Kate Turcotte’s research while affiliated with BC Children's Hospital and other places

Background Indigenous communities bear a disproportionate burden of residential fire-related deaths and injuries compared to non-indigenous counterparts, posing a threat to community health and well-being. Lack of access to fire safety and prevention resources and effective programs contribute to the increased risk of fire-related injuries and deaths. Objective To develop a community resource for Indigenous and small communities interested in reducing the frequency and severity of fire incidents, and their associated injuries and deaths. Methods Development of this resource was based upon previous work to review fire safety and prevention evidence and practices, and to document the process of gathering information regarding Indigenous community needs concerning fire safety knowledge and research needs. Strategies were developed, contextualized, and refined though consultation and input from experts in the field of fire and injury prevention. An evaluation of the National Indigenous Fires Safety Council (NIFSC) community fire safety education programming assessed the evidence supporting each program. A level of evidence (LOE) score was based upon the amount available evidence and study designs, using a summary 5-star system to indicate the overall quality and level of evidence. Results The LEAD Fire Safety and Prevention Community Toolkit is a step-by-step workbook built upon four main strategies: Learn about community characteristics and fire burden; Engage with community members and build support; Assess available resources and identify opportunities; and Develop and implement fire safety and prevention action plan. It leads users through a process from learning about the community fire burden, to raising community support, to planning evidence-based and data-driven fire safety and prevention activities, to implementing the action plan and evaluating the results. The leading NIFSC programs promoted in the toolkit are the Home Safety Assessment, Smoke Alarm and Carbon Monoxide Installation, and Home Escape Planning. A set of indicators is included to document baseline community fire burden and prevention activities, and to evaluate the implementation, short-term outcomes, and long-term impact of the fire safety and prevention action plan. Conclusions This toolkit guides Indigenous and small communities to use best practices in reducing the frequency and severity of fire; those that are evidence-based, cost-effective, and efficient.

Background Concussions occur within and outside of the sports realm, including those resulting from falls, motor vehicle crashes, and violence. Yet emerging concussion research predominantly takes a sports perspective. The 6th International Conference on Concussion in Sport prompted widespread updating of concussion training and resources. Notably, assessments for concussion, and the roles of rest and aerobic physical activity supporting recovery, have been considerably refined. The Concussion Awareness Training Tool (CATT) provides free, evidence-based, concussion education and resources tailored to diverse audiences: medical professionals, coaches, youth, athletes, parents, educators, workers and their employers, and those supporting survivors of intimate partner violence. Objective To outline the knowledge translation practices employed in updating CATT, and highlight new information and features of the courses and website. Programme Description CATT is informed by evidence-based research and concussion experts across Canada. Recently launched on its new online platform, CATT offers up-to-date eLearning modules and downloadable resources, each created using an integrated knowledge translation (iKT) approach. Outcomes and Learnings To date, over 175,000 people worldwide have completed CATT training. The website receives >17,000 visits per month from 50+ countries: Canada, United States, United Kingdom, Australia, China, New Zealand, Ireland, India, South Africa, France, and elsewhere. This wide-reaching approach to online concussion education is available in both English and French. Modules for medical professionals, coaches, and educators will also be available in Arabic. CATT training has been mandated by 100+ sporting associations, universities, schools, and other organizations in Canada and the United States. Furthermore, the University of British Columbia is the first medical school in Canada to incorporate concussion education into its curriculum, using CATT resources. Implications Given its wide reach and relevance to a range of audiences, it is important that CATT is reviewed regularly and updated with newly released, evidence-based research. Through iKT, research is synthesized, adapted, and integrated into the various CATT eModules and resources. Conclusions CATT is used extensively to educate targeted audiences on concussion prevention, recognition, treatment, management, and recovery. Recent updates and website improvements ensure that users are engaging with the most up-to-date information that is easily accessible and available, at no-cost.

Background Concussion education is recommended to increase concussion knowledge, beliefs, and reporting intentions. The Concussion Awareness Training Tool for Youth (CATT-Youth) is a 40-minute e-Learning module developed for high school–aged youth. Aim The aim of the study was to evaluate changes in concussion knowledge, beliefs, and reporting intentions in high school youth from Calgary, Canada, following completion of the CATT-Youth Methods This study used a modified stepped-wedge trial design. High school classes were randomly assigned to an intervention (Ix) or delayed intervention (DIx) group. Ix group participants completed a pre-CATT survey immediately followed by the CATT-Youth, then a post-CATT survey 2 to 6 weeks later. DIx group participants completed two pre-CATT surveys 2 to 6 weeks apart, with the CATT-Youth completed immediately following the second pre-CATT, then a post-CATT survey 2 to 6 weeks later. The pre-/post-CATT survey encompassed 11 subtests evaluating concussion knowledge, beliefs, and reporting intentions. Independent mixed linear regression models were conducted to examine changes in scores for each subtest. Results Participants included 454 high school students: five Ix schools (16 classes, n = 323) and two DIx schools (six classes, n = 131). The CATT-Youth significantly increased general concussion knowledge, Ix δ = 0.546/8 (95% confidence interval [CI] = [0.243, 0.849]), DIx δ = 0.728/8 (95% CI = [0.389, 1.106]), and beliefs about capabilities, Ix δ = 2.462/28 (95% CI = [1.086, 3.838]), DIx δ = 3.219/28 (95% CI = [1.594, 4.844]) for both groups. For some subtests, improvements were noted in the DIx group only. Conclusion The CATT-Youth module improved concussion knowledge and beliefs about capabilities for students in both groups. Future studies should explore the utility of the CATT-Youth in changing knowledge, beliefs, and reporting intentions in high school students.

