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Objective To evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm. Methods 2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases. Results Ninety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ2 = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ2 = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ2 = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ2 = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ2 = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm. Conclusions Among Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.

In the early nineteenth century London society had the opportunity to view large panoramas of the Australasian settlements of Sydney (1828–30), Hobart Town (1831), and the Bay of Islands, N...

In the 1820s British society had the opportunity to experience life in Sydney, New South Wales through the publication of a panorama of the military officer, Major James Taylor (1785–1829). The 1823 aquatints of his watercolours presented views of Sydney from the military area on the present-day Observation Hill. As well as communicating Governor Lachlan Macquarie’s progressive vision for a colony that was advancing beyond its status as a penal settlement, it presented its audience with narratives of life in Sydney. Taylor’s panorama survives through four preparatory watercolours and the three elegant aquatints. This publication drew sufficient interest to prompt subsequent editions in France and Britain. By the early twentieth century the work was valued in Australia as a record of the fabric of colonial Sydney, with later researchers discussing Taylor’s representation of various participants’ roles in the fledgling settlement. Analysis of Taylor’s study and its publication in Europe provides further insight into his composition and its reception, as well as furthering our understanding of life in New South Wales at that time.

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Background Suicide is the second leading cause of death among Canadian adolescents. Youth who make near fatal suicide attempts, such as those requiring intensive care unit (ICU) level care, are the closest proxy to those that die by suicide; however, there is limited data on this group. Objectives To evaluate the minimum incidence rate and patterns of presentation of youth (under 18 years of age) admitted to the ICU for medically serious self-inflicted injury. Design/Methods From January 2017 to December 2018, over 2,700 paediatricians/subspecialist members of the Canadian Paediatric Surveillance Program were electronically surveyed on a monthly basis regarding cases of medically serious self-harm. Participants completed a detailed questionnaire about the reported case and descriptive statistics were used for analyses. Results Ninety-four cases (71 female; mean age 15.2 years) of confirmed (n=87) and suspected/probable (n=7) medically serious self-harm were reported. The majority (87%) of cases were reported from 4 out of 13 provinces and territories in Canada (Alberta, British Columbia, Ontario, Quebec). There were 11 deaths by suicide (M>F; p Conclusion These Canadian findings are consistent with international epidemiologic data that observe a gender paradox of higher rates of suicide attempts in females and greater mental health care engagement but increased suicide mortality in males with decreased involvement with mental health care. This study suggests that family conflict is a potential target for suicide prevention interventions among youth. Future research focusing on gender-specificity in risk factor identification and effectiveness of primary prevention interventions among youth is warranted.

Research emphasizes the importance of asking about suicidality. Unfortunately, misperceptions of harm remain which can compromise clinical care, research, and public health surveillance efforts. Our objective was to evaluate the empirical evidence on whether and how asking about suicide related behaviors (SRB), such as suicidal ideation and suicide attempts, and non-suicidal self-injury (NSSI) results in harmful outcomes. We reviewed and rated seventeen studies and conducted a systematic review and random-effects meta-analysis on eight studies comparing those asked vs. not asked on immediate and later SRB, NSSI, and psychological distress (PD). Forest plots demonstrated no statistically significant effects of asking on SRB, NSSI, or PD. Eight RCTs provided the strongest evidence and demonstrated either low or unclear risk of bias, and the remaining cohort studies were of low to moderate quality. With the current available evidence, we found no harmful outcomes of asking, however more RCTs with a low risk of bias are required to firmly conclude that asking through self-report and interview methods does not further exacerbate distress, SRB and NSSI compared to those not asked.

