Yvonne Robitaille

Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study

Abstract Objective To determine the effect of helmets on the risk of head and neck injuries in skiers and snowboarders. Design Matched case-control and case crossover study. Setting 19 ski areas in Quebec, Canada, November 2001 to April 2002. Participants 1082 skiers and snowboarders (cases) with head and neck injuries reported by the ski patrol and 3295 skiers and snowboarders (controls) with non-head or non-neck injuries matched to cases at each hill. Main outcome measures Estimates of matched odds ratios for the effect of helmet use on the risk of any head or neck injury and for people requiring evacuation by ambulance. Results The adjusted odds ratio for helmet use in participants with any head injury was 0.71 (95% confidence interval 0.55 to 0.92), indicating a 29% reduction in the risk of head injury. For participants who required evacuation by ambulance for head injuries, the adjusted odds ratio for helmet use was 0.44 (0.24 to 0.81). Similar results occurred with the case crossover design (odds ratio 0.43, 0.09 to 1.83). The adjusted odds ratio for helmet use for participants with any neck injury was 0.62 (0.33 to 1.19) and for participants who required evacuation by ambulance for neck injuries it was 1.29 (0.41 to 4.04). Conclusions Helmets protect skiers and snowboarders against head injuries. We cannot rule out the possibility of an increased risk of neck injury with helmet use, but the estimates on which this assumption is based are imprecise.

Surface characteristics, equipment height, and the occurrence and severity of playground injuries

Objectives—To evaluate whether surface characteristics (absorption level (g-max), material) and the height of play equipment are related to the occurrence and severity of injuries from falls. Setting and methods—During the summers of 1991 and 1995, conformity of play equipment to Canadian standards was assessed in a random sample (n=102) of Montreal public playgrounds. Surface absorption (g-max) was tested using a Max Hic instrument and the height of equipment was measured. Concurrently, all injuries presenting at the emergency department of Montreals two childrens hospitals were recorded and parents were interviewed. Inspected equipment was implicated in 185 injuries. The g-max measurements (1995 only) were available for 110 of these playground accidents. Results—One third of falls (35 %) occurred on a surface exceeding 200 g and the risk of injury was three times greater than for g level lower than 150 (95% confidence interval (CI) 1.45 to 6.35). On surfaces having absorption levels between 150 g and 200 g, injuries were 1.8 times more likely (95% CI 0.91 to 3.57). Injuries were 2.56 times more likely to occur on equipment higher than 2 m compared with equipment lower than 1.5 m. Analysis of risk factors by severity of injury failed to show any positive relationships between the g-max or height and severity, whereas surface material was a good predictor of severity. Conclusions—This study confirms the relationships between risk of injury, surface resilience, and height of equipment, as well as between type of material and severity of injury. Our data suggest that acceptable limits for surface resilience be set at less than 200 g, and perhaps even less than 150 g, and not exceed 2 m for equipment height. These findings reinforce the importance of installing recommended materials, such as sand, beneath play equipment.

Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial

Objective: To assess the long term effect of a home safety visit on the rate of home injury. Design: Telephone survey conducted 36 months after participation in a randomized controlled trial of a home safety intervention. A structured interview assessed participant knowledge, beliefs, or practices around injury prevention and the number of injuries requiring medical attention. Setting: Five pediatric teaching hospitals in four Canadian urban centres. Participants: Children less than 8 years of age presenting to an emergency department with a targeted home injury (fall, scald, burn, poisoning or ingestion, choking, or head injury while riding a bicycle), a non-targeted injury, or a medical illness. Results: We contacted 774 (66%) of the 1172 original participants. A higher proportion of participants in the intervention group (63%) reported that home visits changed their knowledge, beliefs, or practices around the prevention of home injuries compared with those in the non-intervention group (43%; p<0.001). Over the 36 month follow up period the rate of injury visits to the doctor was significantly less for the intervention group (rate ratio = 0.74; 95% CI 0.63 to 0.87), consistent with the original (12 month) study results (rate ratio = 0.69; 95% CI 0.54 to 0.88). However, the effectiveness of the intervention appears to be diminishing with time (rate ratio for the 12–36 month study interval = 0.80; 95% CI 0.64 to 1.00). Conclusions: A home safety visit was able to demonstrate sustained, but modest, effectiveness of an intervention aimed at improving home safety and reducing injury. This study reinforces the need of home safety programs to focus on passive intervention and a simple well defined message.

Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings

OBJECTIVES We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. METHODS The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. RESULTS Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. CONCLUSION Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls.

Firearms regulation and declining rates of male suicide in Quebec.

Objectives To examine whether significant changes in method-specific male suicide rates occurred in the province of Quebec after stronger firearms regulations were introduced in Canada in 1991; to ascertain whether more stringent firearms regulations influence firearms and total suicide trends among men and to determine whether different results are obtained according to the statistical methods used. Study design Descriptive analyses of time trends in method-specific suicide rates for men from 1981 to 2006 using Joinpoint regression models and pre–post firearms regulation analyses. Setting Quebec (Canada). Patients or Subjects Men who have commited suicide aged 15–34, 35–64 and 65 years and over, based on the Quebec mortality database, 1981–2006. Interventions A national firearms control initiative enacted in 1991. Results The Joinpoint regression models suggest that firearm suicide rates declined towards the end of the 1990s. Since 1996, the pace of decline was twice as great in men aged 15–34 years (annual percentage change (APC) −11.1%) compared with men aged 35–64 years (APC −5.6%). Total suicide rates also declined among men aged 15–34 and 35–64 years during this period. Pre–post firearms regulation Poisson regression analyses failed to detect the specific point in time when significant changes in the trend occurred. Conclusions Male firearm suicide rates declined following the introduction of restrictive firearms regulations in Canada. Whether this represents a causal relationship requires further study.

