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Cusimano M.D.,Injury Prevention Research Office | Cusimano M.D.,University of Toronto | Sameem M.,Injury Prevention Research Office | Sameem M.,McMaster University
Injury Prevention | Year: 2011

Objective To assess the effectiveness of middle and high school-based suicide prevention curricula. Data sources The following were searched: Ovid MEDLINE(R) in-process and other non-indexed citations and Ovid MEDLINE(R), Ovid Healthstar, CINAHL, PsycINFO, all EBM reviewsdCochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED, and the ISI Web of Science, until October 2009; government web pages for statistics and other demographic data in countries where they were available; citation lists of relevant articles. Review methods Randomised controlled studies, interrupted time series analyses with a concurrent comparison group, studies with follow-up examinations (post-test questionnaires and monitoring suicide rates), and middle to high school-based curriculum studies, including both male and female participants, were included. Results 36 potentially relevant studies were identified, eight of which met the inclusion criteria. Overall, statistically significant improvements were noted in knowledge, attitude, and help-seeking behaviour. A decrease in self reported ideation was reported in two studies. None reported on suicide rates. Conclusion Although evidence exists that school-based programmes to prevent suicide among adolescents improve knowledge, attitudes, and help-seeking behaviours, no evidence yet exists that these prevention programmes reduce suicide rates. Further well designed, controlled research is required before such programmes are instituted broadly to populations at risk.


Cusimano M.D.,St. Michaels Hospital | Cusimano M.D.,University of Toronto | Kwok J.,Injury Prevention Research Office | Kwok J.,University of Toronto
British Journal of Sports Medicine | Year: 2010

Objective To summarise the best available evidence to determine the impact of helmet use on head injuries, neck injuries and cervical spine injuries in skiers and snowboarders. Data sources Relevant publications were identifi ed through electronic searches of MEDLINE, PubMed, EMBASE, CINAHL and the Cochrane Library databases (1966-2009) in addition to manual reference checks of all included articles. Review methods 45 articles were identifi ed through our systematic literature search. Of these, 10 studies met the inclusion criteria after two levels of screening. Two independent reviewers critically appraised the studies. Data were extracted on the primary outcomes of interest: Head injury, neck injury and cervical spine injury. Studies were assessed for quality by the criteria of Downs and Black. Results Studies reviewed indicate that helmet wear reduces the risk of head injuries in skiing and snowboarding. Four case-control studies reported a reduction in the risk of head injury with helmet use ranging from 15% to 60%. Another cohort study found a signifi cantly lower incidence of head injuries involving loss of consciousness in helmet users (p<0.05). The fi ve remaining studies suggested a major protective effect of helmets by indicating that none or few of the headinjured and deceased participants wore a helmet. Conclusions There is strong evidence to support the protective value of helmets in reducing the risk of head injuries in skiing and snowboarding. There is no good evidence to support the claim that the use of helmets leads to an increase risk of cervical spine injuries or neck injuries.


Hutchison M.G.,University of Toronto | Lawrence D.W.,University of Toronto | Cusimano M.D.,University of Toronto | Cusimano M.D.,Injury Prevention Research Office | And 2 more authors.
American Journal of Sports Medicine | Year: 2014

