Factors associated with bicycle helmet use and proper fit: a cross-sectional survey of Montreal cyclists during the COVID-19 pandemic

OBJECTIVES

With increased bicycle use during the COVID-19 pandemic and growing availability of bicycle-sharing programs in Montreal, we hypothesize helmet use has decreased. The aim of this study was to evaluate helmet use and proper fit among Montreal cyclists during the pandemic relative to historical data.

METHODS

Nine observers collected data on bike type, gender, helmet use, and ethnicity using the iHelmet© app at 18 locations across the island of Montreal from June to September 2021. Proper helmet wear was assessed at one busy location. Multiple logistic regression was used to identify factors associated with helmet wear and results were compared to a historical study.

RESULTS

Of the 2200 cyclists observed, 1109 (50.4%) wore a helmet. Males (OR = 0.78, 95%CI = 0.65-0.95), young adults (OR = 0.65, 95%CI = 0.51-0.84), visible minorities (OR = 0.38, 95%CI = 0.28-0.53), and bike-share users (OR = 0.21, 95%CI = 0.15-0.28) were less likely to be wearing a helmet, whereas children (OR = 3.92, 95%CI = 2.17-7.08) and cyclists using racing bicycles (OR = 3.84, 95%CI = 2.62-5.62) were more likely to be wearing a helmet. The majority (139/213; 65.3%) of assessed cyclists wore properly fitting helmets. Children had the lowest odds of having a properly fitted helmet (OR = 0.13, 95%CI = 0.04-0.41). Compared to 2011, helmet use during the pandemic increased significantly (1109/2200 (50.4%) vs. 2192/4789 (45.8%); p = 0.032).

CONCLUSION

Helmet use among Montreal cyclists was associated with age, gender, ethnicity, and type of bicycle. Children were least likely to have a properly fitted helmet. The recent increase in popularity of cycling and expansion of bicycle-sharing programs reinforce the need for bicycle helmet awareness initiatives, legislation, and funding prioritization.

Major Perioperative Complications of Benign Gynecologic Procedures at a University-Affiliated Hospital

Background: With the increasing use of minimally invasive techniques for gynecologic procedures, women are at a low risk for peri-operative complications. The purpose of this study was to determine the incidence of and risk factors for major intra or postoperative complications among women undergoing benign gynecologic surgeries. Methods: We conducted a retrospective observational study of all women who underwent benign gynecologic surgery in 2016-2017 at a University-Affiliated community hospital. Pregnant women, malignancy cases, and hysteroscopic or minor vulvar procedures were excluded. Primary outcome was composite intraoperative and/or 30-day postoperative complications requiring medical or surgical management. Logistic regression identified significant patient, peri-operative and surgeon risk factors associated with complications. Results: Of 975 patients included, 53 patients experienced major intra or postoperative complications (5.4%). Mean age was 47.7 ± 13.8 years. Mean BMI was 27.1 ± 5.8 kg/m2. Prior abdominal surgery (laparotomy or laparoscopy) (adjusted odds ratio [OR]= 2.01, 95%CI 1.05-3.83) and emergency surgery (adjusted OR= 19.54, 95%CI 2.99-127.54) were significantly associated with major complications. Surgeon volume of 1-2 operative days per month (adjusted OR=0.30, 95%CI 0.10 - 0.87) and age 40-64 years (adjusted OR=0.24, 95%CI 0.11- 0.56) had a protective effect on the risk of major complications. Conclusions: Among patients in our sample, 5.4% experienced major complications from a benign gynecologic surgery. Complications from benign gynecologic surgery are rare, even in the absence of robotic equipment. Center-specific data and a discussion of the increased morbidity associated with with prior abdominal surgery and emergency surgery should be considered for pre-operative patient counselling.

Incidence and risk factors for autism spectrum disorder among infants born <29 weeks' gestation

OBJECTIVE

This study was aimed to assess the incidence of and risk factors for autism spectrum disorder (ASD) among preterm infants born <29 weeks' gestational age (GA).