Pomara in London, 1846 'The Spectator' declared it to be "the most interesting exhibition of the season." For three months in the London summer of 1846, George French Angas exhibited watercolours and artefacts of New Zealand and South Australia, providing many Europeans with their first detailed exposure to representations of Māori and their material culture. Exhibits of portraits of Māori, and images of pā, as well as examples of weapons, carvings, canoe models, birds and minerals caused many to reassess the disparaging view of Māori that the New Zealand Company had been putting about. However, the greatest contributor to the exhibition’s outstanding success was the striking presence of a young Māori man named Hemi Pomara, or Pōmare, who attended the show each afternoon. He was described as "the orphaned son of a Chatham Islands chief." In 1844 Pōmare travelled with Angas to Sydney, and then to London. Meeting royalty, members of the nobility and learned society, his intelligence and arresting countenance made an exceptional impression of those who met him. His likeness was published in a magazine and he became the subject of a poem. After the exhibition, things did not go so well. Following the exhibition Pōmare found work in shipping; however, the special status which he received in London did not continue. At sea, he was physically assaulted, returning to Sydney in 1847, and then on to New Zealand. This paper discusses Pōmare’s time abroad and his impact on the Europeans.

Drawing from his travels through Britain and Europe, and mindful of the work of other theorists and designers, Robert Pemberton proposed a model settlement based upon a new understanding of...

It has travelled to Australia and New Zealand, to the new and old settlements of America; in the cities of the States, of Mexico, of Brazil, in our own colonies in Canada, and elsewhere, the Classic column is a familiar object…

Background The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields. Methods We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender. Results A total of 2200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home. Conclusions The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.

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.

OBJECTIVES: To assess the performance of the Canadian Hospitals Injury Reporting and Prevention Program’s newly developed self-harm surveillance tool (CHIRPP-SI) designed to improve emergency department (ED) hospital surveillance of youth self-inflicted injury (SI). METHODS: This was a prospective, single-centre cohort study from February 2015 to September 2015. Eligible participants were aged 6–17.99 years and presented to the ED with a primary mental health complaint. The frequency of SI cases was extracted from three data sources (CHIRPP-SI, medical chart, and the National Ambulatory Care Reporting System Metadata (NACRS)). Cohen’s kappa statistic was used to examine the level of agreement between data sources. RESULTS: Of the 250 participants who received a medical chart review, 70 completed the CHIRPP-SI. Of those who did not complete the CHIRPP-SI, 86% (n = 154) reported no SI related to their presentation, 12% (n = 22) declined to participate without specifying self-injury status, and 2% (n = 4) were unable to be interviewed prior to discharge. The three sources of surveillance data varied considerably; the medical chart captured the highest frequency of individuals reporting SI related to their ED visit (33.6%), followed by the CHIRPP-SI (28.0%), and the NACRS database (8.4%). The CHIRPP-SI captured the method of SI and the place of occurrence in 100% of individuals, and the bodily location harmed in 98.6% of individuals. CONCLUSIONS: Study findings highlight the disparity between different sources of data, in relation to the capture of paediatric SI, presenting to hospital EDs. If greater details of SI events are to be identified, surveillance tools such as the CHIRPP-SI should be considered.

Objective:We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care.Method:This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated.Results:Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: ‘other’ injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, ‘undetermined’ injuries and poisonings in both sexes (aORs > 5), ‘unintentional’ poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days.Conclusions:The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern.

