The goal of this study was to examine whether a storybook about home safety would increase hazard recognition, and reduce risky behaviour in children three through five years of age. Participants were randomly assigned to either receive the storybook intervention or a control condition. While robust group differences were not found, the results revealed trends as expected. There was a significant increase in hazard identification scores from pre- to post-intervention in the intervention but not the control condition, with greater reading time positively associated with larger improvements. Moreover, while children in the control group showed a marginally significant increase in number of hazards they touched from pre- to post-intervention, those in the intervention group did not. The pattern of these findings suggests that the storybook intervention, to some extent, positively impacted both knowledge and behaviour. Suggestions for future research are discussed.

Background: Injury and obesity are two of the leading public health problems in youth around the world. To reduce the burden of obesity, efforts are underway to increase physical activity participation; however, physical activity is also the leading cause of injury in youth. Recovery from injury is also important as long periods away from regular activity can have major effects on the health of youth. Objectives: This thesis is in manuscript format. The objective of the first manuscript was to determine whether relationships between physical activity and physical activity injuries are modified by BMI status in Canadian youth. The objective of the second manuscript was to examine the effect of BMI status on the time to recovery within youth who have suffered an injury. Methods: Data were obtained from the 2006 and 2002 Canadian Health Behaviour in School-Aged Children (HBSC) surveys. The 2006 Canadian HBSC was a nationally representative survey of 9672 youth in grades 6 through 10 from across Canada. The 2002 Canadian HBSC was an analogous survey of 7235 youth, of which approximately 50% experienced a medically treated injury. Analyses were driven by theory, and considered relationships among the major variables. Results: In manuscript 1, cross-sectional analyses indicated that those who reported high levels of physical activity experienced greater risks for physical activity injury in comparison to those with low levels of activity. BMI status was not identified as an effect modifier in any analyses. In manuscript 2, recovery for youth who were obese and suffered a combined injury (broken bone and strain/sprain) were longer than recovery times for normal weight youth. Times to recovery for obese youth were not significantly elevated for broken bones and sprain/strains. Conclusions: Physical activity participation relates to injury experiences in a consistent manner across BMI groups. Special safety precautions are not justified for obese youth in physical activity programs. BMI status was found to influence times for injury recovery. These are important clinical results that demonstrate that obesity may have a role in the osteoarticular health of youth and should be considered as a factor in treatment plans. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-08-26 10:59:39.956

Treatment of burns can be divided into 3 phases. During first 36 hours fluid resuscitation and securing airways are the most important aspects of therapy. The fluid resuscitation is complex, and protocols are used to increase the consistency and success of treatment. The adequacy of the protocols should be continuously monitored and adjusted to the patients response. Current studies are exploring the use of antioxidants to minimize the oxidant stress during the burn shock phase. The aim of this thesis is to review current strategies in fluid resuscitation during the first 36 hours after burns.

EPIDEMIOLOGY ( EPIDEMIOLOGIC RESEARCH) OF BURN INJURIES IN CHILDREN Lenka Eichlová Supervisor: MUDr. Monika Tokarik Background: Burn injury belongs to main cause of morbidity and mortality in children. More than 100 000 people sustain flash burn every year, 40% of them forms children. Near minimus insider babies into two years come to scorch mostly owing second men. Cardinal cause of thermic injury off elderly is by personal endeavour. Burns differ by mechanism, range, depth and localization. An age is other crucial factor determinants prognosis of patient. And just therefore children's burns are very specific disbranch of medicine. Object: I tried to created a labour, in which I elaborate statistical data of newly hospitalized patiens on clinic of burns in FNKV behind the year 2008. Patients: The set contained 373 newly hospitalized patiens. I have divided them according to age, sex, mechanism of scorch, range, depths and localization of scorch. Further I followed longitude of hospitalization, way of applied therapy and occurence of complications. Results: Predomination of burns is in boyhood (65%). The highest occurence of burns is in the group at the age of 0-2. The most frequent reason of burn in this group is caused by scalding hot liquid and further contact with hot body. In a group of 4-15 years old,...

