Concurrent Sessions 1
Wednesday, November 2, 2022 | 11:00 AM – 12:30 PM
For a brief overview of the presentations occurring during Concurrent Sessions 1, please consult the tables below.
To view the full abstracts, please scroll down further or use the links in the tables below.
Topic: Falls and Older Adults | Location: Coal Harbour Ballroom A
Moderator: Suzanne Baker
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Topic: Climate/Emergency/COVID-19/Costing | Location: Grouse Room
Topic: Children and Youth | Location: Seymour Room
Moderator: Patti Stark
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Abstract #2240: Fall-related deaths, hospitalizations, and emergency department visits among older people in Canada
Presenting Author: Xiaoquan Yao1
Authors: Xiaoquan Yao1, Wendy Thompson1
1 The Public Health Agency of Canada
Background: Falls among older people, aged 65 years and older, are a public health concern in Canada. Ongoing surveillance of the trends of the health care burden of falls is essential for effective prevention.
Objective: To understand the trend of fall-related deaths, hospitalizations and emergency department (ED) visits among older people in Canada.
Methods: The data sources include: the Canadian Vital Statistics–Death Database, the Discharge Abstract Database (hospitalization data excluding Quebec) and the National Ambulatory Care Reporting System (ED visits data; Ontario and Alberta only). Age standardized rates (ASR) were calculated for fall-related deaths, hospitalizations and ED visits. The joinpoint regression model was used to estimate the temporal trend by calculating the annual percentage change. To consider the impact of the COVID-19 pandemic, rates were compared between 2019/2020 and 2020/2021.
Results: Overall, among older people, the ASR of fall mortality increased from 2001 to 2019. The average annual percent change (AAPC) was 4.9%. The rate did not change from 2019 to 2020. The AAPC of the ASR of fall-related hospitalization among older people was 0.3% from fiscal year 2008/2009 to 2019/2020. There was a 7.1% decrease in fiscal year 2020/2021 compared to 2019/2020. The AAPC of the ASR for fall-related emergency department visits among older people was 1.1% from fiscal year 2010/2011 to 2019/2020. Compared to fiscal year 2019/2020, there was a 17.0% decrease in 2020/2021.
Conclusion: Our analysis shows that all mortality, hospitalization and ED visit rates among older people show upward trends until the beginning of the pandemic. Compared to the pre-pandemic period, during the pandemic there was a decrease in rates for fall-related hospitalization and emergency department visits, but no change in deaths due to falls. Ongoing health promotion and prevention efforts are critical for Canada’s aging population.
Abstract #2234: “Be Proactive, Not Reactive”: older adults’ experiences of falling, recovery, and care
Presenting Author: Cathy Arnold1
Authors: Catherine Arnold1, Daphne Kemp2
1 University of Saskatchewan
2 Saskatchewan Health Authority
Objectives: Falls and related injuries have a significant impact on older adults, caregivers, health care providers, and the health care system. The purpose of this study was to describe fall experiences, and the challenges and facilitators of fall-related care from both older adult and health care providers’ perspectives in Saskatchewan.
Methods: Four focus groups with older adults/caregivers who experienced injurious falls, two focus groups with health care providers and six independent interviews were conducted to hear their stories of falls, fall risk, health care received, transitions across the continuum of care and communication related to prevention of future falls and injuries.
Results: Twenty-nine older adults and 12 health care providers participated. The range of fall experiences included minor injuries to serious fractures and death. “Be Proactive, Not Reactive” was the overarching theme identified across rural and urban settings and from both older adults/caregivers and health care providers. Three main themes included: Independence/Denial/Self-Blame, Impact of Transitions, and Ways to Improve Care. An additional eight sub-themes emerged emphasizing the importance of communication, access to resources, education and a multi-faceted approach.
Conclusion: The lived experience of falls and receiving care can help to inform future planning to improve identification of fall risk, continuity of care and fall prevention efforts. These results are timely to share to inform a “New look” to address issues which have only escalated further during the pandemic such as aging in place, isolation, hospital admissions, and transitions of care across community, acute and long-term care settings.
Abstract #2264: Finding balance: evidence based falls prevention program for older adults with vision loss
Presenting Authors: Matt Ellies1, Ben Barry1
Authors: Matt Ellies1, Ben Barry1
1 Vision Loss Rehabilitation Canada (VLRC)
Introduction: It’s estimated that 530,000+ Canadians aged 65+ have vision related disabilities and as such, have an 80% greater likelihood of falls . To address this, Vision Loss Rehabilitation Canada (VLRC) developed a falls prevention program using best practice guidelines to integrate information, strategies and technology to address risk factors for a population with vision related disability.
Objective: To provide unique educational programming for older adults experiencing vision loss; to decrease incidences of falls, and improve overall quality of life and independence.