Introduction Cette étude a pour objet de décrire, à l’aide de données administratives canadiennes, les tendances et les caractéristiques des blessures auto-infligées entre 1979 et 2014-2015, afin d’orienter et d’améliorer les mesures de prévention du suicide. Méthodologie Les données sur la mortalité par suicide et sur les congés des patients ont été extraites des fonds de données de l’Agence de la santé publique du Canada (ASPC) provenant de la Base canadienne de données sur l’état civil – Décès (BCDEC-D) de Statistique Canada (1979 à 2012), du Système canadien d’information socioéconomique (CANSIM 2011, 2012), de la Base de données sur la morbidité hospitalière (BDMH, 1994- 1995 à 2010-2011) et de la Base de données sur les congés des patients (BDCP, 2011-2012 à 2014-2015). Le nombre de cas et les taux de décès et d’hospitalisation ont été répartis par sexe, tranche d’âge de 5 ans et méthode. Résultats Le taux de suicide au Canada (hommes et femmes confondus, tous âges, et taux normalisé selon l’âge et le sexe) a diminué, passant de 14,4/100 000 (n = 3 355) en 1979 à 10,4/100 000 (n = 3 926) en 2012, soit une variation annuelle en pourcentage (VAP) de –1,2 % (IC à 95 % : –1,3 à –1,0). Cependant, cette tendance n’a pas été observée chez les deux sexes : chez les femmes, les taux de suicide se sont stabilisés vers les années 1990, tandis que chez les hommes, ils ont continué de décliner au fil du temps – malgré le fait que les suicides chez les hommes constituent toujours 75,7 % de tous les suicides en 2012. La suffocation (pendaison et strangulation) était en 2012 la principale méthode de suicide (46,9 %) chez les Canadiens de tous âges, suivie de l’intoxication (23,3 %). Au cours de l’exercice 2014-2015, il y a eu 13 438 hospitalisations au Canada (à l’exclusion du Québec) associées à des blessures auto-infligées – ce qui représente plus de trois fois le nombre de suicides. Au fil du temps, les femmes ont systématiquement présenté des taux d’hospitalisation plus élevés pour des blessures auto-infligées que les hommes, soit 63 % du total. L’intoxication a été la méthode la plus fréquemment déclarée de préjudice autoinfligé au cours de l’exercice 2014-2015, constituant 86 % de toutes les hospitalisations. Conclusion Les suicides et les blessures auto-infligées demeurent un problème de santé publique grave – mais évitable – qui exige une surveillance constante.

Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population.This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification.Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons.Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.

Trends in rates of adolescent suicide and undetermined deaths in Canada from 1981 to 2012 were examined, focusing specifically on variations between Canadian regions. Exploratory hypotheses were formulated for regional variability in adolescent suicide rates over time in Canada.A descriptive time trend analysis using public domain vital statistics data was performed. All deaths from 1981 to 2012 among 15 to 19 year olds coded as suicides or undetermined intent according to the International Classification of Diseases, 9While there was an overall stability in adolescent suicide and undetermined death rates across Canada, regional analyses showed that Quebec experienced a 7.6% annual reduction between 2001 and 2012 while the Prairies and Atlantic provinces experienced significant annual increases since 2001. Ontario and British Columbia have had non-significant fluctuations since 2001. The trends remained similar overall when excluding undetermined deaths from the analyses.Variations in adolescent suicide trends across provinces were found. Factors such as provincial suicide action and prevention legislation contributing to these variations remain to be studied, but these regional differences point towards the need for better consistency of suicide prevention strategies across the country.Les tendances des taux de suicide adolescent et des décès indéterminés au Canada de 1981 à 2012 ont été examinées, en mettant spécialement l’accent sur les variations entre les régions canadiennes. Des hypothèses exploratoires ont été formulées pour la variabilité régionale des taux de suicide adolescent avec le temps au Canada.Une analyse descriptive de l’évolution dans le temps utilisant les données des statistiques vitales du domaine public a été menée. Tous les décès de 1981 à 2012 chez les 15 à 19 ans codés comme suicides ou de cause indéterminée selon la Classification internationale des maladies, 9Même s’il y avait une stabilité générale des taux de suicide adolescent et des décès indéterminés au Canada, les analyses régionales montraient que le Québec a connu une diminution annuelle de 7,6 % entre 2001 et 2012 alors que les Prairies et les provinces de l’Atlantique ont enregistré des hausses annuelles significatives depuis 2001. L’Ontario et la Colombie-Britannique ont eu des fluctuations non significatives depuis 2001. Les tendances sont demeurées semblables généralement en excluant les décès indéterminés des analyses.Des variations des tendances du suicide adolescent entre les provinces ont été constatées. Les facteurs contribuant à ces variations demeurent à étudier, comme les plans d’action et les mesures législatives provinciales de prévention du suicide. Ces différences régionales indiquent le besoin d’une meilleure cohésion des stratégies de prévention du suicide dans tout le pays.

