bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do socio-economic determinants affect residential fire-related injuries and deaths among Canadian children?
Authors: Beaulieu Emile , Zheng Alex , Smith Jennifer , Pike Ian 
Published: May 2018

Abstract

BACKGROUND
Fire is a leading cause of unintentional injuries among children in Canada. More specifically, residential fires are responsible for too many preventable deaths and injuries. Yet, there is no national database that reports on residential fire-related injuries and deaths among children. Although socio-economic determinants (SED) have been associated with increased risk of residential fire in the USA and UK, little is known about the significance of this impact on the Canadian child population.

OBJECTIVES
This study examined the role of SED (low education, median income and average number of persons per dwelling (ANPD)) in residential fire-related injuries and deaths, and assessed the relationship between age and the severity of residential fire-related injuries and deaths, among children and youth in Canada.

DESIGN/METHODS
A cross-sectional study design was used to examine data from the National Fire Information Database (NFID), which includes 10-years (2005–2015) of microdata information on fire incidents and losses reported by provincial/territorial Fire Marshals and Fire Commissioners Offices across Canada. Census 2011 data at the CSD level, from Statistics Canada, provided the SED variables. Our outcome of interest was the odds of death and major injury over minor injury. A logistic regression model was applied to test the relationship between age and SED with our outcome of interest, while adjusting for province.

RESULTS
For every 1 person increase in the average ANPD at the CSD level, there is a 31% decrease in the odds of dying or being severely injured in a residential fire (p=0.0003). For every 1% increase in CSD’s low education proportion, there is a 2.5% increase in the odds of dying or being severely injured in a residential fire (p=0.0002). Median income was not significantly associated with the odds of death and major injury over minor injury. The odds of death and major injury were not significantly different for youths and adults, compared to children, controlling for ANDP, low education and median income.

CONCLUSION
The National Fire Information Database is one of the first to amass reliable fire incident and loss information across Canada into one database. Using this novel dataset, we determined that increased ANPD strongly decreased the odds of death and major injury over minor injury. Thus, the number of persons living in a household should be considered when targeting vulnerable children and youth for residential fire prevention and safety promotion programs.
THE DEVELOPMENTAL TOOLKIT: A PLAY-BASED LEARNING TOOL
Authors: Young Elizabeth , Jegathesan Thivia , Ng Stella , Mylopoulos Maria , Minhas Ripudaman S , Huber Joelene , Zubairi Mohammad 
Published: May 2018

Abstract

BACKGROUND
Learning child development is complex. Recent paediatric and family medicine graduates reported feeling unprepared to identify and manage children with developmental and behavioural concerns (Comley et al 2008). As part of current developmental education at our centre, residents are trained to assess child development by integrating their pre-rotation knowledge about development with parental report and a general physical examination. This approach lacks hands-on training required to understand and learn the complexities of child development. To address this gap, our study team created the “Developmental Toolkit (Toolkit),” a non-standardized developmental teaching tool comprising specific toys and activities.

OBJECTIVES
The primary objective of this study was to explore how the toolkit may influence the teaching and learning of child development. Through the lens of reflective practice, this study sought to also explore residents’ learning of development in the context of a play-based toolkit.

DESIGN/METHODS
Using a constructivist grounded theory approach, paediatric and family medicine residents from two academic centres were interviewed after they used the toolkit as part of their interactions. Physician supervisors were also interviewed to determine the use of the toolkit as a teaching tool.

RESULTS
We recruited 10 residents to ensure saturation of data. Residents felt positively about their experience with the toolkit and its ease of use. They all agreed the toolkit enabled them to assess a child’s developmental skills in a short period of time. One paediatric resident found it “really useful; it was a more objective way for me to see what skills and milestones they [the child] were at. I think it was quite useful to correlate it with what mom was saying.” The residents’ supervisors all felt the toolkit allowed residents to more critically consider a child’s development and diagnosis in the context of the child’s environment. Furthermore, through the lens of reflective practice,the use of the toolkit revealed additional competencies in child development. These included: 1) maintaining a positive mood with the child; 2) getting a sense of the parent’s mood; 3) identifying when a child may have reached their limits during an interaction; and 4) critiquing previous assumptions about child development.