Introduction: Multiple studies suggest that severely injured patients treated at trauma centers have a lower mortality compared to patients treated at non-trauma centers. In many trauma systems, a significant proportion of patients continue to be transported from the scene to a non-trauma center (undertriaged); only a fraction of these patients are subsequently transferred to trauma center care. Although previous analyses have attempted to examine the mortality associated with transfer and with undertriage, these studies were not population-based, and therefore potentially underestimated the mortality cost of undertriage at the system level. Methods: In this dissertation, we developed an algorithm to convert ICD-10 diagnosis codes to Injury Severity Score. This algorithm allowed us to utilize population-based data to examine the outcomes of all severely injured patients surviving to reach an emergency department in Ontario. We examined whether, among severely injured patients, transfer from a non-trauma center to a trauma center is associated with increased mortality compared to direct transport from the scene. In addition, we used an instrumental variable analysis to produce a population-based estimate of the mortality cost of undertriage in a subset of patients injured in motor vehicle collisions. Results: Patients requiring transfer to trauma center care have significantly higher mortality at 30 days than patients transported directly from the scene of injury (Odds ratio 1.24; 95% CI, 1.10-1.40). Among patients involved in motor vehicle collisions, only 45% were transported directly to a trauma center. In this subset of patients, those triaged directly to a trauma center had significantly lower mortality at 24 hours (Odds ratio 0.58, 95% CI 0.41-0.84) and 48 hours (Odds ratio 0.68, 95% CI 0.48-0.96) compared to undertriaged patients. There was a trend towards decreased mortality among patients triaged to a trauma center at 7 days and 30 days. Conclusions: Undertriage and transfer after major trauma are associated with substantial increase in mortality compared to direct transport to a trauma center. These data suggest a need to design strategies to improve access to trauma center care in Ontario.

