elderly. We conducted a comprehensive search in MEDLINE using “surgery,” “cataract extraction,” “second eye,” and “bilateral.” Ten studies met the inclusion and quality criteria. We found “moderate” evidence supporting improvement in stereopsis, stereoacuity, and anisometropia over and above the benefits of first‐eye surgery. We also found “moderate” evidence supporting improvement in visual acuity, contrast sensitivity, and self‐reported visual functioning. Studies included in the review do not provide definitive evidence of second‐eye surgery benefits on health‐related quality of life, visual fields, falls prevention, and driving performance. However, the heterogeneity of outcome measures and the limited number of studies likely contributed to our findings. The findings have implications for clinicians and policymakers in the health‐care industry and emphasize the need for additional trials examining this important and widely performed clinical procedure. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

A Systematic Review of Community Interventions to Improve Aboriginal Child Passenger Safety

We evaluated evidence of community interventions to improve Aboriginal child passenger safety (CPS) in terms of its scientific merit and cultural relevance. We included studies if they reported interventions to improve CPS in Aboriginal communities, compared at least pre- and postintervention conditions, and evaluated rates and severity of child passenger injuries, child restraint use, or knowledge of CPS. We also appraised quality and cultural relevance of studies. Study quality was associated with community participation and cultural relevance. Strong evidence showed that multicomponent interventions tailored to each community improves CPS. Interventions in Aboriginal communities should incorporate Aboriginal views of health, involve the community, and be multicomponent and tailored to the communitys circumstances and culture.

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.

Go Play Outside! Effects of a risk-reframing tool on mothers’ tolerance for, and parenting practices associated with, children’s risky play: study protocol for a randomized controlled trial

BackgroundChildren’s risky play is associated with a variety of positive developmental, physical and mental health outcomes, including greater physical activity, self-confidence and risk-management skills. Children’s opportunities for risky play have eroded over time, limited by parents’ fears and beliefs about risk, particularly among mothers. We developed a digital tool and in-person Risk-reframing (RR) workshop to reframe parents’ perceptions of risk and change parenting behaviours. The purpose of this paper is to describe our RR intervention, rationale and protocol for a randomised controlled trial to examine whether it leads to increases in mothers’ tolerance of risk in play and goal attainment relating to promoting their child’s opportunities for risky play.MethodsWe use a randomised controlled trial design and will recruit a total of 501 mothers of children aged 6–12 years. The RR digital tool is designed for a one-time visit and includes three chapters of self-reflection and experiential learning tasks. The RR in-person tool is a 2-h facilitated workshop in which participants are guided through discussion of the same tasks contained within the digital tool. The control condition consists of reading the Position Statement on Active Outdoor Play.Primary outcome is increased tolerance of risk in play, as measured by the Tolerance of Risk in Play Scale. Secondary outcome is self-reported attainment of a behaviour-change goal that participants set for themselves.We will test the hypothesis that there will be differences between the experimental and control conditions with respect to tolerance of risk in play using mixed-effects models. We will test the hypothesis that there will be differences between the experimental and control conditions with respect to goal attainment using logistic regression.DiscussionThe results of this trial will have important implications for facilitating the widespread change in parents’ risk perception that is necessary for promoting broad societal understanding of the importance of children’s risky play. In addition, the findings may provide relevant information for the design of behaviour-change tools to increase parental tolerance of risk.Trial registrationClinicalTrials.gov, ID: NCT03374683. Retrospectively registered on 15 December 2017.

Risk Engagement and Protection Survey (REPS): developing and validating a survey tool on fathers’ attitudes towards child injury protection and risk engagement

Introduction Fathers play a unique role in keeping children safe from injury yet understanding of their views and attitudes towards protecting children from injury and allowing them to engage in risks is limited. The purpose of this study was to develop and validate an instrument to measure fathers’ attitudes towards these two constructs. Methods and findings An instrument was developed that used prior qualitative research to inform item generation. The questions were assessed for content validity with experts, then pilot-tested with fathers. The survey was completed by 302 fathers attending hospital with their child for an injury or non-injury reason. Results of confirmatory factor analysis identified eight items relating to the protection from injury factor and six items relating to the risk engagement factor. Correlation between the two factors was low, suggesting these are two independent constructs. Conclusions The Risk Engagement and Protection Survey offers a tool for measuring attitudes and assisting with intervention strategy development in ways that reflect fathers’ views and promotes a balanced view of children’s needs for safety with their needs for engaging in active, healthy risk-taking.