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Objectives Cannabis is a widely used illicit substance that has been associated with acute injuries. This study seeks to provide near real-time injury estimates related to cannabis and other substance use from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database. Methods Data from the eCHIRPP database, years 2011 to 2016, were analyzed via data mining, descriptive, logistic regression, and sensitivity analyses. Drug use trends over time for cannabis and/or other substances (alcohol, illicit drugs, and medications) were assessed. Descriptive statistics (intent, external cause, and nature of injury) and proportionate injury ratios (PIR) associated with cannabis use are presented. Results Cannabis use was observed in 184 cases/100,000 eCHIRPP cases, and related injuries were mostly identified as unintentional (66.8%). Poisoning (68.5%) and intoxication (69.4%) were the external cause and nature of injury most associated with these events, and hospitalization was recorded for 14.3% of cases. Per 100,000 eCHIRPP cases, cannabis was used alone in 72.4 cases, and in combination with alcohol, illicit drugs, or medications in 74.6 cases, 11.3 cases, and 7.9 cases, respectively. Relative to non-use, the PIR of hospitalization was not significant for cannabis-only users of either sex (males: PIR 1.0, 95% CI 0.6–1.7, females: PIR 0.9, 95% CI: 0.5–1.7). Conclusion Cannabis use injuries are rare, but can occur when cannabis is used with or without other substances. As Canada considers legislative changes, our finding of cases related to unintentional injury, poisoning, and intoxication suggests areas that might benefit from health literacy efforts.

A 64-year-old man with a history of atrial fibrillation has been receiving sotalol. A dual chamber pacemaker with antitachycardia pacing capabilities was implanted because of symptomatic bradycardia associated with sotalol therapy. Since being placed on sotalol several months ago he has had no episodes of symptomatic atrial fibrillation and wonders whether he can stop anticoagulation. He has hypertension, but otherwise does not have a history of coronary artery disease, heart failure, prior stroke or transient ischemic attack, or diabetes. The situation is investigated.

A 75-year-old man with an 8-year history of permanent atrial fibrillation comes to your office for a second opinion. He had a single chamber ventricular pacemaker placed 4 years ago for bradycardia. He began developing symptoms of increasing shortness of breath and had his pacing rate increased from 60 to 70 ppm. Progressive shortness of breath developed; an echocardiogram demonstrated severe mitral regurgitation. He has now been referred for mitral valve replacement. Changes to pacing system programming are considered.

An 82-year-old man with permanent atrial fibrillation has a permanent pacemaker implanted after AV nodal ablation. During a routine pacing system evaluation, interrogation of his device demonstrates a cluster of ventricular arrhythmias on one day. Evaluation and investigation are discussed.

A 66-year-old man with a history of coronary artery disease complains of generalized fatigue. He denies chest pain or other symptoms of ischemia, has a history of a myocardial infarction 6 years ago but has normal left ventricular function by recent echocardiogram. He underwent permanent pacemaker implantation in 2001 for a “slow heart rate,” and he is being treated currently with extended-release metoprolol 50 mg daily and aspirin. Rhythm and device-related issues are discussed.

Une brosse à barbecue (BBQ) est un article de ménage très courant destiné à nettoyer les grilles de BBQ. Les données de la base de données de la plate-forme électronique du Système canadien hospitalier d’information et de recherche en prévention des traumatismes (eSCHIRPT) ont été analysées afin d’estimer la fréquence des blessures associées aux brosses à BBQ par rapport à l’ensemble des blessures, ainsi que de décrire les caractéristiques associées à ces accidents. Entre le 1er avril 2011 et le 17 juillet 2017, on a observé des blessures associées aux brosses à une fréquence de 1,5 cas par 100 000 cas dans l’eSCHIRPT (N = 12). Les résultats indiquent qu’outre les risques associés à l’ingestion de poils tombés de la brosse à BBQ et attachés aux aliments, ces poils pourraient aussi causer des blessures par d’autres mécanismes.

The goals of this study were to analyze possible trends of fatal and serious injuries related to vulnerable road users in Canada (pedestrians, cyclists and motorcyclists) from 1990 to 2012 and the role of alcohol and drugs in these cases. Drugs have rarely been documented with respect to vulnerable road users.The Traffic Injury Research Foundation's National Fatality and Serious Injury Databases and the Public Health Agency of Canada's Canadian Hospitals Injury Reporting and Prevention Program databases were used. Numbers and rates of fatalities and serious injuries among vulnerable road users were analyzed and regression models were used to assess changes over time.The analyses show that while the absolute number of fatalities and the rate per 100,000 population among vulnerable road users may be decreasing, no such trends are apparent when looking at the proportions of these road user fatalities out of all motor-vehicle fatalities. The trend for the proportion of motorcyclist fatalities is significantly increasing (coef.=0.16, p0.001). The elderly (76years or older) are overrepresented among pedestrian fatalities, and serious injuries (they represent 18.5% of all pedestrian fatalities but only 5.8% of the population), while those 15years or younger are overrepresented among cyclists (they represent 23.3% of cyclist fatalities but 19.5% of the population), and those 16 to 25years old are overrepresented among motorcyclists (27.2% of motorcyclists fatalities and 13.6% of population). Alcohol and drug use among fatally injured vulnerable road users were significant problems, especially among pedestrians. Among fatally injured pedestrians tested for alcohol and drugs, 39.7% and 43.4% tested positive, respectively.With the promotion of walking and cycling as forms of exercise and the popularity of motorcycling, the safety of vulnerable road users is an important issue. The results corroborate previous research and extend our understanding about the influence of alcohol and drugs in vulnerable road user injuries.These findings can help better inform prevention and mitigation initiatives for vulnerable road users.