Approach: Based on the BEEEACH (Behaviour change, Education, Environment, Equipment, Activities, Clothing, Health management) model modified specifically for individuals with vision loss, our virtual, hybrid, and in-person falls prevention program brings clients through 6 unique 3 hour sessions. Clients learn why vision loss is a high fall risk and are given opportunities to practice strategies to mitigate risks.
Results/findings: Participants are interviewed using semi-structured assessments to assess needs. Formal outcome measures allow objective measurement of the program’s effectiveness. Measures include Falls Efficacy Scale – International (FES-I) and WHO Wellbeing Index (WHO-5). Program leads monitor clients to assess improvement 6 months post completion.
Conclusion/Lessons learned: VLRC’s program is delivered in virtual, hybrid, and in-person modes to eliminate geographic and technological barriers. Exercise videos are available to clients in remote areas. A Multi Device Management (MDM) system adjusts content for virtual users of VLRC provided iPads. Client feedback is incorporated allowing for adjustment to content. Initial outcomes show that providing vison loss specific falls prevention support and education to older adults with vision loss leads to improved demonstrated safety strategies, self-reported decrease in anxiety related to physical activity, and increased independence.
Abstract #2268: Enhancing Access to Osteofit Instructor Training
Presenting Author: Ann Pederson1
Authors: Ann Pederson1, Lana Sullivan1, Avneet Hayer1, Debbie Cheong2
1 BC Women’s Hospital and Health Centre
2Osteofit Master Trainer
Abstract: Osteofit is a BC Women’s Hospital certified exercise, education, and falls prevention program for individuals with osteoporosis or low bone density or who are at risk of fractures and falls. Osteofit instructors are certified BCRPA Fitness Leaders with knowledge of older adult fitness. Training and certification of instructors was in high demand prior to COVID-19, but abruptly interrupted after in-person training sessions and Osteofit classes stopped running. This presentation will outline how the challenges imposed by COVID-19 on the fitness world affected the Osteofit Instructor training model. We will describe changes made to the Osteofit instructor training course; in-person to hybrid. We will outline results of a pilot test of the revised training program. We will showcase the updated training program – developed by an e-learning specialist – to be learner-centre, inclusive and aligned with current practice guidelines and best practices. Knowledge tests were integrated to ensure Osteofit instructors continued to be trained comprehensively and rigorously. The revised course materials were completed in June 2022 and pilot tested with a cohort of instructors. Instructors’ pre-test and post-test knowledge will be reported, as well as their feedback on the blended learning approach. The experience of COVID-19 has created opportunities to challenge “normal” methods of training fitness and exercise instructors and delivering courses. Recognizing the importance of access to trained instructors to teach Osteofit classes across the province, migrating to a blended mode of training ensures access to training and sustainability for delivering training while maintaining instructional rigour.
Abstract #2270: Detecting near-fall and fall events from anywhere on the body
Presenting Author: Calvin Kuo1,2
Authors: Alexi Michael1, Calvin Kuo1,2
1University of British Columbia
2Centre for Hip Health and Mobility
Abstract: Falls are a leading cause of injury in older adults in Canada and the prevention of falls is thus a primary focus for healthy aging. While several factors from neurocognitive deficits to muscle weakness are associated with an increased risk of falls, often these factors are only identified through self-reporting or after an older adult has already fallen. Continuous monitoring with wearable sensors provides an alternative solution to monitor fall risk throughout the life-span. Specifically, it has been shown that near-falls, defined a loss of balance that does not lead to a fall, is an independent predictor of future fall risk. Thus, we have developed a wearable human movement sensor that can differentiate between simulated fall, near-fall, and activities of daily living with an accuracy of >95%. To increase the translatability of our technology, we also recognize that there is not a “one size fits all” preference for wearable form factors among the population. While wrist watches remain one of the more popular form factors, many individuals prefer to have sensors embedded in pocket-worn devices or around the neck. Thus, we have also developed our wearable sensor to be worn anywhere on the body and trained the underlying machine learning algorithm to detect global human movement features indicative of a fall, near-fall, or activity of daily living. While we have shown the efficacy of the device in simulated events, future work will deploy the sensor to populations at risk of falls, such as older adults of workers in environments with a high risk of slips, trips, and falls. By accurately identifying near-fall events in at risk populations, we will demonstrate the ability of our wearable sensor to characterize future fall risk so that preventative interventions can be implemented in a timely manner.
Abstract #2323: Implementing remote video monitoring to reduce inpatient falls at Kelowna General Hospital
Presenting Author: Kelly Wilson1
Authors: Kelly Wilson1
Introduction: Unwitnessed inpatient falls are an ongoing patient safety concern at Kelowna General Hospital (KGH). Interior Health’s largest site, KGH is a 400-bed tertiary hospital located in Kelowna, BC. In January 2022, KGH began implementation of the AvaSure TeleSitter® remote video monitoring technology on two inpatient units. Nurses obtain consent from patients or families prior to placing a non-recording portable camera unit in their room The portable unit provides live video and two-way audio feeds from the bedside to a central monitoring screen in a private office in the hospital. If a patient attempts to get out of bed unattended, the Monitor Staff observing the central monitoring screen intervenes, asks them to wait for assistance, then calls their nurse, if needed. This remote patient video monitoring system enables one trained Patient Care Aide to monitor up to ten high-risk patients simultaneously. While AvaSure TeleSitter® is widely used at hospitals in the United States KGH is only the second hospital in Canada currently using this technology.