Objective: To examine the impact of the Health Canada regulatory warnings regarding antidepressant (AD) prescribing on suicide rates in boys and girls under the age of 18 and aged 18 to 19 years in Canada between 2004 and 2009. We hypothesized that an increase in suicide rates would be specific to girls, reflecting higher AD prescribing rates in girls than boys. Method: We graphed and tested the difference between Canada-wide suicide rates before and after the regulatory warning periods (either from 1995 to 2006 or from 1995 to 2009) in boys and girls under the age of 18 or aged 18 to 19 years. For comparison with prior studies, we estimated rate ratios and 95% confidence intervals using either Poisson regression or negative binomial regression. Results: There was no statistically significant increase in suicide rates in girls under the age of 18, or aged 18 to 19 years in response to the AD regulatory warnings. In boys under the age of 18 or aged 18 to 19 years, suicide rates declined after 2003. Conclusions: We did not find increased rates of suicide after the AD regulatory warnings in boys or girls under the age of 18 or aged 18 to 19 years in Canada-wide rates. However, this does not rule out the possibility that such an effect occurred in some jurisdictions in girls and (or) the regulatory warnings prevented the trend toward declining suicide rates. Factors influencing the downward trend in boys merit further attention.

The purpose of this paper is to describe the trends and patterns of self-inflicted injuries, available from Canadian administrative data between 1979 and 2014/15, in order to inform and improve suicide prevention efforts.Suicide mortality and hospital separation data were retrieved from the Public Health Agency of Canada (PHAC) holdings of Statistics Canada's Canadian Vital Statistics: Death Database (CVS:D) (1979 to 2012); Canadian Socio-Economic Information Management System (CANSIM 2011, 2012); the Hospital Morbidity Database (HMDB) (1994/95 to 2010/11); and the Discharge Abstract Database (2011/12 to 2014/15). Mortality and hospitalization counts and rates were reported by sex, 5-year age groups and method.The Canadian suicide rate (males and females combined, all ages, age-sex standardized rate) has decreased from 14.4/100 000 (n = 3355) in 1979 to 10.4/100 000 (n = 3926) in 2012, with an annual percent change (APC) of -1.2% (95% CI: -1.3 to -1.0). However, this trend was not observed in both sexes: female suicide rates stabilized around 1990, while male rates continued declining over time-yet males still accounted for 75.7% of all suicides in 2012. Suffocation (hanging and strangulation) was the primary method of suicide (46.9%) among Canadians of all ages in 2012, followed by poisoning at 23.3%. In the 2014/15 fiscal year, there were 13 438 hospitalizations in Canada (excluding Quebec) associated with self-inflicted injuries-over 3 times the number of suicides. Over time females have displayed consistently higher rates of hospitalization for self-inflicted injury than males, with 63% of the total. Poisoning was reported as the most frequent means of self-inflicted harm in the fiscal year 2014/15, at 86% of all hospitalizations.Suicides and self-inflicted injuries continue to be a serious - but preventable - public health problem that requires ongoing surveillance.Cette étude a pour objet de décrire, à l’aide de données administratives canadiennes, les tendances et les caractéristiques des blessures auto-infligées entre 1979 et 2014-2015, afin d’orienter et d’améliorer les mesures de prévention du suicide.Le taux de suicide au Canada (hommes et femmes confondus, tous âges, et taux normalisé selon l’âge et le sexe) a diminué, passant de 14,4/100 000 (n = 3 355) en 1979 à 10,4/100 000 (n = 3 926) en 2012, soit une variation annuelle en pourcentage (VAP) de –1,2 % (IC à 95 % : –1,3 à –1,0). Cependant, cette tendance n’a pas été observée chez les deux sexes : chez les femmes, les taux de suicide se sont stabilisés vers les années 1990, tandis que chez les hommes, ils ont continué de décliner au fil du temps – malgré le fait que les suicides chez les hommes constituent toujours 75,7 % de tous les suicides en 2012. La suffocation (pendaison et strangulation) était en 2012 la principale méthode de suicide (46,9 %) chez les Canadiens de tous âges, suivie de l’intoxication (23,3 %).Au cours de l’exercice 2014-2015, il y a eu 13 438 hospitalisations au Canada (à l’exclusion du Québec) associées à des blessures auto-infligées – ce qui représente plus de trois fois le nombre de suicides. Au fil du temps, les femmes ont systématiquement présenté des taux d’hospitalisation plus élevés pour des blessures auto-infligées que les hommes, soit 63 % du total. L’intoxication a été la méthode la plus fréquemment déclarée de préjudice autoinfligé au cours de l’exercice 2014-2015, constituant 86 % de toutes les hospitalisations.Les suicides et les blessures auto-infligées demeurent un problème de santé publique grave – mais évitable – qui exige une surveillance constante.

