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ObjectiveTo determine effective interventions to improve primary care provider involvement in transitioning youth with chronic conditions from paediatric to adult care.DesignSystematic review. Multiple electronic databases were searched including Ovid MEDLINE, EMBASE and Web of Science (from 1 January 1947 to 5 August 2015). Evidence quality was assessed using a 36-point scoring system for disparate study designs.SettingStudies with paediatric-to-adult transition programmes and interventions involving primary care providers or in primary care settings.ParticipantsYouth aged 16 years and over.OutcomesRelevant outcomes were grouped into 3 main domains based on the Triple Aim Framework: experience of care, population health, cost.ResultsA total of 1888 unique citations were identified, yielding 3 studies for inclusion. Overall, primary care provider roles were not well defined. 2 studies used case managers to facilitate referrals to primary care, and the remaining study was the only 1 situated in a primary care setting. None of the studies examined transition in all 3 Triple Aim Framework domains. The most commonly reported outcomes were in the cost domain.ConclusionsThere is limited empiric evidence to guide primary care interventions to improve transition outcomes for youth with chronic conditions. Future research and policy should focus on developing and evaluating coordinated transition interventions to better integrate primary care for high need populations.

PurposeTo estimate the minimum incidence of congenital Zika syndrome (CZS) and severe microcephaly in Canada and describe key clinical, epidemiological, aetiological and outcome features of these conditions.MethodsTwo separate national surveillance studies were conducted on CZS and severe microcephaly using the well-established Canadian Paediatric Surveillance Program from 2016 to 2019. Over 2700 paediatricians across Canada were surveyed monthly and asked to report demographic details, pregnancy and travel history, infant anthropometry, clinical features and laboratory findings of newly identified cases. Reports were reviewed to assign an underlying aetiology of severe microcephaly. Incidence rates were estimated using monthly live birth denominators.ResultsThirty-four infants met the case definition for severe microcephaly and <5 met the case definition for CZS. The associated minimum incidence rates were 4.5 per 100 000 live births for severe microcephaly and 0.1–0.5 per 100 000 live births for CZS. Of severe microcephaly cases, 53% were attributed to genetic causes, 15% to infectious or ischaemic causes and 32% to unknown causes. The median head circumference-for-age Z-score at birth was −3.2 (IQR −3.8 to −2.6), and catch-up growth was often not achieved. Common clinical features included intracranial abnormalities (n=23), dysmorphology (n=19) and developmental delays (n=14). Mothers of infants with non-genetic aetiologies travelled during pregnancy more often (10/16) than mothers of infants with genetic aetiologies (<5/18; p<0.01).ConclusionSevere microcephaly and CZS are both rare in Canada. Minimum incidence rates can be used as a baseline against which novel or re-emergent causes of severe microcephaly or CZS can be compared.

Introduction The unique evidentiary, economic and ethical challenges associated with health technology assessment (HTA) of precision therapies limit access to novel drugs and therapeutics for children and youth, for whom such challenges are amplified. We elicited citizens' perspectives about values‐based criteria relevant to the assessment of paediatric precision therapies to inform the development of a child‐tailored HTA framework. Methods We held four citizen panels virtually in May–June 2021, informed by a plain‐language citizen brief summarizing global and local evidence about the challenges, policy and programmatic options and implementation strategies related to enhancing access to precision therapies for Canadian children and youth. Panellists were recruited through a nationally representative database, medical/patient networks and social media. We inductively coded and thematically analysed panel transcripts to generate themes and identify priority values. Results The perspectives of panellists (n = 45) coalesced into four overlapping themes, with attendant subthemes, relevant to a child‐tailored HTA framework: (1) Childhood Distinctions: vulnerability, ‘fair innings’, future potential, family impacts; (2) Voice: agency of children and youth; lived versus no lived experience; (3) One versus Many: disease severity, rarity, equity, unmet need and (4) Health System Governance: funding, implementation inequities, effectiveness and safety. Participants broadly agreed that childhood distinctions, particularly family impacts, justify child‐tailored HTA. Dissent arose over whose voice should inform HTA and how such perspectives are best incorporated. Conclusions Citizens can offer unique insights into criteria relevant to the development or revision of HTA frameworks to capture holistic, societally responsive dimensions of value attached to unique contexts or populations, including children. Balancing the hopes and expectations of patients and caregivers for access to expensive but potential life‐altering therapies against the opportunity costs borne by encompassing health systems is a fundamental challenge that will require rigorous methods to elicit, weigh and reconcile varied views. Patient or Public Contribution A patient advocate served on the steering committee of this study and co‐authored this article. Key informants for the Citizen Brief included patient advocates and caregivers; a separate patient advocate reviewed the Brief before dissemination. Qualitative and quantitative data were collected from the general public and caregivers of children, with written consent.