CONCLUSION
The toolkit is an innovative tool that may enhance paediatric and family medicine residents’ understanding of child development by enabling hands-on interactions and observations with children. Further exploration of how the toolkit may be enabling reflective practice and its implications on adaptive expertise need to be explored.
PREPARING FOR CBME: HOW OFTEN ARE FACULTY OBSERVING RESIDENTS?
Authors: George Sheenagh , Manos Sarah , Wong Kenny 
Published: May 2018

Abstract

BACKGROUND
Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will be required to adequately assess whether entrustable professional activities have been achieved.

OBJECTIVES
Characterize faculty and resident experiences of direct observation in a single Canadian Paediatric Residency program, pre-CBME implementation. Describe faculty and residents’ perceived barriers and incentives to participating in direct observation.

DESIGN/METHODS
Surveys were sent to faculty and residents asking for demographic information, the frequency of resident observation during an average 4-week rotation in several domains (taking a history, performing a physical examination, delivering a plan,...), perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data was analyzed. Institutional research ethics board approval was received.

RESULTS
The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency faculty observed a resident take a history, perform a physical examination, or deliver a plan, the median FACULTY reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings, respectively. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings, respectively. When asked the MINIMUM frequency for each domain, the median FACULTY AND RESIDENT reply was 0, except for delivering a plan in the inpatient setting (median RESIDENT reply was 2). FACULTY and RESIDENT median replies for how frequently residents should ideally be observed for each domain were the same, 3–4, 3–4, and 5–6 times. 4% of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common responses to barriers to observation were too many patients to see and that both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if they were scheduled at the start of the rotation, if faculty were provided a better tool for assessment, and if residents asked to be observed.

CONCLUSION
This study provides baseline data on how infrequent faculty observation of residents is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation is felt to compete with clinical service demands, but better scheduling strategies and assessment tools may help increase the frequency of resident observation.
FEASIBILITY OF A MANUALIZED FAMILY-BASED SUICIDE PREVENTION STRATEGY TO REDUCE ADOLESCENT SUICIDE RISK AMONG EMERGENCY DEPARTMENT REFERRED YOUTH: A QUALITY IMPROVEMENT PROJECT
Authors: Tracey Matthew , Rowney Gillian , Pignatiello Antonio , Monga Suneeta , Korczak Daphne 
Published: May 2018

Abstract

BACKGROUND
Suicide is the second leading cause of death among Canadian children and adolescents. Youth who present at an Emergency Department (ED) for suicidal ideation and risk behaviours (SRB) are at increased risk for eventual suicide. Despite this risk, current approaches to standard of care are referral to community resources or primary care where waitlists are common, and interventions may not be evidence-based or incorporate crisis management or family participation.

OBJECTIVES
To determine the feasibility and acceptability of a manualized, family-centered suicide prevention intervention administered in an outpatient clinic for ED-referred youth.

DESIGN/METHODS
Youth (aged 12 – 18) and parents presenting to the ED for SRB and referred to the Urgent Psychiatry Care clinic were eligible for the QI program, consisting of weekly individual and family sessions delivered over a 6-week period. The therapist addressed common symptoms and concerns of suicidal youth, sources of conflict within the family, and ways to improve communication and ensure patient safety. Patients were excluded if they did not have a parent or caregiver able to participate.
Suicidal ideation and behavior were assessed using youth-report measures, the Suicidal Ideation Questionnaire-Junior (SIQ-JR) and the Harkavy-Asnis Suicide Scale (HASS), at baseline and following program completion. The Mood and Feeling Questionnaire (MFQ) was used to measure depressive symptoms. Participant and therapist feedback was collected at follow-up using quantitative and qualitative measures.