Objective: The aim of this project is to evaluate the implementation of the AvaSure TeleSitter® technology at KGH, including successes, challenges and recommendations for spread to additional sites.
Methods/Approach: Data is being collected over a six-month period (February to August, 2022) including staff surveys, patient and family surveys, inpatient falls data, and constant care provider hours (1:1 sitters). A “lessons learned” survey was also administered to key informants, including members of the project Steering Committee, Clinical Working Group, Data & Evaluation Working Group and the Technical Working Group.
Findings/Results: Data analysis will commence in September, 2022 and key findings will be shared at the conference in November.
Conclusion/Practice Limitations: Findings from this implementation evaluation will be used to inform future spread to additional sites within Interior Health.
Abstract #2269: Vision Zero: A multi-sectoral approach—why collaboration is key
Presenting Author: Shabnem Afzal1
Authors: Shabnem Afzal1
1WATT Consulting Group
On January 30, 2019, City of Surrey Council approved the Vision Zero Surrey Safe Mobility Plan 2019-2023. The plan outlines the overarching approach of the City to move towards the concept of zero people killed and seriously injured (SIs) within the transportation network.
Since its inception in 2019, City staff and partner organizations have all contributed significantly to the success of Vision Zero Surrey and the implementation of the Safe Mobility Plan. Together, staff and partners have taken a multi-sectoral, strategic approach to reducing death and serious injury, and have established Surrey as a Provincial and National leader in road safety.
A key Vision Zero Surrey partner is health. The City has been working with Fraser Health and the BC Centre for Disease Control, to advance the development of geospatial linked health injury data through the BC Trauma Registry, called the BC Injury Data Cube. Once developed, the Data Cube will provide more granular data on injury severity and the locations of the most severe collisions.
As well, the City has recently been award two BC Vision Zero in Road Safety grants. One focused on understanding why Indigenous populations are over represent in traffic collisions and the other a School Streets program designed to help reduce conflicts with vulnerable road users.
This presentation will showcase these efforts as well as other Vision Zero Surrey initiatives that aim to eliminate fatal crashes and serious injuries on our roads. These include:
– Surrey Slow Streets: Residential Speed Limit Reduction Pilot
– King George Boulevard Safety Review
– Cycling Safety Review
– Effective Countermeasures
– Collaborative Campaigns and Projects
– Other Key Accomplishments
Abstract #2305: Designing our way to Vision Zero
Presenting Author: Amar Lad1
Authors: Amar Lad1, Brandon Orr1, Adam Bell1,2
1TYLin Canada Inc.
2Ontario Traffic Council
Introduction: Vision Zero is a transformational global strategy for rethinking roadway safety, with the goal to eliminate deaths and serious injuries from our transportation system. These tragedies are not an inevitable consequence of our built environment but can be mitigated using a Safe Systems approach based on Vision Zero principals.
Objectives: This presentation will highlight the responsibility of building partnerships across various disciplines and the opportunities we have available through proactive collaboration and coordination to significantly reduce roadway deaths and injuries and reach Vision Zero.
Challenges Faced: The advancement and implementation of Vision Zero ideals have been limited by the current practice of road safety in Canada. Priority has been traditionally given to roadway capacity, throughput, and efficiency, often leaving safety as an afterthought. Consequently, road safety measures are often constrained, and professionals limited by a lack of good quality data for study and monitoring, and information to evolve and improve systems for consistent expansion.
Opportunities: To face these challenges collectively, we need to examine every area of the system with Vision Zero principals, keeping in mind shared responsibility, the likelihood of human error, and user vulnerability. All stakeholders and decision makers have a responsibility to design and promote strong policies which prioritize human life. Supported by a strong foundation and diverse partnerships, system designers can plan and implement best practices to reduce the likelihood of severe collisions. The ultimate success of Vision Zero will be in the monitoring of our solutions, and continued advancement of technologies to eliminate death and serious injuries from our roads.
The Way Forward: Expanding a Safe Systems approached with Vision Zero ideals will help enable all partners in building more safe, livable, sustainable, and complete communities.