Background: Mixed martial arts (MMA) is a full combative sport with a recent global increase in popularity despite significant scrutiny from medical associations. To date, the empirical research of the risk of head injuries associated with this sport is limited. Youth and amateur participation is growing, warranting investigation into the burden and mechanism of injuries associated with this sport. Purpose: (1) To determine the incidence, risk factors, and characteristics of knockouts (KOs) and technical knockouts (TKOs) from repetitive strikes in professional MMA; and (2) to identify the mechanisms of head trauma and the situational factors that lead to KOs and TKOs secondary to repetitive strikes through video analysis. Study Design: Descriptive epidemiology study. Methods: Competition data and video records for all KOs and TKOs from numbered Ultimate Fighting Championship MMA events (n = 844) between 2006 to 2012. Analyses included (1) multivariate logistic regression to investigate factors associated with an increased risk of sustaining a KO or TKO secondary to repetitive strikes and (2) video analysis of all KOs and TKOs secondary to repetitive strikes with descriptive statistics. Results: During the study period, the KO rate was 6.4 per 100 athlete-exposures (AEs) (12.7% of matches), and the rate of TKOs secondary to repetitive strikes was 9.5 per 100 AEs (19.1% of matches), for a combined incidence of match-ending head trauma of 15.9 per 100 AEs (31.9% of matches). Logistic regression identified that weight class, earlier time in a round, earlier round in a match, and older age were risk factors for both KOs and TKOs secondary to repetitive strikes. Match significance and previously sustained KOs or TKOs were also risk factors for KOs. Video analysis identified that all KOs were the result of direct impact to the head, most frequently a strike to the mandibular region (53.9%). The average time between the KO-strike and match stoppage was 3.5 seconds (range, 0-20 seconds), with losers sustaining an average of 2.6 additional strikes (range, 0-20 strikes) to the head. For TKOs secondary to strikes, in the 30-second interval immediately preceding match stoppage, losers sustained, on average, 18.5 strikes (range, 5-46 strikes), with 92.3% of these being strikes to the head. Conclusion: Rates of KOs and TKOs in MMA are higher than previously reported rates in other combative and contact sports. Public health authorities and physicians should be cognizant of the rates and mechanisms of head trauma. Preventive measures to lessen the risks of head trauma for those who elect to participate in MMA are described. © 2014 The Author(s).


Hutchison M.G.,University of Toronto | Hutchison M.G.,Injury Prevention Research Office | Comper P.,University of Toronto | Meeuwisse W.H.,University of Calgary | And 2 more authors.
British Journal of Sports Medicine | Year: 2014

Background: Development of effective strategies for preventing concussions is a priority in all sports, including ice hockey. Digital video records of sports events contain a rich source of valuable information, and are therefore a promising resource for analysing situational factors and injury mechanisms related to concussion. Aim: To determine whether independent raters reliably agreed on the antecedent events and mechanisms of injury when using a standardised observational tool known as the heads-up checklist (HUC) to code digital video records of concussions in the National Hockey League (NHL). Methods: The study occurred in two phases. In phase 1, four raters (2 naive and 2 expert) independently viewed and completed HUCs for 25 video records of NHL concussions randomly chosen from the pool of concussion events from the 2006. 2007 regular season. Following initial analysis, three additional factors were added to the HUC, resulting in a total of 17 factors of interest. Two expert raters then viewed the remaining concussion events from the 2006. 2007 season, as well as all digital video records of concussion events up to 31 December 2009 (n=174). Results: For phase 1, the majority of the factors had a ¥ê value of 0. 6 or higher (8 of 15 factors for naive raters; 11 of 15 factors for expert raters). For phase 2, all the factors had a total percent agreement value greater than 0. 8 and ¥ê values of >0. 65 for the expert raters. Conclusions: HUC is an objective, reliable tool for coding the antecedent events and mechanisms of concussions in the NHL.


Hutchison M.G.,University of Toronto | Hutchison M.G.,Injury Prevention Research Office | Comper P.,University of Toronto | Meeuwisse W.H.,University of Calgary | And 2 more authors.
British Journal of Sports Medicine | Year: 2015

Background: Although there is a growing understanding of the consequences of concussions in hockey, very little is known about the precipitating factors associated with this type of injury. Aim: To describe player characteristics and situational factors associated with concussions in the National Hockey League (NHL). Methods: Case series of medically diagnosed concussions for regular season games over a 3.5-year period during the 2006-2010 seasons using an inclusive cohort of professional hockey players. Digital video records were coded and analysed using the Heads Up Checklist. Results: Of 197 medically diagnosed concussions, 88% involved contact with an opponent. Forwards accounted for more concussions than expected compared with on-ice proportional representation (95% CI 60 to 73; p=0.04). Significantly more concussions occurred in the first period (47%) compared with the second and third periods (p=0.047), with the majority of concussions occurring in the defensive zone (45%). Approximately 47% of the concussions occurred in open ice, 53% occurred in the perimeter. Finally, 37% of the concussions involved injured players' heads contacting the boards or glass. Conclusions: This study describes several specific factors associated with concussions in the NHL, including period of the game, player position, body size, and specific locations on the ice and particular situations based on a player's position. © 2015, BMJ Publishing Group. All rights reserved.

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