Objective Extending evidence from sports-related concussion to multiple audiences and contexts. Design Recognizing that concussions can happen outside of the sports, and that there is growing evidence around minor traumatic brain injury in other settings, a widespread approach to concussion education and awareness was launched in 2013. Pre/post intervention evaluation was undertaken with medical professionals, parents/coaches, and teachers/school administrators. Courses were updated in 2018–2020 and translated into French in partnership with the Canadian Concussion Harmonization Project, the Public Health Agency of Canada, and Parachute. Setting Canada and International. Intervention Concussion Awareness Training Tool (CATT) is a series of online educational modules and resources based upon the latest evidence, expert consultation, and extensive external review. Since 2013, CATT (https://cattonline.com/) has provided the community with easily understandable, digestible information on concussion free-of-charge. Beginning by targeting medical professionals, coaches, and parents/caregivers, CATT now includes school professionals, varsity athletes, workers and workplaces, and those working with survivors of intimate partner violence. Results Original CATT resources demonstrated significant improvements in: physician knowledge among those treating more >10 concussions/year (p<0.04,2014), physician behaviour (p<0.01,2014), parent/coach knowledge (p=0.002,2015), and school teacher/administer knowledge (p<0.03,2016). To date, over 50,000 people worldwide have completed CATT training, over 27,000 print resources have been distributed, and training has been mandated by over 30 organizations. Conclusions CATT is a unique resource providing accessible, reliable concussion information customized to broad audiences, including and outside of sport and education, recognizing the impact on work life. Recognized by the Canadian government, CATT is promoted nationally and internationally.

Objectives To understand Canadian university athletic programme concussion management needs, and to describe development and content of a tailored online concussion education tool for Canadian university/college athletes. Design An integrated knowledge translation multiphased, multimethods approach was used. Phases included a needs assessment survey with university representatives and athletes, content selection, mapping behavioural goals to evidenced-based behaviour change techniques, script/storyboard development, engagement interviews with university athletes and tool development using user-centred design techniques. Setting Canadian U SPORTS universities (n=56). Participants Overall, 64 university representatives (eg, administrators, clinicians) and 27 varsity athletes (52% male, 48% female) completed the needs assessment survey. Five athletes participated in engagement interviews. Outcome measures Surveys assessed previous athlete concussion education, recommendations for concussion topics and tool design, concussion management challenges and interest in implementing a new course. Results Institutions used a median (Med) of two (range 1–5) approaches when educating athletes about concussion. Common approaches were classroom-style education (50%), online training (41%) and informational handouts (39%). University representatives rated most important topics as: (1) what is a concussion, (2) how to recognise a concussion and (3) how to report a concussion (Med all =4.8/5). Athletes felt symptom recognition (96%) and effects on the brain (85%) were most important. The majority of athletes preferred learning via computer (81%) and preferred to learn alone (48%) versus group learning (7%). The final resource was designed to influence four behaviours: (1) report symptoms, (2) seek care, (3) encourage teammates to report symptoms and (4) support teammates through concussion recovery. Examples of behaviour change techniques included: knowledge/skills, problem-solving scenarios, verbal persuasion and social comparison. Athletes are guided through different interactions (eg, videos, flip cards, scenarios, testimonials) to maximise engagement (material review takes ~30 min). Conclusions The Concussion Awareness Training Tool for athletes is the first Canadian education tool designed to address the needs of Canadian university/college athletes.

[This corrects the article DOI: 10.3389/fpubh.2022.938091.].

Aim: Continuing medical education (CME) informs physicians on current research. The Concussion Awareness Training Tool (CATT) provides education on concussion diagnosis and treatment. The aims of this study were to explore physician CME practices and preferences, understand barriers and facilitators to implementing the CATT as CME, and provide recommendations. Materials & methods: Physicians in British Columbia, Canada participated in an online survey and telephone interview. Descriptive analysis of quantitative data, and text-based data analysis were undertaken to identify themes. Results: Barriers included lack of time and awareness of the resource. Facilitators were its ease of use, accessibility, conciseness and comprehensiveness. Conclusion: The perceptions of barriers and facilitators reported by physicians are important to understand and better promote the use of the CATT.

