Low back pain may be having a significant impact on emergency departments around the world. Research suggests low back pain is one of the leading causes of emergency department visits. However, in ...the peer-reviewed literature, there has been limited focus on the prevalence and management of back pain in the emergency department setting. The aim of the systematic review was to synthesize evidence about the prevalence of low back pain in emergency settings and explore the impact of study characteristics including type of emergency setting and how the study defined low back pain.
Studies were identified from PubMed and EMBASE, grey literature search, and other sources. We selected studies that presented prevalence data for adults presenting to an emergency setting with low back pain. Critical appraisal was conducted using a modified tool developed to assess prevalence studies. Meta-analyses and a meta-regression explored the influence of study-level characteristics on prevalence.
We screened 1187 citations and included 21 studies, reported between 2000 and 2016 presenting prevalence data from 12 countries. The pooled prevalence estimate from studies of standard emergency settings was 4.39% (95% CI: 3.67-5.18). Prevalence estimates of the included studies ranged from 0.9% to 17.1% and varied with study definition of low back pain and the type of emergency setting. The overall quality of the evidence was judged to be moderate as there was limited generalizability and high heterogeneity in the results.
This is the first systematic review to examine the prevalence of low back pain in emergency settings. Our results indicate that low back pain is consistently a top presenting complaint and that the prevalence of low back pain varies with definition of low back pain and emergency setting. Clinicians and policy decisions makers should be aware of the potential impact of low back pain in their emergency settings.
In order to address the opioid crisis in North America, many regions have adopted preventative strategies, such as prescription drug monitoring programs (PDMPs). PDMPs aim to increase patient safety ...by certifying that opioids are prescribed in appropriate quantities. We aimed to synthesize the literature on changes in opioid-related harms and consequences, an important measure of PDMP effectiveness.
We completed a systematic review. We conducted a narrative synthesis of opioid-related harms and consequences from PDMP implementation. Outcomes were grouped into categories by theme: opioid dependence, opioid-related care outcomes, opioid-related adverse events, and opioid-related legal and crime outcomes.
We included a total of 22 studies (49 PDMPs) in our review. Two studies reported on illicit and problematic use but found no significant associations with PDMP status. Eight studies examined the association between PDMP status and opioid-related care outcomes, of which two found that treatment admissions for prescriptions opioids were lower in states with PDMP programs (p < 0.05). Of the thirteen studies that reported on opioid-related adverse events, two found significant (p < 0.001 and p < 0.05) but conflicting results with one finding a decrease in opioid-related overdose deaths after PDMP implementation and the other an increase. Lastly, two studies found no statistically significant association between PDMP status and opioid-related legal and crime outcomes (crime rates, identification of potential dealers, and diversion).
Our study found limited evidence to support overall associations between PDMPs and reductions in opioid-related consequences. However, this should not detract from the value of PDMPs' larger role of improving opioid prescribing.
While low back pain is a common presenting complaint in the emergency department, current estimates from Canada are limited. Furthermore, existing estimates do not clearly define low back pain. As ...such, our main objective was to estimate prevalence rates of low back pain in a large Nova Scotian emergency department using various definitions, and to describe characteristics of individuals included in these groups. An additional objective was to explore trends in low back pain prevalence in our emergency department over time.
We conducted a cross sectional analysis using six years of administrative data from our local emergency setting. We first calculated the prevalence and patient characteristics for individuals presenting with any complaint of back pain, and for groups diagnosed with different types of low back pain. We explored prevalence over time by analyzing presentation trends by month, day of the week and hour of the day.
The prevalence of patients presenting to the emergency department with a complaint of back pain was 3.17%. Individuals diagnosed with non-specific/mechanical low back pain with no potential nerve root involvement made up 60.8% of all back pain presentations. Persons diagnosed with non-specific/mechanical low back pain with potential nerve root involvement made up 6.7% of presentation and the low back pain attributed to secondary factors accounted for 9.9% of back pain presentations. We found a linear increase in presentations for low back pain over the study period.