Abstract #2296: Evaluation of an Automated Speed Enforcement Program in Toronto, ON
Presenting Author: Saroar Zubair1
Authors: Saroar Zubair1, Naomi Schwartz2, Linda Rothman2, Marie-Soleil Cloutier3, Alison Macpherson4, Andrew Howard1
1The Hospital for Sick Children
2Toronto Metropolitan University
3Institut National de la Recherche Scientifique
Introduction: Higher vehicle speed is associated with an increased risk of severe injury and fatalities. Observational studies found that Automated Speed Enforcement (ASE) can effectively reduce collisions, injuries, and deaths. Few studies included controlled evaluations of safety impacts of the ASE. In 2020, the City of Toronto began an ASE program with 50 mobile cameras rotated through 300 Community Safety Zones (CSZs) in six phases to achieve the city’s Vision Zero goals around schools. Three phases of the program have been completed.
Objectives: To evaluate the effect of ASE cameras on speeds and pedestrian motor vehicle collisions (PMVC) in CSZs around schools in Toronto.
Methods: Speed and volume data were collected pre-installation and during the time of ASE deployment using pneumatic road tubes and ASE devices respectively. Forty-five future ASE sites were used as controls, and second speed/volume measurements were conducted prior to intervention. Percent driving over the speed limits (% over SL) and 85th percentile speeds were compared pre-installation and during the ASE intervention. Generalized Estimating Equation models were used to estimate the longitudinal impacts of ASE cameras, controlling for seasonality, speed limit changes, and road types. In future analyses, Poisson regression with repeated measures will be used to estimate the impact of ASE on PMVC as data becomes available at all sites.
Results: At the first three phases of ASE sites, the overall % over SL dropped from 55% to 36% during ASE implementation. The 85th percentile speeds dropped from 46 to 36 km/h, 50 to 43 km/h and 61 to 57 km/h on 30, 40 and 50 km/h speed limit roads respectively. Statistical modeling is ongoing to estimate impacts on PMVC collisions.
Conclusion: Early promising results indicate that ASE can effectively reduce speeding. This suggests that ASE may be an effective component of Vision Zero programs to improve safety in community safety zones near schools.
Abstract #2257: The influence of vehicle speed and backpack load on how adults cross 2-lane traffic roads
Presenting Author: Mike Corbett1
Authors: Barbara Morrongiello, Mike Corbett, and Belle Dodd
1 University of Guelph
Abstract: Pedestrian injuries are a major global health issue. In fact, pedestrians account for nearly a quarter of the estimated 1.2 million victims of road traffic injuries each year. Many road traffic injuries are predictable and preventable. However, to develop effective strategies for injury prevention there is a need for research to advance our understanding risk factors involved in pedestrian injury in common situations. Addressing this need, the current study examined how the 2-lane crossing behaviour of adults is influenced by vehicle speed and backpack load.
Emerging adults often cross streets when carrying a heavy backpack for university, yet little is know about if/how this affects their safety. Additionally, most of the research findings on risk factors for pedestrian injury are based on asking adults to make decisions about crossing one-lane roads. However, most roads are at last 2 lanes, which makes a challenging perceptual and cognitive task even more complicated.
The current study used fully-immersive virtual reality technology that enables the opportunity for evasive actions, if needed as adults cross. Two different speed conditions were presented (30km/h and 70km/h) to span the typical speeds encountered on real streets. Five measures of pedestrian behaviour were investigated: gap choice, start delay, attention to traffic, evasive action, and hits and close calls.
Results revealed that wearing a heavy backpack slowed walking speed. However, adults modified their crossing strategy to adjust for wearing a heavy backpack that slowed walking speed and thereby avoid increasing injury risk. As vehicle speed increased, so too did risk of injury (hits and close calls). Implications for the development of these strategies in childhood will be discussed.
Abstract #2308: Providing Concussion Education to Diverse Audiences – The Concussion Awareness Training Tool: CATT
Presenting Author: Shelina Babul1,2
Authors: Shelina Babul1,2, Kate Turcotte1, Shazya Karmali1, Vanessa Linton1, Samantha Bruin1
1 BC Injury Research and Prevention Unit
2 Department of Pediatrics, University of British Columbia
Introduction: Concussion research has ramped-up significantly over the past decade, learning more about what happens to the brain and how to support recovery. Concussions are not just a sport and recreation injury, but rather can result from falls, motor vehicle crashes, and assault including intimate partner violence. Recovery from concussion requires a stepwise protocol including return to school, work, and physical activity.
Objectives: To raise concussion awareness and deliver education to diverse audiences across Canada and beyond.
Approach: Since 2013, CATT (cattonline.com) has provided online access to evidence-based concussion education and resources, free-of-charge. Original CATT evaluations demonstrated significant improvements in concussion knowledge among physicians, community coaches, and teachers. Beginning by targeting medical professionals, coaches, and parents/caregivers, CATT has expanded to include educational resources for schools, workers and their employers, those working with survivors of intimate partner violence, varsity athletes, and high school students.
Results: To date, over 90,000 people worldwide have completed CATT training, over 35,000 print resources have been distributed, and training has been mandated by over 70 organizations.