Background and objectiveDespite firearms contributing to significant morbidity and mortality globally, firearm injury epidemiology is seldom described outside of the USA. We examined firearm injuries among youth in Canada, including weapon type, and intent.DesignPopulation-based, pooled cross-sectional study using linked health administrative and demographic databases.SettingOntario, Canada.ParticipantsAll children and youth from birth to 24 years, residing in Ontario from 1 April 2003 to 31 March 2018.ExposureFirearm injury intent and weapon type using the International Classification of Disease-10 CM codes with Canadian enhancements. Secondary exposures were sociodemographics including age, sex, rurality and income.Main outcomesAny hospital or death record of a firearm injury with counts and rates of firearm injuries described overall and stratified by weapon type and injury intent. Multivariable Poisson regression stratified by injury intent was used to calculate rate ratios of firearm injuries by weapon type.ResultsOf 5486 children and youth with a firearm injury (annual rate: 8.8/100 000 population), 90.7% survived. Most injuries occurred in males (90.1%, 15.5/100 000 population). 62.3% (3416) of injuries were unintentional (5.5/100 000 population) of which 1.9% were deaths, whereas 26.5% (1452) were assault related (2.3/100 00 population) of which 18.7% were deaths. Self-injury accounted for 3.7% (204) of cases of which 72.0% were deaths. Across all intents, adjusted regression models showed males were at an increased risk of injury. Non-powdered firearms accounted for half (48.6%, 3.9/100 000 population) of all injuries. Compared with handguns, non-powdered firearms had a higher risk of causing unintentional injuries (adjusted rate ratio (aRR) 14.75, 95% CI 12.01 to 18.12) but not assault (aRR 0.84, 95% CI 0.70 to 1.00).ConclusionsFirearm injuries are a preventable public health problem among youth in Ontario, Canada. Unintentional injuries and those caused by non-powdered firearms were most common and assault and self-injury contributed to substantial firearm-related deaths and should be a focus of prevention efforts.

Abstract Background All-Terrain Vehicles (ATVs) are a leading cause of serious injury in children and youth. Certain Canadian regions have implemented legislation to promote safety, including age restrictions, mandatory training and helmet use. Jurisdictions with more stringent ATV safety legislation have been shown to have reduced injury rates in the short term. Objectives To estimate the burden of ATV-related serious injury and death in Canada and to identify Canadian physicians’ knowledge of ATV-related legislation, safety and health promotion practices. Methods A one-time survey was distributed to practicing paediatricians and paediatric subspecialists participating in the Canadian Paediatric Surveillance Program (CPSP) in October 2016. Results Of 2793 physicians contacted, 904 responded (32.4%). There were 181 reported cases of serious and/or fatal ATV-related injuries, including 6 deaths. Children aged 10 to 14 represented the most number of cases (n=82, 45.3%), followed by 15 to 19 (n=48, 26.5%) and 5 to 9 (n=40, 22.1%). Most cases occurred in July/August (48.3%) and May/June (25.2%), were in males (n=133, 78.2%), and occurred during recreational activity (n=139, 83.2%) or organized racing (n=6, 3.6%). In 99 cases (58.9%), the child was the driver of the ATV. Only two-thirds of respondents (67.5%) knew that ATVs should not carry passengers while under half (42.2%) never discussed ATV safety with their patients. Conclusions ATV-related injuries and deaths in Canadian children remain a serious public health problem. Education of health care practitioners, including paediatricians, is needed to promote safety. Despite efforts to reduce ATV-related injuries, there remains a significant number of serious injuries and/deaths related to their use.