This is the first multi-year analysis assessing the prevalence of low back pain in a Canadian emergency department. Back pain is a common presenting complaint in our local emergency department, with most of these persons receiving a diagnosis of non-specific/mechanical low back pain with no potential nerve root involvement. Future research should concentrate on understanding the management of low back pain in this setting, to ensure this is the proper setting to manage this common condition.
Athletes participating in contact sports such as ice hockey are exposed to a high risk of suffering a concussion. We determined whether recent rule changes regulating contact to the head introduced ...in 2010-11 and 2011-12 have been effective in reducing the incidence of concussion in the National Hockey League (NHL). A league with a longstanding ban on hits contacting the head, the Ontario Hockey League (OHL), was also studied. A retrospective study of NHL and OHL games for the 2009-10 to 2011-12 seasons was performed using official game records and team injury reports in addition to other media sources. Concussion incidence over the 3 seasons analyzed was 5.23 per 100 NHL regular season games and 5.05 per 100 OHL regular season games (IRR 1.04; 95% CI 1.01, 1.50). When injuries described as concussion-like or suspicious of concussion were included, incidences rose to 8.8 and 7.1 per 100 games respectively (IRR 1.23; 95% CI 0.81, 1.32). The number of NHL concussions or suspected concussions was lower in 2009-10 than in 2010-11 (IRR 0.61; 95% CI 0.45, 0.83), but did not increase from 2010-11 to 2011-12 (IRR 1.05; 95% CI 0.80, 1.38). 64.2% of NHL concussions were caused by bodychecking, and only 28.4% of concussions and 36.8% of suspected concussions were caused by illegal incidents. We conclude that rules regulating bodychecking to the head did not reduce the number of players suffering concussions during NHL regular season play and that further changes or stricter enforcement of existing rules may be required to minimize the risk of players suffering these injuries.
Education is a crucial social determinant of health. Food insecurity can be detrimental to children's academic achievement, potentially perpetuating a cycle of poverty and food insecurity. We aimed ...to assess the relationship between food insecurity and academic achievement in Canadian school-aged children.
Cross-sectional study of children and parents. Parents completed the short-form Household Food Security Survey Module and questions about income and education level (socio-economic status). Children completed FFQ. Data were prospectively linked to children's performance on standardized exams written one year later. Mixed-effect logistic regression was employed to assess the relationship between food insecurity and likelihood of meeting academic expectations adjusting for socio-economic status, diet quality and potential confounders.
Nova Scotia, Canada in 2011-2012.
Students (n 4105) in grade 5 (10-11 years; 2167 girls) and their parents.
Low food security was reported by 9·8 % of households; very low food security by 7·1 % of households. Students from low-income households and reporting poor diet quality were less likely to do well in school. Children who lived in households reporting very low food security had 0·65 times the odds (OR=0·65; 95 % CI 0·44, 0·96) of meeting expectations for reading and 0·62 times the odds (OR=0·62; 95 % CI 0·45, 0·86) of meeting expectations for mathematics.
Very low household insecurity is associated with poor academic achievement among children in Nova Scotia.
Few studies have investigated the independent associations of lifestyle behaviors (diet, physical activity, sleep, and screen time) and body weight status with academic achievement. Even fewer have ...investigated the combined effect of these behaviors on academic achievement. We hypothesize that the combined effect of these behaviors will have a higher impact on academic achievement than any behavior alone, or that of body weight status.
In 2011, 4253 grade 5 (10-11 years old) students and their parents were surveyed about the child's diet, physical activity, screen time and sleep. Students' heights and weights were measured by research assistants. Academic achievement was measured using provincial standardized exams in mathematics, reading and writing, and was expressed as 'meeting' or 'not meeting' expectations as per standardized criterion. Exams were written 1 year following the measurement of lifestyle behaviors. Lifestyle behaviors were measured with self- and parental proxy reports and expressed as meeting recommendations (yes/no) for each behavior. Mixed effects logistic regression models adjusting for demographic confounders and caloric intake were used to determine the independent and combined associations.