Conclusion: CATT is a unique concussion resource providing accessible and reliable information to a range of target audiences, going beyond the traditional thought of it being a sport-related injury. CATT is promoted provincially, nationally, and internationally, and is recognized as a credible evidence-based resource by government. Ongoing knowledge translation activities continue to raise population-level concussion awareness and increase knowledge.
Abstract #2266: Mortality during the 2021 extreme heat event in British Columbia, Canada
Presenting Author: Michael J Lee1
Authors: Michael J Lee1, Michael Kuo1, Kathleen E McLean1, Tom Kosatsky1, Sarah B Henderson1
1 Environmental Health Services, British Columbia Centre for Disease Control
Introduction: From 25 June to 02 July 2021, British Columbia (BC), Canada experienced an extreme heat event (EHE) during which there was a 95% increase in population mortality. Here, we present the results of two studies investigating the association between mortality during the EHE and (1) neighborhood characteristics and (2) chronic diseases.
Methods: Deaths during the 2021 EHE were compared with deaths on the same calendar dates in previous years. Conditional logistic regression, adjusted for age, sex, and geographic location, was used to assess the relationship between death during the EHE and neighborhood characteristics and chronic diseases. Specifically, in study 1, we assessed the association between EHE mortality and neighborhood deprivation and greenspace in greater Vancouver. In study 2, we investigated the relationship between 21 chronic diseases and EHE mortality across the entire province.
Results: In study 1, we found significantly increased odds of mortality in neighborhoods with higher levels of material and social deprivation, and in areas with lower levels of greenness. In study 2, we found that schizophrenia and depression were associated with significantly increased odds of death during the EHE, and the odds for substance use disorder and diabetes were elevated. Many conditions, including heart failure, were associated with decreased odds of death during the EHE.
Conclusions: These studies begin to paint a stark picture of those at highest risk during the 2021 EHE in BC. Those at greatest risk included people with mental and physical illnesses and disabilities who were economically and socially deprived. Future interventions need to target these interconnected risks factors, including finding ways to reach susceptible people in their homes.
Abstract #2310: Use of artificial intelligence to automate reporting of emergency department injury cases
Presenting Author: Evangeline Zhang1
Authors: Evangline Zhang1, Daniel Rosenfield1, Eric Liu1, Deborah Taylor1, Devin Singh1
1 Hospital for Sick Children
Introduction: The Hospital for Sick Children is a center supporting the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national injury and poisonings surveillance initiative essential for the planning, implementation, and assessment of injury prevention and control in Canada. Our emergency department (ED) has one of the largest patient volumes in the CHIRPP network. The traditional approach of manually parsing through ~80,000 clinical notes and performing data entry is inefficient. Using prior data, machine learning algorithms can analyze unstructured text data from triage notes to train artificial intelligence models to predict future CHIRPP patients presenting to the ED, thereby streamlining the workflow dramatically through process automation. This will minimize delays and allow for real-time reporting of injury data while reducing resource expenditures.
Methods: Deidentified triage notes were obtained from an electronic health record system for all patients visiting the ED from Jan to Dec 2019 (n=77,677). All charts were manually reviewed to determine if patients met the criteria for CHIRPP (i.e. were an injury or poisoning). CHIRPP patients made up 20.1% (n=15,638) of total ED presentations. Patient charts were split into training and testing datasets in ascending chronological order to simulate prospective implementation of the model and enable reproducible results.
Results: Our model captured 98% of all CHIRPP cases while reducing the total charts for review by 52.3%. To capture 90% of CHIRPP cases, our model can be adjusted to reduce the total charts for manual review from 77,677 to 21,749 (72% reduction).
Conclusion: Our model shows that high volumes of charts that were previously screened manually can effectively be automated with machine learning while maintaining accuracy in data capture. This application to an injury prevention program has wide scale applicability and scalability to other health promotion and surveillance systems.
Abstract #2298: Unintended consequences of COVID-19 policies: violence outcomes in children/youth (BC and ON)
Presenting Author: Sarah Richmond1
Authors: Alison Macpherson2, Brendan Smith1, Sarah Carsley1, Natasha Saunders3, Steven McFaull4, Carolyn Snider5, Emma Cory3, Jenny Smith3, Wendy Thompson4, Nita Jain6, Noorjean Hassam7, Len Garis8, Harriet MacMillan9, Shelina Babul7, Fahra Rajabali10, Alex Zheng10, Shazya Karmali10,Alexia Medeiros1, Breanna Nelson10, Shikha Saxena4, Ian Pike7
1Public Health Ontario
3The Hospital for Sick Children
4Public Health Agency of Canada
5St. Michael’s Hospital
6BC Children’s Hospital
7University of British Columbia
8University of Fraser Valley
10BC Injury Research and Prevention Unit
Background: Unintentional and preventable injuries are the primary threat to the health and well-being of children/youth in Canada. Over the course of the COVID-19 pandemic, stay-at-home policies, including the closure of schools and disruption of community services, placed many children/youth at an increased risk of violence-related incidents and injuries. In the early days of the pandemic, Kids Help Phone calls increased 70% in Vancouver, British Columbia (BC) as well as a 22% increase in the number of reported interpersonal violence incidents and sexual assaults in Ontario (ON). Key groups who have suffered disproportionately from policies related to COVID-19 are children/youth, and people of low socioeconomic status. Despite calling violence against children the “hidden crisis” of the pandemic, there are no data specific to the effects of COVID-19 on inflicted injury among Canadian children/youth.