Objective: The aim of this study is to compare Canadian suicide rates with other external causes of death to examine potential poisoning misclassifications as a contributor to suicide underreporting. Method: The study used Statistics Canada mortality data from 2000 to 2011 to calculate sex-and age-specific ratios by external cause of injury codes. Results: The overall Canadian suicide rate, as well as the poisoning suicide rate, declined over the study timeframe by an average annual percentage change (AAPC) of 1.0% each year. However, unintentional and undetermined poisonings increased significantly during the timeframe. Unintentional poisoning mortality (primarily narcotics and hallucinogens, including opioids) increased in proportion to suicides for both sexes, although females were consistently higher. The undetermined death to suicide ratio was higher and increasing for females. Poisonings of undetermined intent increased over time to comprise 47% to 80% of the undetermined death category for males and females combined. Conclusions: Canadian poisoning suicide rates declined, in contrast to rising unintentional and undetermined poisoning mortality rates. This trend is similar to that of the United States, supporting the hypothesis that misclassification of poisoning deaths may also be an issue in Canada.

Introduction Due to space constraints, bunk beds are a common sleeping arrangement in many homes. The height and design of the structure can present a fall and strangulation hazard, especially for young children. The primary purpose of this study was to describe bunk bed-related injuries reported to the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), 1990–2009. Methods CHIRPP is an injury and poisoning surveillance system operating in 11 pediatric and 4 general emergency departments across Canada. Records were extracted using CHIRPP product codes and narratives. Results Over the 20-year surveillance period, 6002 individuals presented to Canadian emergency departments for an injury associated with a bunk bed. Overall, the frequency of bunk bed-related injuries in CHIRPP has remained relatively stable with an average annual percent change of 21.2% (21.8% to 20.5%). Over 90% of upper bunk-related injuries were due to falls and children 3–5 years of age were most frequently injured (471.2/100 000 CHIRPP cases). Conclusion Children with bunk bed-related injuries continue to present to Canadian emergency departments, many with significant injuries. Injury prevention efforts should focus on children under 6 years of age.

In its various professional manifestations between 1946 and 1968, New Zealand's Group Architects sought to create an indigenous architecture: of New Zealand, suited to the needs of its people, and under a banner that “overseas solutions will not do.” Despite this pronouncement, from the 1950s commentators have cited Japanese, Scandinavian and American influence on the Group's output. In the late 1970s one of the early Group members, Allan Wild, belatedly acknowledged the impact of the Californian architect, Gordon Drake, and two decades later he extended his list to include leading world architects of the twentieth century and others from Scandinavia and California. These influences have recently been discussed, notably in the extensive study of the Group where Julia Gatley, Bill McKay and Andrew Barrie, in particular, have challenged a once taken-for-granted argument for a truly local architecture. This paper continues this investigation, focussing in particular on claims for an indigenous New Zealand bu...

In 1861 Scott designed an innovative hybrid for Christchurch Cathedral, New Zealand, combining a stone exterior with an independent wooden interior, at once expression of the primitive ruggedness of what he imagined to be the Maori wood tradition and an experimental response for this earthquake-prone colony.Commissioning George Gilbert Scott (1811-78) to design a cathedral for the relatively new settlement at Christchurch, in the province of Canterbury, New Zealand, was an ambitious undertaking by a predominantly Anglican community that had been established only eleven years earlier. The cathedral, which was constructed between late 1864 and 1904, was a conventional stone building, designed by Scott and executed locally by B. W. Mountfort. However, in an unusually experimental move, Scott had earlier proposed a structure that incorporated a stone exterior with an interior frame made of a series of high piers of New Zealand native timber, each almost 50 feet tall. The dramatic interior of this proposal referenced a wide variety of timber- and church-building traditions; had it been constructed, its tall wooden structure would have been ‘unique amongst colonial cathedrals’. After examining previously discussed sources for his design, this paper speculates upon further influences, testing — in particular — Barry Bergdoll’s assertion that the design was an expression of the ‘primitive ruggedness’ that Scott imagined derived from Maori work in wood, examples of which had been known in Europe since the 1770s.

