academic years.Main Outcome Measure(s): Sport-related concussion counts, percentages, rates per 10 000 athlete-exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Rate ratios and IPRs with 95% CIs not containing 1.0 were considered significant.Results: Overall, 2004 SRCs were reported among 27 high school sports, for a rate of 3.89 per 10 000 AEs. Football had the highest SRC rate (9.21/10 000 AEs), followed by boys' lacrosse (6.65/10 000 AEs) and girls' soccer (6.11/10 000 AEs). The SRC rate was higher in competition than in practice (RR ¼ 3.30; 95% CI ¼ 3.02, 3.60). Among sex-comparable sports, the SRC rate was higher in girls than in boys (RR ¼ 1.56; 95% CI ¼ 1.34, 1.81); however, the proportion of SRCs due to player-to-player contact was higher in boys than in girls (IPR ¼ 1.48; 95% CI ¼ 1.27, 1.73). Common symptoms reported among all athletes with SRCs were headache (94.7%), dizziness (74.8%), and difficulty concentrating (61.0%). Only 0.8% of players with SRCs returned to play within 24 hours. The majority of athletes with SRCs (65.8%) returned to play between 7 and 28 days. More players had symptoms resolve after 7 days (48.8%) than less than a week (40.7%).Conclusions: Our findings provide updated high school SRC incidence estimates and further evidence of sex differences in reported SRCs. Few athletes with SRCs returned to play within 24 hours or a week. Most injured players returned after 7 days, despite a smaller proportion having symptoms resolve within a week.Key Words: injury surveillance, traumatic brain injuries, return to play Key PointsPer 10 000 athlete-exposures, the rates of sport-related concussion were highest in football (9.21), boys' lacrosse (6.65), and girls' soccer (6.11). Among sex-comparable sports, the rate of sport-related concussion was 56% higher in girls than in boys. Most athletes with sport-related concussions returned to play after 7 days, despite resolution of symptoms in a smaller proportion within 1 week.

Background The Mental Health Continuum–Short Form (MHC-SF) is a measure of positive mental health and flourishing, which is widely used in several countries but has not yet been validated in Denmark. This study aimed to examine its qualitative and quantitative properties in a Danish population sample and compare scores with Canada and the Netherlands. Methods Three thousand five hundred eight participants aged 16–95 filled out an electronic survey. Both the unidimensional and multidimensional aspects of the Danish MHC-SF were studied through bifactor modelling. Cognitive interviews examined face validity and usability. Results The general score of the Danish MHC-SF was reliable for computing unit-weighted composite scores, as well as using a bifactor model to compute general factor scores or measurement models in an SEM context. Nonetheless, subscale scores were unreliable, explaining very low variance beyond that explained by the general factor. The participants of the qualitative interviews observed problems with wording and content of the items, especially from the social subscale. The general score correlated with other scales as expected. We found substantial variation in flourishing prevalence rates between the three cultural settings. Conclusions The Danish MHC-SF produced reliable general scores of well-being. Most of the issues observed regarding the subscale scores have been shown in previous research in other contexts. The further analysis of indices of the bifactor model and the inclusion of qualitative interviews allowed for a better understanding of the possible sources of problems with the questionnaire’s subscales. The use of subscales, the substantive understanding of the general score, as well as the operationalization of the state of flourishing, require further study.

This study presents nationally representative estimates of self-reported changes in alcohol and cannabis consumption since the onset of COVID-19 in Canada. We used data from the Survey on COVID-19 and Mental Health (collected from September to December 2020) to calculate the prevalence of self-reported change in alcohol and cannabis consumption. We found that 15.7% of respondents self-reported an increase in alcohol consumption and 5.4% in cannabis consumption since the start of the pandemic. Sociodemographic disparities were also observed, indicating that increased alcohol and cannabis consumption may be more prevalent among certain populations.

The 2019 edition of the Canadian Chronic Disease Indicators (CCDI) provides recent estimates of the burden of chronic conditions and measures of general health and associated determinants in Canada. Using data from the CCDI and 2017 Canadian Community Health Survey, we explored the relationship between sociodemographic factors and selfreported mental health. Our findings suggest that sex (males vs females: adjusted odds ratio [aOR] = 1.22); age (65–79 vs 35–49 year age group: aOR = 1.48); education (postsecondary graduate vs less than high school: aOR = 1.68); household income adequacy (highest quintile [Q5] vs lowest [Q1]: aOR = 2.25); and immigrant status (recent immigrants vs nonimmigrants: aOR= 2.29) were significantly associated with higher self-reported mental health.