Introduction: Multiple studies suggest that severely injured patients treated at trauma centers have a lower mortality compared to patients treated at non-trauma centers. In many trauma systems, a significant proportion of patients continue to be transported from the scene to a non-trauma center (undertriaged); only a fraction of these patients are subsequently transferred to trauma center care. Although previous analyses have attempted to examine the mortality associated with transfer and with undertriage, these studies were not population-based, and therefore potentially underestimated the mortality cost of undertriage at the system level. Methods: In this dissertation, we developed an algorithm to convert ICD-10 diagnosis codes to Injury Severity Score. This algorithm allowed us to utilize population-based data to examine the outcomes of all severely injured patients surviving to reach an emergency department in Ontario. We examined whether, among severely injured patients, transfer from a non-trauma center to a trauma center is associated with increased mortality compared to direct transport from the scene. In addition, we used an instrumental variable analysis to produce a population-based estimate of the mortality cost of undertriage in a subset of patients injured in motor vehicle collisions. Results: Patients requiring transfer to trauma center care have significantly higher mortality at 30 days than patients transported directly from the scene of injury (Odds ratio 1.24; 95% CI, 1.10-1.40). Among patients involved in motor vehicle collisions, only 45% were transported directly to a trauma center. In this subset of patients, those triaged directly to a trauma center had significantly lower mortality at 24 hours (Odds ratio 0.58, 95% CI 0.41-0.84) and 48 hours (Odds ratio 0.68, 95% CI 0.48-0.96) compared to undertriaged patients. There was a trend towards decreased mortality among patients triaged to a trauma center at 7 days and 30 days. Conclusions: Undertriage and transfer after major trauma are associated with substantial increase in mortality compared to direct transport to a trauma center. These data suggest a need to design strategies to improve access to trauma center care in Ontario.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Introduction: The majority of University of the Western Cape coaches believe that in most sport codes, many female and male athletes get injured at least once a season. Consequently, occurrence of injuries signifies many set-backs in any team sports. University of the Western Cape sports injury intervention and rehabilitation strategies are relatively under-developed, and have not been systematically implemented, despite their proven effectiveness. However, due to intensive training, local and national league competitions, the number of injured athletes at University of the Western Cape has increased, and so delays of athletes’ recovery are caused. Thus, it is assumed that University of the Western Cape efforts may have lack of the necessary injury precautions on prevention and rehabilitation such as proactive injury treatment, paying special attention to the therapeutic process, including other necessary mechanisms. The current study has explored facilitating factors and some of the barriers on the implementation of injury prevention strategies, and determined the effectiveness of rehabilitation within University of the Western Cape sport teams in views of athletes, coaches, and medical staff. Methods: This study used a sequential exploratory design which entailed an initial phase of quantitative data collection and analysis, followed by a phase of qualitative data collection and analysis. This study used a close-ended survey and semi-structured interviews to identify the barriers and facilitators associated with the implementation of injury prevention strategies among sports clubs at the University of the Western Cape. Results: Data were collected on the general knowledge of players and team coaches about injury prevention as well as their sources of information regarding injury prevention. Football players were 49.5% while 15.8% were basketball players in this study. Cricket players were 10.9% while rugby players were 9.9%. Sources of players’ knowledge of injury prevention included doctor/physiotherapist, coaches and the media. Sources of coaches’ knowledge of injury prevention included doctor/physiotherapist, media and seminars. Most players and coaches agreed that there is a greater chance of sustaining an injury during a competitive match than during training. Players and coaches also agree that the risk of injury is reduced by wearing preferred protective clothing and thoroughly warming up and stretching prior to training or competition. Barriers to the implementation of an injury prevention strategy include not having enough time, being too tired after training, no advice given on such techniques, the notion that nobody else does it and lack of proper equipment. Facilitators of an injury prevention strategy include availability of medical staff (doctors and physiotherapists), players’ understanding of the coach’s instructions, and injury prevention facilities at University of the Western Cape, services accessibility and quality, injury discovery and follow-up, and injury prevention policy at University of the Western Cape. Conclusion: Based on the findings of this study, the following recommendations were made: (i) Intervention directed at players and coaches in the form of health promotion programmes through education to increase their knowledge and support in implementation of all prevention strategies either in training or in competition; (ii) Governing bodies at University of the Western Cape should develop and disseminate written sports safety policies and guidelines and supervise clubs in their development programmes.

Background: Muscle, joint and bone injuries affect mobility and stability, which in turn limits physical activity. Screening tests such as the Functional Movement Screen (FMS) are used to assess an individual’s mobility and stability to determine whether any movement dysfunctions exist. Screening tests aim to establish an individual’s injury risk with the goal of guiding an intervention program. The Evaluation of Mobility Screen (EMS) is a screening test that has been developed at the Sports Science Institute of South Africa. The EMS has been adapted from the FMS by exchanging the Rotatory Stability test for the Seated Rotation test. The current use of screening tools is limited because of the lack of normative data sets that represent the diversity of age, gender and physical activity levels in the general population. Most current published data represent athletes or younger populations. By establishing the relationship between screening outcomes and variables such as age, gender and physical activity level, the effectiveness of screening tests may be improved. Aim: To describe associations between EMS scores for males and females across different age groups and levels of physical activity. Objective: To evaluate and compare differences in EMS scores relating to age, gender and physical activity levels. Methods: This was a quantitative study, with a descriptive, correlational design. The sample consisted of 135 males and 127 females between the ages of 18 and 60. The EMS data were collected at the HighPerformance Centre, in the Sports Science Institute of South Africa, Cape Town. Results: There was no difference between the total scores of males and females (median = 17). The two youngest groups (20-30 and 31-40 years) scored the highest (median = 17), while the oldest group (51-60 years) scored the lowest (median = 15). Gender had a significant effect (p < 0.05) on five subtests (Single Leg Hurdle, Shoulder Mobility, Asymmetric Leg Raise, Stability Push Up and Seated Rotation). Age had a significant effect (p < 0.05) on three subtests (Overhead Squat, Single Leg, Hurdle Split Squat). Physical activity level had a significant effect (p < 0.05) with two subtests (Single leg Hurdle and Stability Push Up). Conclusion: Gender, Age and Physical Activity are associated with changes in EMS scores. EMS total scores declined as age increased. While the total scores remain similar between genders, there were clear variations within the different subtests. The oldest participants (51-60 year) scored the lowest throughout all subtests. Males scored higher in the strength components, while females scored higher in the flexibility components. Physical activity levels did not have a clear pattern as expected but still demonstrated association with two subtests. The results add to the sentiment that the focus should move away from the composite scoring system, and towards analyzing individual subtest scores. Future studies should also investigate if subtest scores can be improved by targeted intervention programs.