Appreciation of seismicity is fundamental to New Zealand's architectural development. Reports of the earthquakes of 1848 and 1855, in particular, help determine how this condition shaped the colony's architectural development. Despite initial official reluctance to acknowledge this hazard, reports of the disasters spread. The superior performance of wooden buildings under seismic loading meant that, by the late 1850s, timber was becoming understood internationally as the prudent building material choice in New Zealand. Although early colonists' ideas regarding the design of their settlements shifted, few connected seismic condition with wider contemporary aesthetic argument. Despite the prevalence of earthquakes, and because of the threat of fire, desire for substantial masonry buildings remained. This encouraged the colony's architects and engineers to develop boldly innovative technical solutions. These innovations, which sometimes drew upon work abroad, foreshadowed ground-breaking research and practice by the country's leading seismic designers and specialists in the 20th century.

Supporting their argument for a distinctive pragmatic tradition, post-war writers on architecture in New Zealand have frequently cited a photograph of a man sitting alone on the verandah of a hut. This image of H. P. Knutzen at the timber milling settlement of Piha near Auckland (c. 1916) is referred to as the 'man alone image' and has come to represent an architectural origin. Comparing the circumstances of this photograph and the history of its subject with the interpretations of the last half-century highlights writers' mythmaking. It reveals a modernist, nationalist, masculine, individualistic agenda that gives authority to a modest timber tradition and serves to legitimate the Pakeha (the New Zealand European) as settler in the new land.

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic, neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses (including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain (through substance use and help-seeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s) (e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth. Language: en

(1999). The Cringe Commences: Nineteenth Century Reviews of Pakeha Architecture. Fabrications: Vol. 9, No. 1, pp. 68-80.

Objective: To determine whether emergency department (ED) presentations for suicide-related behaviours (SRBs) in boys and girls were identified as more clinically acute in the ED in the period after the regulatory warnings against prescribing antidepressants and during the global economic recession, and to characterize the medical severity of SRBs among boys and girls to aid surveillance activities. Method: Among Ontario boys and girls (aged 12 to 17 years) presenting to the ED with an incident (index) ED SRB event between fiscal years (FYs) 2002 to 2010, we compared the number of high (compared with lower) acuity events in FYs 2005 to 2010 to those in FYs 2002 to 2004. We described the SRB method by its acuity and tested the linearity of varying trends in the SRB method in boys and girls. Results: In both boys and girls, high acuity events were 50% greater after FY 2004 than before, regardless of subsequent admission, and most common among boys and girls who self-poisoned. In girls, opposing linear trends before and after FY 2004 were observed in the proportion of self-poisonings and cut (or) pierce SRB methods. Throughout the study period, there was a linear decline in the proportion of boys presenting to the ED with other methods. Conclusions: The previously reported increase in hospital admissions after the warnings and during the recession is unlikely artifactual. An equivalent increase in high acuity events was also evident among those not subsequently admitted. The reasons for varying responses in boys and girls by SRB method warrant further study.

We explore sets of measures by which Canada could achieve CO 2 emission reductions of 50% or 75%. Full implementation of cost-effective efficiency measures, combined with substantial fuel switching from coal and oil to natural gas (NG), will only slightly reduce Canadian CO 2 emissions in 2020 compared to 1991, given the high growth in energy-intensive industries assumed in the reference scenario. To achieve a 50% emission reduction requires more fundamental changes involving, for example, constant economic output from energy-intensive industries (with compensating increases elsewhere in the economy), limiting the increase in total distance travelled by light vehicles, displacement of 30–80% (depending on the region) of the remaining fossil-fuel-generated electricity with electricity derived from renewable energy, and use of hydrogen (H 2 ) derived from renewable energy in selected niche markets. The 75% emission-reduction target will require greater use of H 2 , but replacement of direct use of NG in commercial and residetial buildings with H 2 would not be required if other measures are implemented to the extent assumed here.