This status report on the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), an emergency department-based injury and poisoning surveillance system, describes the result of migrating from a centralized data entry and coding process to a decentralized process, the web-based eCHIRPP system, in 2011. This secure system is improving the CHIRPP's overall flexibility and timeliness, which are key attributes of an effective surveillance system. The integrated eCHIRPP platform enables near real-time data entry and access, has user-friendly data management and analysis tools, and allows for easier communication and connectivity across the CHIRPP network through an online collaboration centre. Current pilot testing of automated data monitoring and trend analysis tools-designed to monitor and flag incoming data according to predefined criteria (for example, a new consumer product)-is revealing eCHIRPP's potential for providing early warnings of new hazards, issues and trends.

Ce rapport d’étape sur le Système canadien hospitalier d’information et de recherche en prévention des traumatismes (SCHIRPT), un système de surveillance des blessures et des empoisonnements utilisé par les services d’urgence, décrit le résultat de la migration d’un processus d’entrée et de codage des données centralisé vers le processus décentralisé de l’eSCHIRPT, réalisée en 2011. Ce système sécurisé accroît la souplesse et la rapidité globales du SCHIRPT, attributs clés d’un système de surveillance efficace. La plate-forme intégrée de l’eSCHIRPT permet une entrée de données et un accès aux données en temps quasi réel, comprend des outils conviviaux de gestion et d’analyse des données et facilite la communication et la connectivité au sein du réseau du SCHIRPT grâce à un centre de collaboration en ligne. L’essai pilote mené actuellement sur les outils automatisés de contrôle de données et d’analyse des tendances – destinés à surveiller et à mettre en évidence les données d’entrée à partir de critères prédéfinis (par exemple un nouveau produit de consommation) – révèle le potentiel de détection rapide des nouveaux dangers, enjeux et tendances que possède l’eSCHIRPT.

There is an alarming lack of public awareness surrounding the safety of glass-fronted fireplaces. This has resulted in an active campaign from the American Burn Association Prevention Committee. One issue encountered while advocating for prevention among manufacturers is the lack of corroborating and accurate data. The purpose of this study was to examine the annual trends and epidemiology of glass-fronted fireplace-related burn injuries to children less than 15 years old, who presented to Canadian emergency departments between 1990 and 2010. Records of pediatric burn injuries related to glass-fronted fireplaces were extracted from the Canadian Hospitals Injury Reporting and Prevention Program database for the study period (1990-2010). Cases were analyzed in terms of anatomic area affected, demographics, seasonality, safety device use, and injury severity. A total of 616 cases of burns from glass-fronted fireplaces were identified. The incidence increased at an average of 2.7 cases per year. This is a greater than 20-fold increase over 20 years. Seventy-five percentage of the cases occurred in children less than 2 years, and 95% occurred in children less than 5 years. The study demonstrated a growing risk from glass-fronted fireplace burns, likely due to the increasing popularity of household gas fireplace units. These units are a particular risk to children less than 2 years, attributable to their developing mobility and reduced reaction time. This is a preventable injury that should be addressed through changes to legislation and manufacturing.

Off-road vehicles (ORVs; this includes snowmobiles, all-terrain vehicles or ATVs and dirt bikes) were once used primarily for work and travel. Such use remains common in Canada, although their recreational use has also gained popularity in recent years. An epidemiological injury profile of ORV users is important for better understanding injuries and their risk factors to help inform injury prevention initiatives. The Traffic Injury Research Foundation (TIRF) partnered with the Public Health Agency of Canada (PHAC) to analyze the epidemiology of ORV-related injuries. The primary aim was to assess crashes and injuries in Canada, including the extent of alcohol involvement. Secondly, the burden of injury among children and teen ORV drivers in Canada, as well as passengers, was investigated. Descriptive and inferential epidemiological statistics were generated using the following data sources: first, TIRF's National Fatality Database, which is a comprehensive, pan-Canadian, set of core data on all fatal motor vehicle crashes; second, TIRF's Serious Injury Database, which contains information on persons seriously injured in crashes; and, third, PHAC's Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a surveillance system currently operating in the emergency departments of some pediatric and general hospitals across Canada. Exposure data have been used in the analyzes where available. Between 1990 and 2010, fatality rates increased among ATV and dirt bike operators. The fatality rate among snowmobilers declined during this period. Of particular concern, among fatally injured female ATV users, children aged 0-15 years comprised the highest proportion of any age group at 33.8%. Regarding alcohol use, among fatally injured snowmobile and ATV/dirt bike operators tested for alcohol, 66% and 55% tested positive, respectively. Alcohol involvement in adult ORV crashes remains an important factor. In light of the growing popularity of ORVs, prevention and mitigation measures are required to address this issue.