METHODS

A retrospective cohort study of infants born <29 weeks' GA admitted to two tertiary neonatal intensive care units (2009 to 2017) and followed ≥18 months corrected age (CA) at a neonatal follow-up clinic. The primary outcome was ASD, diagnosed using standardized testing or provisional diagnosis at ≥18 months CA. Patient data and 18-month CA developmental outcomes were obtained from the local Canadian Neonatal Follow Up Network database and chart review. Stepwise logistic regression assessed factors associated with ASD.

RESULTS

Among 300 eligible infants, 26 (8.7%) were diagnosed with confirmed and 21 (7.0%) with provisional ASD for a combined incidence of 15.7% (95% confidence interval [CI] 11.7 to 20.3). The mean follow-up duration was 3.9 ± 1.4 years and the mean age of diagnosis was 3.7 ± 1.5 years. Male sex (adjusted odds ratio [aOR] 4.63, 95% CI 2.12 to 10.10), small for gestational age status (aOR 3.03, 95% CI 1.02 to 9.01), maternal age ≥35 years at delivery (aOR 2.22, 95% CI 1.08 to 4.57) and smoking during pregnancy (aOR 5.67, 95% CI 1.86 to 17.29) were significantly associated with ASD. Among ASD infants with a complete 18-month CA developmental assessment, 46% (19/41) had no neurodevelopmental impairment (Bayley-III<70, deafness, blindness, or cerebral palsy).

CONCLUSIONS

ASD is common among infants born <29 weeks' GA and possibly associated with identified risk factors. Such findings emphasize the importance of ASD evaluation among infants <29 weeks' GA and for continued reporting of developmental outcomes beyond 18-months of corrected age.

72 Identifying Perinatal and Neonatal Factors Associated with Autism Spectrum Disorder among Preterm Infants Born &lt; 29 Weeks’ Gestation

Primary Subject area

Neonatal-Perinatal Medicine

Background

Preterm infants born &lt;29 weeks’ gestational age (GA) are at risk for autism spectrum disorder (ASD), typically diagnosed at age &gt;2 years. Perinatal and neonatal factors, including interventions and morbidities during neonatal intensive care unit admission, may contribute to the risk of ASD among these infants.

Objectives

We aimed to assess the incidence of and risk factors for, ASD among preterm infants born &lt; 29 weeks’ GA.

Design/Methods

&lt;29 weeks’ GA admitted 2009-2017 to two tertiary NICUs and followed ≥18 months at the Neonatal Follow-Up Clinic. Primary outcome was ASD defined as a confirmed diagnosis using standardized testing or suspected diagnosis at &gt;18 months of corrected age. Patient data and 18-month developmental outcomes were obtained from the local Canadian Neonatal Follow Up Network database and from chart review. Stepwise logistic regression was used to identify significant perinatal, neonatal, and socio-economic factors associated with ASD.

Results

Among 300 eligible infants, 47 (15.7%) developed ASD (Figure 1, Table 1). Mean follow-up duration was 3.9 ± 1.4 years and mean age at diagnosis was 3.7 ± 1.5 years. Male sex (adjusted odds ratio [aOR] 4.63, 95% CI 2.12, 10.10), small for gestational age status (aOR 3.03, 95% CI 1.02, 9.01), maternal age ≥ 35 years at delivery (aOR 2.22, 95% CI 1.08, 4.57), and tobacco use in utero (aOR 5.67, 95% CI 1.86, 17.29) were significantly associated with ASD. Major neonatal morbidities (retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, late-onset sepsis, severe neurological injury) were not associated with ASD. Among infants with a complete 18-month corrected age developmental assessment and later diagnosed with ASD, 46% (19/41) did not have significant neurodevelopment impairment (Bayley-III &lt; 70, deafness, blindness, or cerebral palsy).

Conclusion

ASD is a significant morbidity among infants born &lt; 29 weeks’ GA. ASD was associated with infant and prenatal risk factors but not with neonatal morbidities or socio-economic factors. These findings emphasize the need for ASD evaluation among preterm infants &lt; 29 weeks and for reporting developmental outcomes beyond 18-months corrected age.