Purpose: To investigate inflicted, violence-related injuries among children and youth associated with COVID-19 stay-at-home policies.
Methods: This quasi-experimental design will outline violence-related harms in each province, using data from provincial and national sources. The study population includes individuals ages 0-19yr who have (i) presented at an emergency room, (ii) been hospitalized for an injury, or (iii) been referred to child protection services due to a violence-related incident. A policy timeline will be created for each province, and change in violence-related injury rates during pandemic and pre-pandemic periods will be estimated by province, using an observed versus expected analysis.
Implications: Findings will inform future lockdown measures. Exploring differences in inflicted injury rates while considering the scope and varying timelines of policies will provide societal and environmental context to the findings.
Abstract #2312: What is the impact of COVID-19 policies on traumatic head injury-child maltreatment rates in, BC?
Presenting Author: Karen Sadler1
Authors: Fahra Rajabali1, Karen Sadler1, Ian Pike1,2
1BC Injury Research and Prevention Unit
2Department of Pediatrics, University of British Columbia
Background: This presentation focuses on infants 0-2 months as part of a larger study looking at the trends and patterns of violence-related outcomes among children and youth associated with COVID-19 policies, including complete closures, school closures, early childhood education and daycare closures, recreation and outdoor play spaces closures, and changes to roadway structures for active transportation. Specifically, we will look at changes in Traumatic Head Injury-Child Maltreatment/Shaken Baby Syndrome (THI-CM/SBS) rates to better understand the burden of 0-2yrs traumatic head injury consequences during the pandemic to inform prevention now and in future.
Methods:Ten years of pre-pandemic data (2010-2019) will be used to model the number of THI-CM/SBS injury cases in children 0-2 yrs over time. The model will be projected into the pandemic period (2020 onwards), along with confidence bands, to estimate the expected number of cases had the pandemic not occurred. The actual observed number of cases will be compared with the expected to see how the numbers differed as a result of different pandemic policies in order to observe their effects on 0-2yrs for THI-CM/SBS injury outcomes and COVID-19 in B.C. This presentation will focus on 0-2 yrs who have presented at an emergency department (ED) or been hospitalized for THI-CM/SBS injuries.
Conclusion: Descriptive analysis will be presented as rates, means, or medians for continuous variables and counts and proportions for categorical variables. Expected and observed rates will be presented as time series data over time, with the beginning and ends of important relevant policies clearly indicated. Results will tell us if there are generalized differences in the number of THI-CM/SBS cases between pre-pandemic and pandemic periods and if different phases of COVID-19 policies and restrictions had an impact.
Abstract #2300: Examining effects of COVID-19 policies on unintentional injuries in BC children/youth
Presenting Author: Dr. Alison Macpherson1
Authors: Alison Macpherson1, Linda Rothman2, Shelina Babul3, Natasha Saunders4, Andrew Howard4, Pamela Fuselli5, Megan Oakey6, Shazya Karmali7, Saroar Zubair4, Alex Zheng7, Fahra Rajabali7, Ian Pike3
2Toronto Metropolitan University
3University of British Columbia
4The Hospital for Sick Children
6BC Centre for Disease Control
7BC Injury Research and Prevention Unit
Background: With more time spent at home during the COVID-19 pandemic, caregivers have had to balance supervision with other responsibilities (e.g., remote work, home schooling), and children may have experienced different exposure to injury risks such as cooking (burns, scalds), climbing and stairs (falls), household cleaning supplies or sanitizers (poisonings), active transportation, and sports/recreational activities. Risk factors for unintentional injuries among children/youth are multifactorial, involving complex interactions between societal and individual factors, including material and social deprivation.
Purpose: To explore differences in unintentional injury in children/youth in BC considering the scope and varying timelines of pandemic-related policies in the provinces, which will further the understanding of societal and environmental contexts of the findings. Examination of unintentional injury in the context of area-based deprivation will allow for local understanding and more targeted interventions.
Methods: By comparing observed versus expected cases of unintentional injury, based on a pre-pandemic baseline, the research team will compare rates at: 1) pre-pandemic: Apr 2017-Mar 2020; 2) during COVID-19 pandemic: Mar 2020-Jun 2021; and 3) pandemic-recovery: Jul 2021-present. The study population will be individuals age 19yrs and younger who received hospital care (ED or admission) for injury. Data will be accessed using national and provincial sources. A policy timeline will be created for BC and ON using school/daycare, playground, and recreation site closures/re-openings. This presentation will present preliminary findings for children/youth in BC.