Objectives This study explored how demographic characteristics, life experiences, and firefighting exposures have an impact on cancer among female firefighters, and described the types and biologic characteristics of cancers as reported by women in the fire service. Methods The online survey was available from June 2019 to July 2020. Questions related to demographic characteristics, lifestyle factors, firefighting exposures, and cancer diagnoses. Descriptive analyses characterized variables by the presence or absence of cancer. Qualitative data provided insight into both firefighting and cancer experiences among women. Results There were 1,344 female firefighter respondents from 12 different countries, 256 of whom provided information on their cancer diagnosis. North American respondents made up 92% of the total. Those with cancer were older, had been in the fire service longer, had more career fires and toxic exposures, and were less likely to still be in active service. They also reported more tobacco use, and more full-term pregnancies. There were no differences in family history of cancer between the two groups. The average age at diagnosis was 39.0 years. The major types of cancer reported included breast (25.4%), cervical (21.1%), melanoma (20.7%), base cell/skin (16.4%), and uterine (14.8%). The cancer was detected when seeking medical attention for symptoms (42.1%), during routine health screening (29.8%), and during specific cancer screening (28.1%). The stage of cancer was reported by 44.5%, and 30.9% included the histopathological grade. Treatments included surgery (72.7%), chemotherapy (14.8%), radiotherapy (13.7%), and observation (13.7%). Challenges associated with cancer included psychosocial (33.2%), financial (18.8%), physical (6.6%), and spiritual (6.3%). Concerns about reporting a cancer experience to their employer included the desire to keep health information private (11.3%), a feeling of vulnerability (7.4%), and being perceived as weak (7.0%). Lack of support from their employer or insurer was also noted. Conclusion Female firefighters experienced a wide variety of different types of cancers which may come earlier than similar cancers in the public. These findings can help inform resource allocation, the development of new policies, and the need for broader presumptive coverage to support female firefighters diagnosed with cancer.

Background: Poisoning, from substances such as illicit drugs, prescribed and over-the-counter medications, alcohol, pesticides, gases and household cleaners, is the leading cause of injury-related death and the second leading cause for injury-related hospital admission in British Columbia. We examined the health and economic costs of poisoning in BC for 2016, using a societal perspective, to support public health policies aimed at minimizing losses to society. Methods: Costs by intent, sex and age group were calculated in Canadian dollars using a classification and costing framework based on existing provincial injury data combined with data from the published literature. Direct cost components included fatal poisonings, hospital admissions, emergency department visits, ambulance attendance without transfer to hospital and calls to the British Columbia Drug and Poison Information Centre (BC DPIC) not resulting in ambulance attendance, emergency care or transfer to hospital. Indirect costs, measured as loss of earnings and informal caregiving costs, were also calculated. Results: We estimate that poisonings in BC totalled $812.5 million in 2016 with$108.9 million in direct health care costs and $703.6 million in indirect costs. Unintentional poisoning injuries accounted for 84% of total costs, 46% of direct costs and 89% of indirect costs. Males accounted for higher proportions of direct costs for all patient dispositions except hospital admissions. Patients aged 25-64 years accounted for higher proportions of direct costs except for calls to BC DPIC, where proportions were highest for children younger than 15 years. Interpretation: Hospital care expenditures represented the largest direct cost of poisoning, and lost productivity following death represented the largest indirect cost. Quantifying and understanding the financial burden of poisoning has implications not only for government and health care, but also for society, employers, patients and families.

Introduction This study aimed to quantify the total cost of violent firearm-related offenses in British Columbia in 2016 Canadian dollars over a five-year period, 2012 to 2016. The purposes of this study were to estimate the direct costs to the health care system and indirect costs to society for violent firearm injuries and deaths; and to estimate criminal justice system costs pertaining to firearm incidents. Methods Human and economic costs to the health care system and productivity losses were calculated using health administrative datasets such as B.C. Vital Statistics and Discharge Abstract Database. Criminal justice system costs pertaining to firearm incidents were estimated by applying weighted average costs to aggregate expenditures using methodology consistent with that used by Statistics Canada. Results There was a total of 108 deaths and 245 hospitalizations resulting from violent firearm injuries. The total estimated cost of all violent firearm crime averaged $294,378,985 per year; human costs averaged$188,416,841 per year, where health care costs averaged $3,910,317 per year, productivity losses from workforce and household averaged$17,299,054 and $4,559,470 per year, respectively, and loss of life averaged$162,648,000; and $105,021,145 in criminal justice system costs, and$941,000 in programming costs. Conclusion This study clearly demonstrates the significant cost of violent firearm injury in British Columbia and the impacts on the health care system, criminal justice system, and to society at large, particularly within the criminal justice system where the costs were significantly higher than health care.