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Background Pedestrian related deaths have recently been on the rise in Canada. The effect of changing posted speeds on the frequency and severity of pedestrian motor vehicle collisions (PMVC) is not well studied using controlled quasi-experimental designs. The objective of this study was to examine the effect of lowering speed limits from 40 km/h to 30 km/h on PMVC on local roads in Toronto, Canada. Methods A 30 km/h speed limit on local roads in Toronto was implemented between January 2015 and December 2016. Streets that remained at a 40 km/h speed limit throughout the study period were selected as comparators. A quasi-experimental, pre-post study with a comparator group was used to evaluate the effect of the intervention on PMVC rates before and after the speed limit change using repeated measures Poisson regression. PMVC data were obtained from police reports for a minimum of two years pre- and post-intervention (2013 to 2018). Results Speed limit reductions from 40 km/h to 30 km/h were associated with a 28% decrease in the PMVC incidence rate in the City of Toronto (IRR = 0.72, 95% CI: 0.58–0.89). A non-significant 7% decrease in PMVC incidence rates were observed on comparator streets that remained at 40 km/h speed limits (IRR = 0.93, 95% CI: 0.70–1.25). Speed limit reduction also influenced injury severity, with a significant 67% decrease in major and fatal injuries in the post intervention period on streets with speed limit reductions (IRR = 0.33, 95% CI: 0.13–0.85) compared with a 31% not statistically significant decrease in major and fatal injuries on comparator streets (IRR = 0.69, 95% CI: 0.37–1.31). The interaction term for group and pre-post comparisons was not statistically significant ( p  = 0.14) indicating that there was no evidence to suggest a pre-post difference in IRRs between the intervention and comparator streets. Conclusions Declines in the rate of PMVC were observed on roads with posted speed limit reductions from 40 km/h to 30 km/h, although this effect was not statistically greater than reductions on comparator streets.

Introduction Several systematic and scoping reviews have focused on the impact of patient and public involvement (PPI) in child health research. The aim of this research was to examine the data sources and analytic approaches used by researchers to evaluate the impact of PPI in child health research. Methods A comprehensive literature search identified published reviews focused on PPI impact in child health research. Titles, s, and full texts were screened to determine eligibility. Individual studies from eligible reviews created the sampling frame, from which 100 individual studies were randomly selected. Information was extracted on primary study characteristics, type of PPI, data sources and analytic approaches used to evaluate PPI impact, and reported PPI impact. Frequency distributions were used to summarise the findings. Results The initial search yielded 5868 citations. After screening, 15 reviews (comprising 406 individual studies, of which 303 were unique) met inclusion criteria. Among the 100 randomly selected individual studies, PPI was reported across all phases of the research process including priority setting (30/100), input on study materials (50/100), and dissemination of study findings (52/100). The method of PPI was most commonly focus groups (29/100) or advisory committees (27/100). Of the 100 studies selected, 67/100 reported impact on the research process, 69/100 reported impact on patients and families, and 32/100 studies reported impact on researchers. Regarding the data sources used to evaluate PPI impact, 69/100 studies reviewed primary study field notes along with researcher observations and reflections, while 31/100 studies conducted independent, specific, focus groups and/or interviews and/or surveys to gather data. Regarding the analytic approaches used to evaluate PPI impact, formal qualitative and/or quantitative analyses of the data occurred in only 25/100 studies. Only 2/100 studies used a formal PPI reporting guideline. Conclusion Only 31/100 studies collected specific, independent data on the impact of PPI in child health research, and only 25/100 studies applied formal analyses. Robust evaluation of PPI impact in child health research is essential for a strong PPI evidence base. Patient or Public Contribution A patient partner (co‐author, FB) was a member of the research team from study inception, and contributed to the development of the study protocol, including refining the research question, input on study design, selection of relevant outcomes, interpretation of findings, writing the manuscript, and developing dissemination plans.

The Infant Toddler Checklist (ITC) may be promising as a single tool at the 18-month visit to detect a range of developmental concerns. We examined the predictive validity of the ITC; and the association between positive ITC screening and health care utilization (HCU). Prospective cohort study of children at average-risk for developmental delay attending their 18-month visit in primary care in Toronto, Canada. Parents completed the ITC. HCU from the single-payer provincial health system was collected from health administrative databases ensuring complete follow-up. Physician billing code for a neurodevelopmental consultation was the primary outcome and criterion measure. Six other HCU types were assessed. Of 1460 children with a mean age at screening of 18 months, 11% screened ITC positive. Mean age at follow-up was 8 years, 2.6% had a neurodevelopmental consultation. Screening test properties (with neurodevelopmental consultation as the criterion measure): 40% sensitivity (95% CI 24%, 57%), 90% specificity (95% CI 88%, 91%), 10% false positive rate (95% CI 9%, 12%). Using multivariable negative binomial regression, a positive ITC was associated with higher rates of 6 of 7 HCU types, including neurodevelopmental consultation (aRR 2.78, 95% CI 1.37, 5.67, p = 0.005). The ITC had high specificity and a low false positive rate, suggesting that most children with a negative ITC will not have a later neurodevelopmental consultation, and use of the tool may minimize unintended harms such as anxiety and resource use. The low sensitivity highlights the importance of ongoing developmental surveillance. Low sensitivity of other screening tools is discussed.