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Objectives & Background We identified that there is a cohort of people who attend our Emergency Department (ED) extremely frequently (>24 times per year) or who have frequent admissions (>12 per year). Analysing hospital clinical records identified that in many cases medically unexplained symptoms (MUS) drive the frequent presentation. The needs of these patients were not being met by a traditional dualistic approach in which people are seen in either physical or mental health settings. Indeed, despite frequent medical investigations/treatments, their symptoms persist, their problems are not resolved, they frequently complain and they keep coming back. This carries risk and distress for the patients, and heavy use of resources for the hospitals involved. Methods Each month we looked at attendance data for the previous 3 months (this identified people who in an acute phase of repeat presentations). By accessing patients clinical records we determined the main factors which appeared to drive their frequent attendance and admissions and identified those who presented with MUS. Care plans were developed and each patient was contacted and offered weekly Cognitive Behavioural Therapy (CBT) sessions to help them manage their symptoms. This was part of a case management approach in which coordinated, multidisciplinary reviews were undertaken resulting in an individualised care plan. Results Thus far the pilot has seen a reduction in attendances at ED for 100% of patients included in study (N=20). Crucially, all now attend less than once per month. In total 245 attends were saved after the CBT interventions Conclusion Providing a psychological intervention to this patient cohort is effective in reducing hospital costs by containing the most frequent attenders. CBT and care plans have reduced attendance to under once per month and subsequently reduced medical interventions and prescribing costs. 866Emerg Med J 2013;30(10):866-880

Objectives: Suicide is a complex global public health issue. The objective of this study was to assess time trends in suicide mortality in Canada by sex and age group. Methods: We extracted data from the Canadian Vital Statistics Death Database for all suicide deaths among individuals aged 10 years and older based on International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (E950-959; 1981 to 1999) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (X60-X84, Y87·0; 2000 to 2017) for a 37-year period, from 1981 to 2017. We calculated annual age-standardized, sex-specific, and age group-specific suicide mortality rates, and used Joinpoint Regression for time trend analysis. Results: The age-standardized suicide mortality rate in Canada decreased by 24.0% from 1981 to 2017. From 1981 to 2007, there was a significant annual average decrease in the suicide rate by 1.1% (95% confidence interval, −1.3 to −0.9), followed by no significant change between 2007 and 2017. From 1981 to 2017 and from 1990 to 2017, females aged 10 to 24 and 45 to 64 years old, respectively, had a significant increase in suicide mortality rates. However, males had the highest suicide mortality rates in all years in the study; the average male-to-female ratio was 3.4:1. Conclusion: The 3-decade decline in suicide mortality rates in Canada paralleled the global trend in rate reductions. However, since 2008, the suicide rate in Canada was relatively unchanged. Although rates were consistently higher among males, we found significant rate increases among females in specific age groups. Suicide prevention efforts tailored for adult males and young and middle-aged females could help reduce the suicide mortality rate in Canada.

Objective This study presents national estimates on symptoms consistent with postpartum anxiety (PPA) and postpartum depression (PPD) and the association between these conditions and possible risk and protective factors in women who gave birth in Canada. Methods Data were collected through the Survey on Maternal Health, a cross-sectional survey administered in Canada’s ten provinces between November 2018 and February 2019 among women who gave birth between January 1 and June 30, 2018. A total of 6558 respondents were included. Weighted prevalence estimates were calculated, and logistic regression was used to model the relationship between symptoms consistent with PPA, PPD, and potential risk factors. Results Overall, 13.8% of women had symptoms consistent with PPA, while the prevalence of having symptoms consistent with PPD was 17.9%. Results of the logistic regression models indicated that women who had a history of depression were 3.4 times (95% CI 2.7–4.2) more likely to experience symptoms consistent with PPA and 2.6 times more likely to experience symptoms consistent with PPD (95% CI 2.2–3.2) compared with those who did not. Women who reported good, fair, or poor physical health were 2.4 times more likely to experience symptoms consistent with PPD (95% CI 2.0–2.9) and 2.0 times more likely to experience symptoms consistent with PPA (95% CI 1.7–2.4) compared with those who reported very good or excellent health. Maternal marital status, other postpartum maternal support, and sense of community belonging were also significant. Conclusion This study highlights that a history of depression and good, fair, or poor physical health are associated with an increased odds of symptoms consistent with PPA and PPD, while other maternal support and sense of community belonging are associated with a decreased odds of these conditions.