RESULTS
Ten patients were enrolled and completed baseline measures, however four participants withdrew prior to 6 week completion: two withdrew at week 2 and one participant each withdrew at weeks 3 and 6. As such, 7/10 completed 5 weeks of the intervention. Significant improvement in both suicidal ideation (SIQ-JR, x̅ = -16.67; t(5) = 3.125, p = .026) and SRB (HASS, x̅ = -20.17; t(5) = 3.204, p = .024) were observed. Depressive symptoms also decreased (MFQ, x̅ = -15.5, t(5) = 2.724, p = .042). Youth and caregivers rated the program favorably. Improved family communication was most frequently reported by both patients and caregivers as a main benefit of the program.

CONCLUSION
These preliminary data indicate that SRB may be improved by a brief manualized, family-focused therapy. Early data suggest that the protocol is feasible and acceptable for adolescents presenting to the ED with safety concerns, and warrant further examination in a controlled trial.
PAEDIATRIC SCHOOL OUTREACH: DEMOGRAPHICS AND CLINICAL NEEDS OF A UNIQUE INNER-CITY STUDENT POPULATION
Authors: Ng Pamela , Cohen-Silver Justine , Yang Heather , Swaminathan Aparna , Wormsbecker Anne 
Published: May 2018

Abstract

BACKGROUND
Paediatric School Outreach (PSO) clinic is a school-based health centre housed in a Kindergarten-Grade 8 public school. It serves an inner-city community impacted by the social determinants of health, such as language and income, which are barriers to accessing health care. This clinic focuses on developmental/behavioural, mental health and educational concerns.

OBJECTIVES
To characterize demographics, social determinants of health and some clinical characteristics of patients accessing services at PSO. By gaining a better understanding of the challenges of patients, services may be tailored to better suit patient/family needs.

DESIGN/METHODS
We conducted a retrospective chart review of children enrolled at PSO from November 2015 to March 2017. Data were obtained from demographic questionnaires and the electronic medical record. Analyses were performed in Microsoft Excel and SPSS (version 23) and are primarily descriptive. This work was funded by a faculty of medicine student research program and approved by research ethics boards at our hospital and school board.

RESULTS
138 children, between the ages of 2 and 15 years (average birth year 2008) enrolled at PSO during the study period. 73% were male. 70% of patients were in Grade 1 or above at enrolment. Children tended to be Canadian born to immigrant mothers; 74% of children were born in Canada but only 34% of mothers were also Canadian-born. After Canada, Hungary was the second common maternal place of birth (12%). English was the most common language spoken by patients (71%), followed by Hungarian, Tibetan, Portuguese and Spanish. 58% of patients’ families had a household annual income (HAI) of <$30,000 and 18% a HAI of $30,000–49,999.
84% of 138 patients reported having a family physician. Referrals were made by school support team (54%), teacher (36%) or principal (28%). The common presenting concerns were behaviour (81%), school performance (60%), followed by social communication (51%) and emotional presentation (49%).
Among 132 patients with clinical records, 13% were on any medication at enrolment; and 3% (4/132) on psychostimulants. 14% of patients were started on medication during the study period, most frequently psychostimulants (11%, 15/132).

CONCLUSION
PSO patients are culturally diverse and at least three quarters have HAIs below our city’s median of $65,829 (2015). The majority reported having a family physician but accessed our clinic for educational/behavioural concerns, suggesting PSO may be a stream-lined approach. With knowledge of maternal languages, we can begin to translate questionnaires and clinic materials. Further data analyses will better describe diagnoses and referrals made at the clinic.
Early Comparative Outcomes of Carbon Fiber–Reinforced Polymer Plate in the Fixation of Distal Femur Fractures
Authors: Mitchell Phillip M. , Lee Adam K. , Collinge Cory A. , Ziran Bruce H. , Hartley Kate G. , Jahangir A. Alex 
Published: May 2018

Objective:
To evaluate the early clinical results of distal femur fractures treated with carbon fiber–reinforced polyetheretherketone (CFR-PEEK) plates compared with stainless steel (SS) lateral locking plates.

Design:
Retrospective comparative cohort study.

Setting:
ACS Level I trauma center.