Implementing a Community-Based Falls-Prevention Program: From Drawing Board to Reality

Plusieurs études ont démontré,à l’aide de devis randomisés, l’efficacité de programmes de prévention des chutes destinés aux aînés vivant dans la communauté. Cependant, on connaît peu de choses quant à la faisabilité d’implanter ces programmes dans des conditions naturelles et quant à l’efficacité de ces programmes lorsqu’ils sont offerts dans de telles conditions. Les objectifs de cet article sont de: (a) décrire un programme multifactoriel de prévention des chutes (pIED) destiné à des aînés autonomes vivant dans la communauté et (b) présenter les résultats d’une analyse de la faisabilité d’une implantation du programme dans les organismes communautaires. Le programme aété implanté dans 10 organismes du milieu communautaire situés dans la région métropolitaine de Montréal dans le contexte d’une étude d’efficacité. Les résultats concernant la population recrutée et la façon dont le programme a été offert, ainsi que le niveau de participation au programme montrent qu’un programme de prévention des chutes visant plusieurs facteurs de risque peut être implanté avec succès dans des milieux communautaires. Several studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this paper are to (a) describe a multifactorial falls-prevention program (called Stand Up!) designed for independent community-dwelling seniors and (b) present the results of an analysis of the practicability of implementing this program in community-based settings. The program was implemented in the context of an effectiveness study in 10 community-based organizations in the Montreal metropolitan area. Data pertaining to the reach and delivery of the program as well as participation level show that a falls-prevention program addressing multiple risk factors can be successfully implemented in community-based settings.

Severity of fall injuries on sand or grass in playgrounds

Playground injuries are a major public health problem.1-3 Laboratory studies have recommended sand, pearock, synthetic materials, or wood chips as protective surfaces beneath equipment,2 and epidemiological studies have confirmed that hard surfaces are dangerous. However, some questions remain about grass.1-3 To compare the protection offered by grass and sand, public and residential playgrounds need to be considered. Most sand surfaces are in public playgrounds, while grass is used mostly at home where up to 25% of accidents occur.2 4 This study aimed at comparing the risk of severe injuries after a fall on sand or on grass. During the summers of 1991 and 1995, children aged 1 to 14, who attended the emergency department of Montreals two childrens hospitals for a fall related injury involving playground equipment, were identified (n=930). The following information was gathered during a telephone interview with the parents: age, sex, mother tongue, mothers educational level, family size, location (Island of Montreal or not), mechanism of the accident and of the injury, type of playground (home, public, other), supervision (presence of an adult), mean number of playground visits weekly, type of equipment, surface material, nature of injury and body part injured, and number of medical consultations for injuries in the past year. A 91% response rate was achieved. The nature of the injury reported was validated using information from the doctor.5 This variable represents one of our two main outcomes, and it was divided into two categories. The “fracture and head injury” category includes concussions, skull fractures, or head contusions (n=110), fractures and dislocations (n=508). All others types of injuries were grouped into the “other” category. This classification by nature of injury was added to the Abbreviated Injury Scale (AIS) where 1 corresponds to a minor injury and 6 to death,6 …

Impact of a community-based falls prevention program on maintenance of physical activity among older adults.

Objective: This study examines the 9-month impact of a 12-week falls prevention program (called Stand Up!) which included balance exercises and educational components on maintenance of physical activity among community-dwelling seniors. Method: Data were collected among 98 experimental and 102 control participants at baseline, immediately after the program and 9 months later. Involvement in physical activity was measured with three indicators. Program effects were examined using linear and logistic regression procedures. Results: Both groups showed similar increases in weekly frequency of exercise at the 9-month posttest. However, the programs participants showed higher increases in their variety of exercises at the 9-month posttest (especially among those with greater baseline scores). Among seniors reporting lower levels of energy expenditure at baseline, the programs participants showed significantly greater increases in energy expenditure than control participants. Discussion: These preliminary findings suggest that programs such as Stand Up! have the potential to stimulate continued involvement in physical activity.

Search for a Simple Means to Identify Dangerous Surfaces Under Play Equipment

The instrument used to measure the capacity of material under playground equipment that absorbs the impact caused by a child falling on it is expensive and impractical when carrying out field experiments. This study compares results obtained by simple observation with those obtained from using such a device (Max-Hic). The goal was to ascertain whether visual inspection can assess a safe threshold of absorption (g-max n = 356 equipments). Based on visual inspection, 59% of surface materials were classified as non-compliant. However, only 21% of all surfaces had a g-max above 200 g. The g-max increases according to the height of equipment and the apparent compactness of the ground. Equipment exceeding 2 m had a mean g-max of 215 g on a compact surface compared to 163 g on a loose surface. In a context of scarce resources, the height of equipment and an obviously hard-packed surface are useful factors for identifying surfaces requiring more immediate attention.

Effect of a Fall Prevention Program on Balance Maintenance Using a Quasi-experimental Design in Real-World Settings

Objectives: To examine the effect of a fall prevention program offered under real-world conditions on balance maintenance several months after the program. To explore the program’s impact on falls. Method: A quasi-experimental study was conducted among community-dwelling seniors, with pre- and postintervention measures of balance performance and self-reported falls. Ten community-based organizations offered the intervention (98 participants) and 7 recruited participants to the study’s control arm (102 participants). An earlier study examined balance immediately after the 12-week program. The present study focuses on the 12-month effect. Linear regression (balance) and negative binomial regression (falls) procedures were performed.falls. Results: During the 12-month study period, experimental participants improved and maintained their balance as reflected by their scores on three performance tests. There was no evidence of an effect on falls.falls. Discussion: Structured group exercise programs offered in community-based settings can maintain selected components of balance for several months after the program’s end.