William Pickett

Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents

This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.

Cross-national comparison of adolescent drinking and cannabis use in the United States, Canada, and the Netherlands

BACKGROUND This research examined the prevalence of drinking and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with substantially different laws and policies relating to these substances. METHODS Laws regarding drinking and cannabis use were rated for each country. Substance use prevalence data among 10th graders from the Health Behaviour in School-Aged Children Survey conducted in each country in 2005-2006 were examined. RESULTS Laws regarding alcohol and cannabis were found to be strictest in the United States, somewhat less strict in Canada, and least strict in the Netherlands. On most measures of drinking, rates were lower in the United States than in Canada or the Netherlands. With United States as the referent, relative risks (RR) for monthly drinking were 1.30 (1.11-1.53) for Canadian boys and 1.55 (1.31-1.83) for girls, and 2.0 (1.73-2.31) for Dutch boys and 1.92 (1.62-2.27) for Dutch girls. Drunkenness was also higher among Canadian boys and girls and Dutch boys. However, rates of cannabis use did not differ between the countries, except that Dutch girls were less likely to use cannabis in the past year (RR=.67; .46-.96). CONCLUSIONS The lower prevalence of adolescent drinking and drunkenness (except among Dutch girls) in the United States is consistent with the contention that strict drinking policies may limit drinking among 10th graders. However, the finding that cannabis use rates did not differ across countries is not consistent with the contention that prohibition-oriented policies deter use or that liberal cannabis policies are associated with elevated adolescent use. Based on these findings, the case for strict laws and policies is considerably weaker for cannabis than for alcohol.

Colorimetric carbon dioxide detector to determine accidental tracheal feeding tube placement

PurposeTo determine the accuracy of colorimetric CO2 detection compared to the reference standard two-step radiological confirmation of feeding tube position.MethodsA prospective study was conducted with patients presenting to a 21-bed medical-surgical intensive care unit. An adapter was developed using an endotracheal tube adapter to connect a colorimetric CO2 detector to a feeding tube in an airtight manner. In part I of the study a feeding tube connected to the colorimeter was inserted into the endotracheal tubes of ten ventilated patients to test the device’s ability to detect tracheal placement. In part II patients undergoing feeding tube insertion had tube position confirmed with the colorimeter as well as the reference standard twostep x-ray.ResultsIn phase I the colorimeter correctly identified tracheal placement in all ten patients. In phase II 93/100 procedures ultimately were eligible; the colorimeter had a sensitivity of 0.88 (95% confidence interval: 0.65-1.00) and specificity of 0.99 (0.97-1.00). The device missed one of the eight tracheal placements. Agreement between the colorimeter and two-step x-ray interpretations was excellent (Kappa 0.86; standard error 0.10).ConclusionWe describe a novel, convenient method to confirm esophageal feeding tube placement. The device is easily assembled and inexpensive, but should not be reused. Colorimetric determination of tracheal feeding tube placement with this device has excellent agreement with the reference standard two-step radiological technique.ObjectifDéterminer la précision de la détection colorimétrique du CO2, comparée à la confirmation radiologique de référence en deux étapes, de la position du tube d’alimentation.MéthodeL’étude prospective a été menée chez des patients admis dans une unité de soins intensifs médicaux et chirurgicaux de 21 lits. En utilisant un adaptateur de tube endotrachéal, nous avons relié de façon étanche un détecteur colorimétrique de CO2 à un tube d’alimentation. Dans la phase I de l’étude, un tube d’alimentation relié au colorimètre a été inséré dans le tube endotrachéal de dix patients ventilés pour vérifier la capacité de l’appareil à détecter la mise en place endotrachéale. Dans la phase II, la mise en place du tube a été confirmée par le colorimètre et par la technique radiographique en deux étapes.RésultatsEn phase I, le colorimètre a correctement reconnu la position endotrachéale chez les dix patients. En phase II, 93/100 des interventions ont été finalement admissibles ; le colorimètre avait une sensibilité de 0,88 (intervalle de confiance de 95 : 0,65-1,00) et une spécificité de 0,99 (0,97-1,00). L’appareil n’a pu identifier une des huit insertions endotrachéales. La concordance entre les interprétations du colorimètre et du rayon-x en deux étapes a été excellente (Kappa 0,86 ; erreur type de 0,10).ConclusionNous avons décrit une méthode nouvelle et pratique de confirmer la mise en place du tube d’alimentation dans l’oesophage. L’appareil est facile à assembler et économique, mais ne doit pas être réutilisé. La détermination colorimétrique de la position endotrachéale du tube d’alimentation avec cet appareil présente une excellente concordance avec la technique radiologique habituelle en deux étapes.

Screening for acute myocardial injury: creatine kinase is comparable to myoglobin.

Abstract During the last decade, there have been many studies comparing myoglobin and the troponins to creatine kinase MB. Myoglobin was introduced as an early marker, but most studies have not directly compared it to total creatine kinase in any detail. We retrospectively (9/98–5/99) examined 1772 paired samples from 1572 patients drawn in the emergency department to assess the optimum decision limits, sensitivity, specificity, positive predictive values (PPV), and negative predicitve value (NPV) for creatine kinase and myoglobin in predicting acute myocardial injury. Of the admitted patients, 114 had acute myocardial injury, 166 had angina and 89 had non-cardiac chest pain; 1203 patients were discharged. Initially low creatine kinase (<100 IU/l; minimum 19 IU/l) and myoglobin (<100 μg/l; minimum 9.5 μg/l) results were identified in 63.5% and 88.3% of patients, respectively, emphasizing the importance of serial sampling. Receiver operator characteristic analysis demonstrated optimum decision limits at 100 IU/l and 70 μg/l, respectively. These levels were associated with sensitivity/specificity/PPV/NPV of 66/66/13/96 for creatine kinase and 54/85/22/96 for myoglobin. We conclude that both tests are comparable for initial screening of patients with chest pain in the emergency department. Since creatine kinase is faster, cheaper, and more widely available, it is the test of choice for our institution.