Patients/Participants:
Twenty-two patients (11 SS, 11 CFR-PEEK) with closed distal femur fractures treated by a single surgeon over a 6-year period.

Main Outcome Measurements:
Nonunion, hardware failure, reoperation, time to full weight-bearing, and time union were assessed.

Results:
The CFR-PEEK cohort was on average older (71 vs. 57 years, P = 0.03) and more likely to have diabetes (P = 0.02). Nonunion was diagnosed in 4/11 (36%) patients in the SS group and 1/11 (9%) patients in the CFR-PEEK group (P = 0.12). Hardware failure occurred in 2 SS patients (18%) compared with none in the CFR-PEEK group (P = 0.14). Time to full weight–bearing was similar between groups, occurring at 9.9 and 12.4 weeks in the CFR-PEEK and SS groups, respectively (P = 0.23). Time to radiographic union averaged 12.4 weeks in the SS group and 18.7 weeks in the CFR-PEEK group (P = 0.26). There were 4 reoperations in the SS group and 1 in the CFR-PEEK group (P = 0.12).

Conclusions:
CFR-PEEK plates show encouraging short-term results in the treatment of distal femur fractures with a comparable nonunion, reoperation, and hardware failure rates to those treated with SS plates. This data suggest that CFR-PEEK plates may be a viable alternative to SS plates in fixation of these fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Case Report: Use of Sports and Performance Vision Training to Benefit a Low Vision Patient's Function
Authors: Laby Daniel M. 
Published: May 2018

SIGNIFICANCE
Despite our inability to attenuate the course of many ocular diseases that can ultimately lead to loss or significantly decreased visual function, this report describes a potential technique to aid such patients in maximizing the use of the vision that remains.

PURPOSE
The aim of this study was to demonstrate the applicability of utilizing sports vision training to improve objective and subjective visuomotor function in a low vision patient.

CASE REPORT
A 37-year-old woman with Usher syndrome presented with reduced central visual acuity and visual field. Although we were unable to reverse the damage resulting from her diagnosis, we were able to improve the use of the remaining vision. A 27 to 31% improvement in hand-eye coordination was achieved along with a 41% improvement in object tracking and visual concentration. Most importantly, following the 14-week training period, there was also a subjective improvement in the patient's appreciation of her visual ability.

CONCLUSIONS
The sports vision literature cites many examples in which sports vision training is useful in improving visuomotor and on-field performance. We hypothesized that these techniques may be used to aid not only athletes but also patients with low vision. Despite suffering from reduced acuity and a limited visual field, these patients often still have a significant amount of vision ability that can be used to guide motor actions. Using techniques to increase the efficient use of this remaining vision may reduce the impact of the reduced visual function and aid in activities of daily living.
Mobility Analysis of AmpuTees II
Authors: Wurdeman Shane R. , Stevens Phillip M. , Campbell James H. 
Published: May 2018

Objective
The aim of the study was to determine the impact of comorbidities on mobility in patients with lower limb prostheses.

Design
Cohort database chart review was conducted to examine mobility in lower limb prosthesis users grouped according to comorbidities. Regression models were used to determine significant predictor comorbidities for mobility. General linear univariate models were implemented to investigate differences in mobility among cohorts (N = 596).

Results
Patient age and history of stroke, peripheral vascular disease, and anxiety/panic disorders were predictors of decreased mobility. After adjusting for covariates, the differences in mobility reported by patients older than 65 yrs was compared with those younger than 65 yrs; in addition, we compared those with a history of peripheral vascular disease with those without. The comparative analyses for both categories did not satisfy the minimal clinically important difference. There were no significant differences when comparing overall comorbid health after adjusting for covariates.