Meeting dietary recommendations was associated with increased likelihood of meeting academic expectations for each of math, reading and writing. Meeting recommendations for screen time and sleep was associated with meeting expectations for writing. For all three subjects, meeting additional lifestyle behavior recommendations was associated with higher likelihood of meeting expectations. Children who met 7-9 lifestyle behavior recommendations had greater than three-times the odds of meeting expectations for reading compared to those who met 0-3 recommendations (OR: 3.07, 95% CI: 2.09, 4.51), and 1.47 and 2.77 times the odds of meeting expectations in mathematics and writing, respectively. Body weight status was not associated with academic achievement.
We found that lifestyle behaviors, not body weight status, are strongly associated with student academic performance. Promoting compliance with established healthy lifestyle recommendations could improve both the health and educational outcomes of school-aged children. School-based health promotion initiatives that target multiple lifestyle behaviors may have a greater effect on academic achievement than those that focus on a single behavior.
We described public views toward harm reduction among Canadian adults and tested a social exposure model predicting support for these contentious services, drawing on theories in the morality policy, ...intergroup relations, addiction, and media communication literatures. A quota sample of 4645 adults (18+ years), randomly drawn from an online research panel and stratified to match age and sex distributions of adults within and across Canadian provinces, was recruited in June 2018. Participants completed survey items assessing support for harm reduction for people who use drugs (PWUD) and for seven harm reduction interventions. Additional items assessed exposure to media coverage on harm reduction, and scales assessing stigma toward PWUD (α = .72), personal familiarity with PWUD (α = .84), and disease model beliefs about addiction (α = .79). Most (64%) Canadians supported harm reduction (provincial estimates = 60% - 73%). Five of seven interventions received majority support, including: outreach (79%), naloxone (72%), drug checking (70%), needle distribution (60%) and supervised drug consumption (55%). Low-threshold opioid agonist treatment and safe inhalation interventions received less support (49% and 44%). Our social exposure model, adjusted for respondent sex, household income, political views, and education, exhibited good fit and accounted for 17% of variance in public support for harm reduction. Personal familiarity with PWUD and disease model beliefs about addiction were directly associated with support (βs = .07 and -0.10, respectively), and indirectly influenced public support via stigmatized attitudes toward PWUD (βs = 0.01 and -0.01, respectively). Strategies to increase support for harm reduction could problematize certain disease model beliefs (e.g., "There are only two possibilities for an alcoholic or drug addict-permanent abstinence or death") and creating opportunities to reduce social distance between PWUD, the public, and policy makers.
Diet Quality and Academic Performance Florence, Michelle D.; Asbridge, Mark; Veugelers, Paul J.
The Journal of school health,
April 2008, Letnik:
78, Številka:
4
Journal Article
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ABSTRACT
Background: Although the effects of nutrition on health and school performance are often cited, few research studies have examined the effect of diet quality on the academic performance of ...children. This study examines the association between overall diet quality and academic performance.
Methods: In 2003, 5200 grade 5 students in Nova Scotia, Canada, and their parents were surveyed as part of the Children’s Lifestyle and School‐performance Study. Information on dietary intake, height, and weight and sociodemographic variables were linked to results of a provincial standardized literacy assessment. Diet Quality Index—International was used to summarize overall diet quality. Multilevel regression methods were used to examine the association between indicators of diet quality and academic performance while adjusting for gender and socioeconomic characteristics of parents and residential neighborhoods.
Results: Across various indicators of diet quality, an association with academic performance was observed. Students with decreased overall diet quality were significantly more likely to perform poorly on the assessment. Girls performed better than boys as did children from socioeconomically advantaged families. Children attending better schools and living in wealthy neighborhoods also performed better.