Background Nonpowdered firearms discharge projectiles at forces capable of inflicting serious harm. Regulations governing access and use of non-powdered firearms vary by jurisdiction, and the injury burden resulting from these weapons is not well described and may also vary by region. Measurement and comparison of nonpowdered firearm injury rates is important to inform injury prevention strategies. We aimed to describe published rates of nonpowdered firearm injuries across Organization for Economic Co-Operation and Development (OECD) countries. Methods We searched MEDLINE, EMBASE, the Cochrane Library, Web of Science, Scopus, and Criminal Justice Abstracts databases from inception to April 7, 2023 for sources reporting population-level rates of nonpowdered firearm injuries (ball bearing, airsoft, or pellet guns). We excluded case reports, case series, and experimental studies. We identified grey literature through targeted webpages and Google search engine. We extracted population and injury characteristics, rates of injury, and intent and severity data. Results We identified 31 sources from five countries (United States, Canada, United Kingdom, Finland, and Sweden) that reported rates of nonpowdered firearm injury. Data were heterogenous in terms of population, year (range: 1970–2021), injury type (ocular, head/neck, all injuries). Most data sources reported high unintentional injury burden, however, a substantial number of injuries reported were due to assaults. Younger age groups (5- to 9- and 10- to 14-year-olds) were disproportionately impacted. Conclusions Nonpowdered firearms are an important cause of injury. Gaps in reporting and lack of uniformity exist in defining these injuries and must be addressed to inform injury prevention strategies.

Direct comparisons of paediatric hospitalizations for acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) can inform health system planning. We describe the absolute and relative hospital burden of acute paediatric COVID-19 and MIS-C in Canada. This national prospective study was conducted via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Children younger than 18 years old and hospitalized for acute COVID-19 or MIS-C were included in the analysis. Outcomes included supplemental oxygen (low-flow oxygen or high-flow nasal cannula), ventilation (non-invasive or conventional mechanical), vasopressors, paediatric intensive care unit (PICU) admission, or death. Adjusted risk differences (aRD) and 95% confidence intervals (CI) were calculated to identify factors associated with each diagnosis. Overall, we identified 330 children hospitalized for acute COVID-19 (including five deaths) and 208 hospitalized for MIS-C (including zero deaths); PICU admission was required for 49.5% of MIS-C hospitalizations versus 18.2% of acute COVID-19 hospitalizations (aRD 20.3; 95% CI, 9.9-30.8). Resource use differed by age, with children younger than one year hospitalized more often for acute COVID-19 (aRD 43.4% versus MIS-C; 95% CI, 37.7-49.1) and more children 5-11 years hospitalized for MIS-C (aRD 38.9% vs. acute COVID-19; 95% CI, 31.0-46.9). While there were more hospitalizations and deaths from acute paediatric COVID-19, MIS-C cases were more severe, requiring more intensive care and vasopressor support. Our findings suggest that both acute COVID-19 and MIS-C should be considered when assessing the overall burden of severe acute respiratory syndrome coronavirus 2 in hospitalized children.

Risk factors for severe outcomes of SARS-CoV-2 infection are not well established in children. We sought to describe pediatric hospital admissions associated with SARS-CoV-2 infection in Canada and identify risk factors for more severe disease. We conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP). Cases involving children who were admitted to hospital with microbiologically confirmed SARS-CoV-2 infection were reported from Apr. 8 to Dec. 31 2020, through weekly online questionnaires distributed to the CPSP network of more than 2800 pediatricians. We categorized hospital admissions as related to COVID-19, incidental, or for social or infection control reasons and determined risk factors for disease severity in hospital. Among 264 hospital admissions involving children with SARS-CoV-2 infection during the 9-month study period, 150 (56.8%) admissions were related to COVID-19 and 100 (37.9%) were incidental infections (admissions for other reasons and found to be positive for SARS-CoV-2 on screening). Infants (37.3%) and adolescents (29.6%) represented most cases. Among hospital admissions related to COVID-19, 52 (34.7%) had critical disease, 42 (28.0%) of whom required any form of respiratory or hemodynamic support, and 59 (39.3%) had at least 1 underlying comorbidity. Children with obesity, chronic neurologic conditions or chronic lung disease other than asthma were more likely to have severe or critical COVID-19. Among children who were admitted to hospital with SARS-CoV-2 infection in Canada during the early COVID-19 pandemic period, incidental SARS-CoV-2 infection was common. In children admitted with acute COVID-19, obesity and neurologic and respiratory comorbidities were associated with more severe disease.