Conclusions
Clinicians should consider patient age and history of stroke, peripheral vascular disease, or anxiety/panic disorders when optimizing a lower limb prosthesis users' mobility because these variables may be predictive of modest but clinically meaningful decreased prosthetic mobility. By contrast, common comorbid health conditions such as arthritis, chronic obstructive pulmonary disease, congestive heart failure, and diabetes do not seem predictive of decreased mobility among lower limb prosthesis users.
Co-Occurrence of Posttraumatic Stress Disorder and Cardiovascular Disease Among Ethnic/Racial Groups in the United States
Authors: Vidal Carmen , Polo Ruth , Alvarez Kiara , Falgas-Bague Irene , Wang Ye , Lê Cook Benjamin , Alegría Margarita 
Published: May 2018

ABSTRACT

Objective
Trauma and/or symptoms of posttraumatic stress disorder (PTSD) have been linked to the onset of cardiovascular disease (CVD), but the exact mechanism has not been determined. We examine whether the risk of CVD is different among those who have a history of trauma without PTSD symptoms, those who have experienced trauma and developed any symptoms of PTSD, and those with a PTSD diagnosis. Furthermore, we examine whether this association varies across ethnic/racial groups.

Methods
We used two data sets that form part of the Collaborative Psychiatric Epidemiology Surveys - the National Latino and Asian American Study and the National Comorbidity Survey Replication.

Results
We found an increased likelihood of cardiovascular events for those with a diagnosis of PTSD (odds ratio [OR] = 2.10, 95% CI = 1.32–3.33) when compared with those who had not experienced trauma. We did not find an increased risk for those who had experienced trauma without symptoms or with subclinical symptoms of PTSD. The higher likelihood of having a cardiovascular event in those with PTSD was significant for non-Latino whites (OR = 1.86, 95% CI = 1.08–3.11), Latinos (OR = 1.94, 95% CI = 1.04–3.62), and non-Latino blacks (OR = 3.73, 95% CI = 1.76–7.91), but not for Asian respondents.

Conclusions
The constellation of symptoms defining PTSD diagnosis reflect adverse reactions to traumatic events and indicate that complex responses to traumatic events may be a risk factor for CVD.
Coronary artery disease risk and lipidomic profiles are similar in familial and population-ascertained hyperlipidemias
Authors: Rämö Joel T. , Ripatti Pietari , Tabassum Rubina , Söderlund Sanni , Matikainen Niina , Gerl Mathias J. , Klose Christian , Stitziel athan O. , Havulinna Aki S. , Salomaa Veikko , Freimer Nelson B. , Jauhiainen Matti , Palotie Aarno , Taskinen Marja-Riitta , Simons Kai , Ripatti Samuli 
Published: May 2018

AbstractAims: To characterize and compare coronary artery disease (CAD) risk and detailed lipidomic profiles of individuals with familial and population-ascertained hyperlipidemias.Methods and Results: We determined incident CAD risk for 760 members of 66 hyperlipidemic families (≥ 2 first degree relatives with the same hyperlipidemia) and 19,644 Finnish FINRISK population study participants. We also quantified 151 lipid species in plasma or serum samples from 550 members of 73 hyperlipidemic pedigrees and 897 FINRISK participants using a mass spectrometric shotgun lipidomics platform. Hyperlipidemias (LDL-C or triacylglycerides over 90th population percentile) were associated with increased CAD risk (high LDL-C: HR 1.74, 95% CI 1.48–2.04; high triacylglycerides: HR 1.38, 95% CI 1.09–1.74) and the risk estimates were very similar between the family and population samples. High LDL-C was associated with altered levels of 105 lipid species in families (p-value range 0.033–7.3*10−20 at 5% false discovery rate) and 51 species in the population samples (p-value range 0.017–6.8*10−21). Hypertriglyceridemia was associated with altered levels of 117 lipid species in families (p-value range 0.035–1.8*10−49) and 119 species in the population sample (p-value range 0.038–2.3*10−56). The lipidomics profiles of hyperlipidemias were highly similar in families and population samples.Conclusion: We identified distinct lipidomic profiles associated with high LDL-C and triacylglyceride levels. CAD risk, lipidomic profiles and genetic profiles are highly similar between familial and population-ascertained hyperlipidemias, providing evidence of similar and overlapping underlying mechanisms. Our results do not support different screening and treatment for such hyperlipidemias.