Implications: By examining the patterns in child/youth unintentional injury during the pandemic by levels of deprivation, injury incidence, and severity can be mitigated through evidence-based interventions.
Abstract #2313: Challenges and Limitations to Measuring the Economic Burden of Injuries
Presenting Author: Fahra Rajabali1
Authors: Fahra Rajabali1, Alex Zheng1, Stephanie Cowle2, Kate Turcotte1, Pamela Fuselli2, Ian Pike3
1BC Injury Research and Prevention Unit
3University of British Columbia
Abstract: SMARTRISK, now Parachute, raised the profile and communication of injury using the language of economics with the publication of The Economic Burden of Unintentional Injury in Canada Report in 1998. The Electronic Resource Allocation Tool (ERAT), a spreadsheet-based injury classification and costing model was developed by the Hygeia Group in Ottawa. The tool was created to fulfill two major objectives, 1) to provide estimates of the economic burden of injuries in Canada using available data; and 2) to serve as a resource to be used by researchers and public health officials to support resource allocation, policy development and decision-making.
Although the ERAT has been used for many years, there are significant gaps, challenges, and limitations to the methods of creating the Cost of Injury Report. One of the main limitations is the availability of data. With the exception of Alberta and Ontario, that have population level data for injury cases treated at emergency departments, detailed data are only available for deaths and injuries that result in a hospitalized inpatient stay. Injuries that are not treated in a hospital or are only treated in the emergency/outpatient department are not captured or reported through a central body. Furthermore, there is a large data gap for hospitalized injuries that require on-going care outside a hospital setting for either a short period or for a longer term of permanent disability.
This presentation will discuss the challenges and limitations of costing injuries and provide specific examples from ongoing studies that expand on the existing methods to include additional sources. Costing studies that incorporate the cost of abusive head trauma, burns, firearms and poisoning will be highlighted. The objective of the presentation is to provide resources and ideas for future work that involves the costing of injuries or external causes and types of injuries.
Abstract #2306: School Resources and the Provision of Academic Accommodations to Students Following Concussion
Presenting Author: Heather Shepherd1-4
Authors: Heather A. Shepherd1-4, Keith Owen Yeates2,3,5, Nick Reed6-8, Jeffrey G. Caron9,10, Kathryn J. Schneider1-3,11,12, Carolyn A. Emery1-4,13, Amanda M. Black1-4
1Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta;
2Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta;
3Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta;
4O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta;
5Department of Psychology, University of Calgary, Calgary, Alberta;
6Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario;
7Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario;
8Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario;
9School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec;
10Center for Interdisciplinary Research in Rehabilitation, Montreal, Quebec;
11Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada;
12Evidence Sport and Spine, Calgary, AB, T3B 4N2, Canada
13Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
Rationale: Educators are tasked with providing academic accommodations to facilitate the return to school of students with concussion. However, little research has examined the feasibility of providing accommodations, nor the resources available to educators to support students with concussion.
Objective: The objectives of this study were to describe, from the perspective of educators, the 1) prevalence and feasibility of providing academic accommodations to students with concussion; and 2) resources available to support students’ return to school following a concussion.
Methods: A cross-sectional survey was administered online to middle school and high school educators (grades 7-12) across Canada. Descriptive statistics examined the 1) prevalence of academic accommodations; 2) feasibility of providing academic accommodations; and 3) prevalence of school resources.
Findings: The survey was completed by 180 educators (138 teachers and 41 school administrators), of whom 86% (153/176) had previously provided academic accommodations to students with concussion and 96% (172/179) believed it is important or very important that students with concussion have access to accommodations. Some accommodations (e.g., extra time) were provided more often (89%, 154/173) and were more feasible to provide (97% [166/168] very feasible or somewhat feasible) than other accommodations (e.g., no new learning, 32% [54/170] provided; 49% [82/168] very feasible or somewhat feasible). In total, 41% (69/167) of the participants indicated their school had a concussion management plan. Only 27% (44/165) indicated their school had a point-person for students with a concussion.
Conclusions: Middle and high school educators confirmed the importance of providing accommodations to students following concussion. The most feasible accommodations should be prioritized, and resources allocated to facilitate accommodations are provided, to ensure students are supported with their return to school.
Abstract #2249: Who is being missed? Developing an intersectionality approach to youth injury prevention
Presenting Author: Brandy Tanenbaum1
Authors: Brandy Tanenbaum1, Alyssa Miles2, Shari-Thompson-Ricci3
1Sunnybrook Health Sciences Centre – Centre for Injury Prevention
3University of Toronto
Introduction: Injury is deadly, expensive, and rates are increasing. For children and youth in Canada, injuries are the leading cause of death and disability. However, the risk of preventable injury is not equal for all youth. The Transforming Injury Prevention for Youth (TRIPY) model aims to recognize and remediate these inequities.