Children and families are increasingly involved as equal partners in child health research, however, considerations around authorship have received little attention and there is limited guidance on the topic. Our objective was to determine the frequency and nature of patient partner authorship and/or acknowledgment among articles focused on patient engagement in child health research. In this umbrella review, we searched MEDLINE, Embase, APA PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, and Web of Science for systematic/scoping reviews on patient engagement in child health research. Individual articles included in eligible reviews comprised the sample of articles for analysis and were examined to identify patient partner authorship. Descriptive statistics were used to quantify patient partner authorship and/or acknowledgment and to summarize article characteristics. Twelve systematic/scoping reviews met eligibility criteria, from which 230 individual articles were examined. In 16/230 (7%) articles, there was at least one patient partner author, and in 6/230 (3%) articles, patient partners were included as group authors. Within article Acknowledgments sections, patient partners were acknowledged by name in 41/230 (18%) articles, and anonymously or as a group in 98/230 (43%) articles. Patient partner authorship and/or acknowledgment was more frequent among articles published more recently (after 2015) and among articles where patient engagement was explicitly reported in the article. Patient partners were more likely to be acknowledged than listed as an author on articles on patient engagement in child health research. Understanding patient partner preferences about authorship and acknowledgment, examination of the unique aspects of child and youth authorship and developing supports to empower patient partner authorship are needed.

Aim  The aim of this study was to develop a tool to identify paediatric hypertonia subtypes. Method  Items generated by experts were subscaled (spasticity, dystonia, rigidity). The tool was administered to 34 children (19 males, 15 females, mean age 8y 2mo, range 2y 5mo–18y 7mo) with hypertonia and cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels: I, n=7; II, n=5; III, n=7 level IV, n=7; and level V, n=8 level. Kuder–Richardson Formula 20 determined internal consistency. To assess reliability, two physicians administered the tool to 25 additional children with CP (15 males, 10 females; mean age 10y 8mo; GMFCS levels I, n=4; II, n=3; III, n=7; IV, n=4; and V, n=7) on two occasions, 2 weeks apart. To evaluate validity, a third physician diagnosed the hypertonia by neurological examination. Results  The internal consistency of the spasticity items was moderate (α=0.58), and dystonia was high (α=0.79). Item reduction eliminated seven of the 14 original items. The agreement of the spasticity and rigidity subscales was adequate (prevalence‐adjusted bias‐adjusted kappa [PABAK] ranging from moderate [0.57] to excellent [1.0]) for validity, test–retest reliability, and interrater reliability. For dystonia agreement was lower, with PABAK ranging from fair (0.30) to good (0.65). Eighty‐seven per cent had spasticity and 78% had dystonia. Interpretation  The Hypertonia Assessment Tool has good reliability and validity for identifying spasticity and the absence of rigidity, and moderate findings for dystonia.

ObjectivesAuthentic patient and family engagement in child health research is defined as researchers working in partnership with patients and families on all aspects of the research process, including refining the research question, tailoring the intervention, devising study procedures and disseminating study findings. While there is good evidence of a positive impact of patient engagement on the research process, on research teams and on patient partners, there are few empirical data on the impact of patient and family engagement on research quality and dissemination. We conducted a systematic review to compare research quality and dissemination metrics for paediatric randomised controlled trials (RCTs) that engaged patients and families in the research process with trials that did not.DesignSystematic review using the Cochrane Highly Sensitive Search to identify RCTs.Data sourcesOvid MEDLINE from 1 January 2011 through to 31 December 2020.Eligibility criteriaWe included RCTs involving children and youth (<18 years of age) published in The BMJ (a peer-reviewed general medical journal).Data extraction and synthesisTrials were categorised as those engaging patients and families (PE+) and those that did not (PE−). A standardised review form was used to confirm trial eligibility and extract data on study characteristics. Two reviewers independently screened and sorted RCTs into PE+ and PE− groups, extracted data and assessed research quality using the modified Cochrane Risk of Bias Tool (based on seven methodological criteria). The dissemination of RCT findings was determined using measures of academic and non-academic citation collected from Web of Science and Scopus.ResultsFrom 2011 to 2020, The BMJ published 45 RCTs involving children and youth. Only 10/45 RCTs (22%) reported engaging patients and families in the research process. Research quality for PE+ and PE− paediatric RCTs was similar; 4/10 (40%) of PE+ trials and 13/35 (37%) of PE− trials were rated as ‘fair’ or ‘good’ (p=1.00). Academic citation frequency per year was similar for PE+ trials and PE− trials: Web of Science (median 6.6 vs 7.1, respectively; p=0.84). Non-academic dissemination measures were generally higher among PE+ trials; for example, median PlumX Social Media score per year for PE+ trials was 46.6, compared with a median score of 7.6 for PE− trials (p=0.02).ConclusionsDespite increasing interest in patient and family engagement in child health research, this review showed that few paediatric RCTs report patient engagement activity. Research quality was similar for trials engaging patients and families compared with those that did not. Patient and family engagement in the trial, however, was associated with higher metrics for social media attention, compared with trials with no engagement.

