Objectives: Walking or cycling to school represents an opportunity for children to engage in physical activity. The study objectives were to: 1) describe active transportation policies, programs, and built environments of Canadian schools and their surrounding neighbourhoods, and 2) document variations based on urban-rural location and school type (primary vs. secondary vs. mixed primary/secondary schools). Methods: 397 schools from across Canada were studied. A school administrator completed a questionnaire and responses were used to assess schools' policies and programs related to active transportation and the safety and aesthetics of their respective neighbourhoods. Built environment features in a 1 km-radius circular buffer around each school were measured using geographic information systems. Results: Greater than 70% of schools had passive policies (e.g., skateboards permitted on school grounds) and facilities (e.g., bicycle racks in secure area to avoid theft) to encourage bicycle and small-wheeled vehicle use. Less than 40% of schools had active programs designed to encourage active transportation, such as organized 'walk to school' days. Garbage in the streets, crime and substance abuse were barriers in most school neighbourhoods. Approximately 42% of schools were located on high-speed roads not amenable to active transportation and 14% did not have a sidewalk leading to the school. Secondary schools had less favourable active transportation policies/programs and neighbourhood safety/aesthetics compared to primary schools. Rural schools had less favourable built environments than urban schools. Conclusion: Canadian children, particularly those from rural areas, face a number of impediments to active transportation as a method of travelling to school.
A 37-year-old man presented with a 7-month history of vertigo, nausea, dysphagia, right-sided tinnitus, and hearing loss. He denied headache, paresthesias, change in vision, or problems with cognition. He endorsed a history of progressive fatigue, generalized weakness, and poor libido. His symptoms left him functionally impaired and bedridden.His medical history was remarkable for dyslipidemia, obesity hypoventilation syndrome, nephrolithiasis, and an episode of bilateral anterior uveitis 6 years prior. In addition, he had been in a motor vehicle collision that caused a facial degloving injury requiring multiple operations, leaving the patient with vision loss in his left eye.On examination, the patient was morbidly obese with extensive scarring on the left side of his face. There was decreased visual acuity and left exotropia. The right pupil was dilated with a sluggish response to light. The left pupil could not be reliably examined due to the changes from his prior facial degloving injury. There was also lower lid scarring on the left with lagophthalmos, again secondary to his prior injury. The right lid was normal. There was a mild left-sided facial weakness in a lower motor neuron pattern. His speech was dysarthric. Examination of the remaining cranial nerves (CNs) was normal. Strength was 5/5 in the upper extremities bilaterally and 41/5 in the lower extremities bilaterally. Muscle bulk and tone were normal, as were coordination and fine motor movements. Sensation and reflexes were intact. Romberg test was negative. Bilateral sensorineural hearing loss, mild to moderate on the left and moderate to severe on the right, was confirmed objectively with audiometry.
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