Objectives: TRIPY conceptualizes injury prevention (IP) through an intersectionality lens with evidence-based behaviour change theory. This approach shifts the prevention mandate away from non-specific interventions to ones more suited to the reality of the heterogenous youth population with varying risk and protective factors, needs and perspectives.
Approach: TRIPY was developed with diverse youth in mind, and the intended users include IP practitioners, partners, stakeholders, communities and decision makers. TRIPY was developed from a transformative perspective and built on core concepts within public health, IP, intersectionality, gender analysis, youth risk, health equity, and systems of privilege and oppression.
Findings: TRIPY helps to analyze intersecting inequities along multiple dimensions, to improve IP for diverse youth with unique identities, skills/lived experiences. The end goal of implementing intersectionality within IP is to find out is being missed, to understand and address existing inequities concerning youth injury such that all youth have the opportunity to prevent injury and achieve their full health potential.
Conclusions: Critically evaluating IP programs through an intersectionality lens is needed to understand unique factors that interact to influence an individual’s risk for injury. There is a need for more research that explores the experiences of youth at the intersection of various identity factors, including gender, race and ethnicity, and socioeconomic status. With this knowledge, programs can be more culturally responsive, gender- transformative, inclusive, and engaging for all diverse youth.
Abstract #2247: Youth injury prevention: In-person or virtual?
Presenting Author: Jennifer Britton1
Authors: Jennifer Britton1, Kaitlyn Jacobs1, Tania Haidar1, Alison Armstrong1, Fran Priestap1
1London Health Sciences Centre – Trauma Program
Introduction: Since 1988, London Health Sciences Centre has delivered its youth injury prevention program, Impact. The pandemic resulted in a pause of the program, allowing for a review of delivery method.
- Adapt Impact to be virtually accessible
- Analyze the effectiveness of virtual delivery demonstrated by consistent or improved self-reported risk-taking scores pre- and post-pandemic
Approach: Video testimonials were created pre-pandemic but not implemented. During redesign, these videos were included as well as remote polling technology to create a virtual 1-hour interactive presentation. The virtual program launched in September 2020 and the first presentation was delivered the following month. A feedback survey was administered following both pre- and post-pandemic versions of the program to examine potential changes in student’s risk-taking behaviour.
Results: In 2019-2020, Impact was presented in-person to 963 students in 2 municipalities. Two classrooms were excluded due to incomplete survey data rendering a sample of 763 students. In the first 7 months of virtual delivery, 546 students participated across 11 municipalities. Eight classrooms were excluded providing a sample of 447 students. For the current school year (2021-22), 465 students have completed Impact in 7 municipalities. The response rate for each of these three phases was 79.8%, 57.9% and 50.3%, respectively. A reduction in self-reported risk-taking behaviours was observed in 48.2% of the in-person attendees, and 57.4% and 55.0% of those attending the virtual program during the initial 7 months and the current school year, respectively.
Conclusion: The virtual program has expanded the reach of Impact and resulted in an increased percentage of students reporting a positive effect on their risk-taking. Further student consultation is needed to better understand if Impact is addressing their needs; along with, a communication strategy to expand the reach of the program.
Abstract #2220: #HighAndLocked: Lessons learned from a poisoning-prevention campaign for parents who use cannabis.
Presenting Authors: Kelley Teahen1, Claire Westmacott1
Authors: Kelley Teahen1, Claire Westmacott1
Introduction: Connections between cannabis and injury have been studied internationally. Lessons learned from other jurisdictions, such as Colorado, provided insight on injury trends to anticipate following marijuana legalization (Berger, 2014). Unintended paediatric cannabis poisoning has been identified as an emerging and ongoing issue. Calls to Canadian poison centres for cannabis-related exposures in children and youth have doubled compared to 2013. Public awareness and education are necessary to complement regulatory strategies for reducing cannabis-related harms.
Objectives: With the legalization of cannabis edibles at the end of 2019, Parachute developed a campaign with the goal of raising awareness among parents and caregivers about preventing unintentional cannabis poisoning.
Approach: Between 2019 and 2022, Parachute developed and implemented a two-phase national social and digital media campaign. The #HighAndLocked campaign was informed by poisoning-prevention best practice and two nationally representative surveys of parents and caregivers on knowledge, attitudes and behaviours regarding cannabis use.
Findings: The gaps we identified were knowledge and practice related to safe storage of cannabis products and awareness of local poison centres. The marketing and communications strategies used, such as targeted social media ads, were effective in reaching the intended audience. While cannabis is legal in Canada, there are still roadblocks to sharing cannabis-related messaging on social media platforms; we developed creative strategies to address these challenges.
Conclusions: Cannabis legalization has created new opportunities for injury prevention interventions. Parents and caregivers are a key audience for addressing unintentional paediatric cannabis poisoning, and social and digital media are effective channels to reach them. However, promoting cannabis-related content on these platforms has inherent challenges practitioners should be prepared to address.