Background Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury. Methods First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist’s route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries. Discussion This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team’s national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

Background Patient and public involvement (PPI) in the design and conduct of clinical trials has been increasingly encouraged by funders as an essential ingredient in the conduct of research. Recognition of PPI partners through acknowledgement or authorship, and financial supports, including remuneration and reimbursement, may facilitate involvement. However, little empirical data exists regarding current practices of recognising, remunerating and reimbursing PPI partners for their contributions to research. Aims To describe the extent to which patient and public partners are recognised and remunerated for their involvement in a cohort of pragmatic randomised controlled trials (RCTs). Methods Cross sectional survey of corresponding authors of pragmatic RCTs published between January 1, 2014, and April 3, 2019. Results From 2585 delivered invitations, 710 responded, with 334 (47%) indicating that they had involved PPI partners within the trial. Among 300 respondents to questions about authorship, 59 (20%) reported PPI partners were included as named authors and 19 (6%) that PPI partners were included as part of a group authorship. Of 300 respondents to questions regarding remuneration, 132 (44%) indicated that PPI partners were provided some form of remuneration. Of the 303 respondents to questions about reimbursement, 186 (61%), indicated that PPI partners were reimbursed for expenses incurred. Of 274 respondents who completed all three questions regarding reimbursement, remuneration, and authorship or acknowledgment, 83 (30%) indicated that all three were provided to PPI partners, while 40 (15%) indicated that they provided none of the options. Conclusion A fifth of researchers reported including PPI partners as named co-authors, less than half provided remuneration, and over a third did not reimburse partners. There is a need to better understand the nature of any barriers that research teams and PPI partners face regarding recognition, reimbursement, and remuneration, and to develop targeted interventions that will address these barriers. Plain English summary Patient and public involvement (PPI) in the design and conduct of clinical trials is encouraged or required in many cases. It is important to recognise PPI partners for their time and insight. Despite many guidelines being produced, we actually know very little about how researchers recognise and financially support PPI partners. To address this gap, we surveyed the authors of published clinical trials about their practices. Specifically, we asked researchers whether they had acknowledged their PPI partners or included them as co-authors, provided financial support for their time, or had covered expenses. From 2585 delivered invitations, a total of 710 researchers responded. Almost half (334/710, 47%) said they had involved PPI partners in their trial. A fifth of these researchers (59/300, 20%) reported that they included PPI partners as named co-authors. Just under half (132/300, 44%) reported that they had provided financial support for the time of their PPI partner. Almost two thirds (186/303, 61%) did cover expenses. Of those who completed all three questions almost a third (83/274, 30%) reported that all three options were provided to PPI partners. However, 40 (40/274, 15%) reported that they provided none of the options.

Patient and public involvement (PPI) in the design, conduct, and dissemination of pragmatic trials may make trial results more relevant and meaningful. The nature of PPI in paediatric pragmatic trials has been poorly characterized in the literature. This study examined the prevalence and nature of PPI in paediatric pragmatic trials and lessons learned from researchers' experiences. For this mixed methods study, we conducted an online survey and semi-structured interviews with corresponding authors of published paediatric pragmatic trials, identified using an online search filter in MEDLINE. Descriptive statistics and qualitative thematic analysis were used to analyse the data. PPI was reported by 71/127 (56%) survey respondents. Reported impacts of PPI in the survey included the following: more feasible interventions (71%), higher-quality research (57%), improved recruitment and retention (57%), and increased applicability of research findings (57%). Both survey and interview participants identified that insufficient resources, time, and training for relationship development were challenges to PPI in paediatric trials. Three themes were identified from the semi-structured interview data (recruitment and engagement, sustaining PPI relationships, and PPI value added). PPI aligns with the purpose and intended impact of pragmatic trials, and paediatric researchers perceive that PPI leads to increased research relevance, quality, and dissemination. There is, however, a need for institutional and funding bodies to invest in PPI partnership, including offering support for researchers and providing opportunities for children, youth, and parents as PPI partners.

Background Household food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP® FI question using the 2-item Hunger Vital Sign™ as the criterion measure in a primary care population of healthy children ages 18 months to 5 years. Results The sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP® question “I have difficulty buying food I want to feed my child because food is expensive” had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign™. Conclusion The single NutriSTEP® question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits. Trial registration TARGet Kids! practice-based research network (Registered June 5, 2013 at www.clinicaltrials.gov ; NCT01869530); www.targetkids.ca