Background: Suicide is the second leading cause of death for young Canadians (10–19 years of age) — a disturbing trend that has shown little improvement in recent years. Our objective was to examine suicide trends among Canadian children and adolescents. Methods: We conducted a retrospective analysis of standardized suicide rates using Statistics Canada mortality data for the period spanning from 1980 to 2008. We analyzed the data by sex and by suicide method over time for two age groups: 10–14 year olds (children) and 15–19 year olds (adolescents). We quantified annual trends by calculating the average annual percent change (AAPC). Results: We found an average annual decrease of 1.0% (95% confidence interval [CI] −1.5 to −0.4) in the suicide rate for children and adolescents, but stratification by age and sex showed significant variation. We saw an increase in suicide by suffocation among female children (AAPC = 8.1%, 95% CI 6.0 to 10.4) and adolescents (AAPC = 8.0%, 95% CI 6.2 to 9.8). In addition, we noted a decrease in suicides involving poisoning and firearms during the study period. Interpretation: Our results show that suicide rates in Canada are increasing among female children and adolescents and decreasing among male children and adolescents. Limiting access to lethal means has some potential to mitigate risk. However, suffocation, which has become the predominant method for committing suicide for these age groups, is not amenable to this type of primary prevention.

The objective of the present research was to compare the severity of playground-related injuries in backyards of home with those occurring in public settings. This case–control study used emergency-based surveillance data from Canada regarding children, 3–11 years old, who were injured after falling from playground equipment (PGE). Cases were those whose injuries occurred at home (backyards), and controls were those whose injuries occurred in parks, schools or daycare centres. Of the 39 730 subjects selected, 84% happened in public and 16% at home. Children falling from a home PGE had greater odds of severe injuries (OR=1.30; 95% CI 1.23 to 1.37) and fractures (OR=1.47; 95% CI 1.39 to 1.55) than those from public PGE. Children aged 3–5 years falling off slides at home, compared to slides in public settings, had the greatest odds of severe injuries (OR=1.72; 95% CI 1.41 to 2.09) and fractures (OR=2.17; 95% CI 1.79 to 2.64.) When setting up PGE at home, parents should be diligent in using proper landing surfaces, such as those found in public playgrounds.

A critical review of the book 'Whare Karakia: Maori Church Building, Decoration and Ritual in Aotearoa New Zealand 1834-1863' by Richard Sundt. Review(s) of: Whare Karakia: Maori Church Building, Decoration and Ritual in Aotearoa New Zealand 1834-1863, by Richard Sundt, Auckland University Press, Auckland, 2010 xiii, 225 pp. ISBN 9781869404567.

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.

Introduction Safe design and use of cribs is fundamental to infant safety. Because international coding (ICD) does not specify crib-related injuries, few surveillance systems provide data to study these injuries. Methods The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) collects information on injuries treated in the emergency departments of 11 paediatric and 3 general hospitals. Its database was used to study crib-related injuries to children under 5 years of age, 1990–2007. Results 3201 cases were identified. The proportion of crib cases among all CHIRPP injuries remained relatively constant over time. The median age was 16 months (IQR, 1023 months). The male to female ratio was 1.2:1. Falls out of cribs accounted for 75% of injuries followed by body part entrapment (7.2%), accessing hazardous objects (2.3%) and crib malfunction ( Discussion Although Canada introduced product standards for cribs before 1990 (updates pending), crib-related injuries continue to occur. Injuries could be reduced through review/enforcement of standards, and, vigilance by parents regarding: correct installation and maintenance of approved cribs, minimising bedding and removing extra objects, removing hazards around the crib, and, discontinuing use when a child can climb out.