Conclusions: These findings demonstrate an association between diet quality and academic performance and identify specific dietary factors that contribute to this association. Additionally, this research supports the broader implementation and investment in effective school nutrition programs that have the potential to improve student access to healthy food choices, diet quality, academic performance, and, over the long term, health.
The mode of medical cannabis delivery-whether cannabis is smoked, vapourized, or consumed orally-may have important implications for its therapeutic efficacy and health risks. However, there is very ...little evidence on current patterns of use among Canadian medical cannabis users, particularly with respect to modes of delivery. The current study examined modes of medical cannabis delivery following regulatory changes in 2014 governing how Canadians access medical cannabis.
A total of 364 approved adult Canadian medical cannabis users completed an online cross-sectional survey between April and June 2015. The survey examined patterns of medical cannabis use, modes of delivery used, and reasons for use. Participants were recruited through a convenience sample from nine Health Canada licensed producers.
Using a vapourizer was the most popular mode of delivery for medical cannabis (53 %), followed by smoking a joint (47 %). The main reason for using a vapourizer was to reduce negative health consequences associated with smoking. A majority of current vapourizer users reported using a portable vapourizer (67.2 %), followed by a stationary vapourizer (41.7 %), and an e-cigarette or vape pen (19.3 %). Current use of a vapourizer was associated with fewer respiratory symptoms (AOR = 1.28, 95 % CI 1.05-1.56, p = 0.01).
The findings suggest an increase in the popularity of vapourizers as the primary mode of delivery among approved medical users. Using vapourizers has the potential to prevent some of the adverse respiratory health consequences associated with smoking and may serve as an effective harm reduction method. Monitoring implications of such current and future changes to medical cannabis regulations may be beneficial to policymakers.
Early evidence from some of those jurisdictions shows significant increases in the presence of cannabis in injured drivers as well as in non-crash-involved drivers following the legalization of ...recreational cannabis use6,7; however, not all studies have observed significant changes in rates of driving after cannabis use or related activities following legalization.8,9 THE COINVOLVEMENT OF CANNABIS AND ALCOHOL Second, the work of Lira et al. points to the concerning interplay between the presence of cannabis and alcohol in fatal crashes, where cannabis was strongly associated with alcohol coinvolvement across differing blood alcohol concentration (BAG) levels (0.01 %-0.049%; 0.05% to 0.079%; and 0.08% and higher). ...population surveys, roadside surveys, and hospital and coroner data have noted substantial declines in drinking and driving behaviors, particularly among drivers aged younger than 25years, as well as the observation that rates of driving under the influence of alcohol have dropped below rates for driving after using cannabis in certain populations.11,12 More importantly, this work speaks to the potential interaction of alcohol and cannabis and how concurrent use of cannabis and alcohol affect driving performance, crash risk, and road safety. Cannabis is typically associated with poorer reaction time, lane violations, and slower driving speeds, while alcohol is associated with increased speed and more reckless driving actions.13 The level of impairment when alcohol and cannabis are combined is also questioned: some studies suggest the effect is multiplicative, whereby the combined effect is stronger than what would be expected from simply adding the effect of cannabis and alcohol to crash risk, while others suggest the effect is additive14; there is also some evidence that lowerdose-tetrahydrocannabinol (THC) cannabis might mitigate select dangerous driving actions associated with alcohol such as speeding.15 Despite this heterogeneity, the consistent observation is that the combined use of cannabis and alcohol imposes greater deficits on driving performance and an increased crash risk relative to the use of either substance alone.14 IMPLICATIONS ON POLICY, PRACTICE, AND RESEARCH As articulated by Lira et al., further research is warranted to better understand how differing levels of cannabis consumption, as well as distinct kinds of cannabinoids, interact with alcohol consumption to affect driving ability and road safety. ...primary research must be coupled with continuing policy development and evaluation to maximize road safety efforts.
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