Background Emotional/psychological child maltreatment (ECM) is a major public health problem with serious consequences including emotional and behavioral problems. Nevertheless, ECM is an understudied area. Objectives The aims of this review are to identify measures of ECM and to evaluate their psychometric properties and utilities. We provide a summary of ECM measures that have been tested for their reliability and validity, evaluate the quality of these assessments and suggest directions for future research. Methods We searched PsycINFO and Medline databases from 2000 to 2010 in addition to a hand search of retrieved references; 2344 were identified and the abstracts reviewed independently by two authors to identify relevant articles. Using pre-established criteria, 144 of those articles were selected and reviewed in full to assess whether the instruments included a separate measure of ECM and its psychometric properties. Results Forty-five articles examining 33 measures met the inclusion criteria and were selected for further review. The majority of measures demonstrated acceptable reliability; fewer measures had evaluated one or more types of validity. Conclusion Both reliability and validity testing are required in order to establish more accurate measures of ECM. Practice implications Reliable and valid measures are necessary to enhance our limited knowledge about the distribution, determinants and consequences of ECM.

CONTEXT In August 2004, the Northern Medical Program (NMP), a distributed campus of the Faculty of Medicine at the University of British Columbia, Canada, admitted its first students. Situated at the University of Northern British Columbia in Prince George, the NMP created new opportunities, challenges, stresses and changes for the approximately 180 local specialists and family doctors. This study examines the initial impacts of the NMP on doctors practising in its host community. METHODS Qualitative interview methods were used. A purposive sample was drawn from: (i) doctors who had involvement with the NMP, and (ii) doctors who were not involved with the NMP. Data were collected from May to September 2007 using a semi-structured interview guide. Interviews were audiotaped, transcribed and checked by participants. Analysis involved identifying, coding and categorising key emergent themes until saturation. RESULTS Prior to the implementation of the NMP, doctors in Prince George had formed cohesive networks, in the face of adverse conditions, that functioned effectively as a form of social capital. The introduction of new doctors and resources through the NMP disrupted this sense of community cohesiveness. Over time, however, the NMP has created new mechanisms by which doctors interact and develop partnerships. DISCUSSION The study confirms the value of a social capital framework for understanding a medical community's adaptation to change. At this early point, it appears the NMP has created new mechanisms by which doctors can interact and develop the partnerships and relationships necessary to renew a sense of community cohesion.

A hoverboard is a battery-powered, hands-free, self-balancing two-wheeled vehicle similar to a skateboard, capable of travelling up to 20 km/hour. We conducted a search of narratives within the eCHIRPP database for hoverboard-related injuries on July 7, 2016. Reported events were searched for in the injury event description field using the phrases “hover” and “self” + “balanc” + “scooter”. For completeness, additional terms were also considered (e.g. “swagway”, “segway”, “planche de hover” and “hover planche”). We conducted manual resolution to ensure accuracy and precision of identified events. Results The first hoverboard-related injury reported through eCHIRPP was in October 2015. As of July 7, 2016, 35 cases have been recorded in eCHIRPP (Table 1). Cases were equally distributed among males and females. The average age at injury was 12.7 years (SD 5.0). Most of the injuries (N = 20) resulted in a fracture involving the upper arm, elbow, forearm or wrist (Table 2). Of the 35 reported cases, 19 required treatment in the emergency department and further follow-up. The majority of the injuries occurred indoors (N = 23) and in December and January. Language: fr

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Injury in Review, 2012 Edition: Spotlight on Road and Transport Safety, the first national public health report of its kind, synthesizes road- and transport-related injury statistics from a variety of sources. It profiles injury patterns among Canadians aged up to 24 years, explains risks and protective factors, and makes recommendations for action. The findings inform the development of targeted injury prevention efforts. Language: en

Le rapport Étude sur les blessures, édition 2012 : Pleins feux sur la sécurité routière et dans les transports, le premier rapport de santé publique à l'échelle nationale en la matière, présente une synthèse des statistiques provenant de diverses sources sur les blessures survenues dans les réseaux routiers et de transport. Il établit le profil des blessures chez les Canadiens et les Canadiennes âgés de 24 ans et moins, explique les risques et les facteurs de protection et formule des recommandations sur les mesures à prendre. Les conclusions servent à guider l'élaboration de programmes ciblés de prévention des blessures.