In the current study, mechanoporation-related neuronal injury as a result of mechanical loading has been studied using a multiscale approach. Injurious mechanical loads to the head induce strains in the brain tissue at the macroscale. As each length scale has its own unique morphology and heterogeneities, the strains have been scaled down from the macroscale brain tissue to the nanoscale neuronal components that result in mechanoporation of the neuronal membrane, while relevant neuronal membrane mechanoporation-related damage criteria have been scaled up to the macroscale. To achieve this, first, damage evolution equations has been developed and calibrated to molecular dynamics simulations of a representative neuronal membrane at the nanoscale. These damage evolution equations are strain rate and strain state dependent. The resulting damage evolution model has been combined with Nernst-Planck diffusion equations to analytically compare to intracellular ion concentration disruption through mechanical loading of in vitro neuron cell culture and found to agree well. Then, these damage evolution equations have been scaled up to the microscale for dynamic simulations of 3-dimensional reconstructed neurons of similar mechanical loads. It was found that the neuronal orientation significantly affects average damage accumulation on the neuron, while the morphology of neurons, for a given neuron type, had little effect on the average damage accumulation. At the mesoscale, finite element simulations of geometrical complexities of sulci and gyri, and the structural complexities of the gray and white matter and CSF on stress localization were studied. It was found that the brain convolutions, sulci, and gyri, along with the effects of impedance mismatch between the cerebrospinal fluid (CSF) and brain tissue localized shear stresses, at the depths of the sulcus end (near field effects) and in-between sulci (far field effects), that correlated well with the regions of tau protein accumulation that is observed in chronic traumatic encephalopathy (CTE). Further, sulcus length and orientation, with respect to impending stress waves, had a significant impact on the magnitude of stress localization in the brain tissue. Lastly, gray-white matter differentiation, pia matter, and brain-CSF interface interaction properties had minimal impact of the shear stress localization trends observed in these simulations.

Title: Reliability of Child SCAT 3 Component Scores in Children at Rest and Following Exercise Author Names: Jeff Billeck, BPE, CAT(C)1, Mike Ellis, MD2, Jeff Leiter, PhD2, Joanne Parsons, PhD, BPT3. Jason Peeler, PhD, CAT(C)4 Problem: A lack of research exists regarding the test-retest reliability of the Child Sport Concussion Assessment Tool 3 (Child SCAT 3) in healthy non-concussed adolescent females in both baseline and post-exercise settings. Method: This study consisted of two testing sessions. Within each session the Child Sport Concussion Assessment Tool 3 (Child SCAT 3) was administered once prior to exercise and once after a bout of exercise. Results: Individual component scores displayed a wide range of reliability and response stability values. A positive correlation existed within one session, between child symptom scores and slower rates of heart rate recovery after exercise. Conclusions: Overall, the Child SCAT 3 appears to be a moderately reliable assessment tool when used to evaluate uninjured female children. However, further research is required to clarify the exact sources of method error within individual Child SCAT 3 component scores. / May 2016