Dr. Abu-Laban is an emergency physician at the Mineral Springs Hospital, Banif Alta. Reprint requests ... 90% of North America's ski resorts.3 In 1989 there were some ... active in competitions. In the late ..... it is not surprising that such injuries were absent. Another ..... (cosponsors include the Canadian Cancer Society and.
ORIGINAL RESEARCH * NOUVEAUTES EN RECHERCHE
Snowboarding injuries: an analysis and comparison with a pine skiing injuries Riyad B. Abu-Laban, MD Objective: To analyse the types and causes of injuries associated with recreational snowboarding and to compare these with the injuries seen in alpine skiing. Design: Prospective case series. Setting: Rural hospital near three large ski resorts. Patients: All people presenting to the Emergency Department with an injury caused by snowboarding during two ski seasons (1988-90). Of the 115 injured snowboarders identified, 73 (63%) completed the questionnaire. Information on the other patients was obtained from the hospital emergency records. Information was also obtained on seven alpine skiers who collided with snowboarders. Results: Of the snowboarders 87 (76%) were male, and the mean age was 20.3 years. A total of 132 injuries were documented. Of the respondents to the questionnaire 83% reported that their fitness level was excellent or above average, 36% had never been on a snowboard previously, 25% were in their first year of snowboarding, 39% reported excellent snow conditions, 59% reported light traffic on the hill, and 7% had consumed alcohol before their accident. Injuries were equally divided between the upper body and the legs, 75% of the lower-limb injuries involving the left (lead) leg. Significant differences were noted between the pattern of injuries in snowboarding and alpine skiing: snowboarders were less likely to have lacerations (0% v. 8% respectively), boot-top contusions (0% v. 4%), thumb injuries (1% v. 10%) and knee sprains (14% v. 27%) and more likely to have spinal injuries (12% v. 4%), foot or ankle injuries (28% v. 5%) and distal radius fractures (10% v. 1%). Conclusions: Snowboarding is associated with a unique pattern of injuries, the knowledge of which could influence snowboarder education, accident prevention and equipment design. Additional research is needed to understand better the types, causes and rates of injury associated with snowboarding.
Objectif: Analyser les types et les causes de blessures reliees au monoski recreatif et les comparer avec les blessures observees en ski alpin. Conception: Serie prospective de cas. Contexte: H6pital rural a proximite de trois stations de ski. Patients: Toutes les personnes qui se presentent au service d'urgence avec une blessure causee par le monoski au cours de deux saisons de ski (1988-1990). Parmi les 115 monoskieurs blesses, 73 (63 %) ont rempli le questionnaire. Les renseignements sur les autres patients proviennent des archives du service d'urgence de l'h6pital. Des renseignements ont aussi e obtenus aupres de sept skieurs alpins qui sont entres en collision avec des monoskieurs. Resultats: Quatre-vingt-sept monoskieurs (76 %) etaient des hommes, et l'age moyen etait de 20,3 ans. Au total, 132 blessures ont etc documentees. Parmi les repondants au Dr. Abu-Laban is an emergency physician at the Mineral Springs Hospital,
Banif Alta.
Reprint requests to: Dr. Riyad B. Abu-Laban, Mineral Springs Hospital, PO Box 1050, Banff AB TOL OCO NOVEMBER 1, 1991
CAN MED ASSOC J 1991; 145 (9)
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questionnaire, 83 % estimaient que leur condition physique etait excellente ou au-dessus de la moyenne, 36 % n'avaient jamais utilise de monoski precedemment, 25 % en etaient a leur premiere annee de monoski, 39 % ont signale une excellente qualite de neige, 59 % ont mentionne une circulation legere sur la pente et 7 % avaient consomme de l'alcool avant l'accident. Les blessures etaient egalement reparties entre le haut du corps et les jambes, 75 % des blessures aux membres inferieurs touchaient la jambe gauche (avant). Des differences significatives ont ete notees entre les blessures causees par le monoski et le ski alpin: les monoskieurs sont moins exposes aux lacerations (O % contre 8 % respectivement), aux contusions causees par la hausse d'une botte (O % contre 4 %), aux blessures du pouce (1 % contre 1O %) et aux entorses du genou (14 % contre 27 %), et ils risquent davantage de subir des traumatismes de la colonne vertebrale (12 % contre 4 %), des blessures au pied ou a la cheville (28 % contre 5 %) et des fractures de l'articulation radio-cubitale distale (1O % contre 1 %). Conclusions: Le monoski est relie a des blessures particulieres dont la connaissance pourrait influer sur la formation des monoskieurs, la prevention des accidents et la conception de l'equipement. II importe d'effectuer des recherches supplementaires pour mieux comprendre les types, les causes et les taux de blessures reliees au monoski. S nowboarding, with its youthful participants, flashy padded clothing and specialized vocabulary, stands in sharp contrast to the more established sport of alpine skiing. Snowboards resemble small surfboards with fixed straps to hold the feet in position. They are used with the arms held outward, and shifts in weight cause the board to turn, slow down or stop. The majority of snowboards do not have a releasable binding system, and snowboarders do not use ski poles. In Canada most snowboarders wear soft boots that are often reinforced with hpavy tape or inserts. There has recently been an increased use of hard-shell special-
alpine skiing. It was thought that the knowledge gained from such an analysis could influence not only snowboarder education and accident prevention but also equipment design and perhaps the evolution of the sport.
Methods
The Mineral Springs Hospital is a 20-bed facility in Banff (population 5084 [in 1988]). It treats some 13 000 patients in the Emergency Department annually; about 10% of them have ski-related injuries. Banff National Park, Canada's oldest and most heavily visited national park, is an ideal location for ized footwear. There have been reports of crude "ski boards" studying snowboarding injuries, since there are three and "snurfers" from as early as 1963,12 but it has major ski resorts (representing some 800 000 skierbeen only in the last 5 years that the sport of days per year) within a short distance from the town snowboarding has grown and become popular at a of Banff. In addition, Banff hosted the 1984, 1988 phenomenal rate. Although viewed by many as a and 1991 North American snowboarding championpassing craze snowboards are now accepted at over ships. From November to May of 1988-89 and 198990% of North America's ski resorts.3 In 1989 there were some 1.5 million snowboarders worldwide, 40% 90 all people who presented to the Emergency of whom were in North America.3 This number was Department with an injury caused by snowboarding double that of the previous ski season, and thus were included in the study. The diagnoses were snowboarding has been touted as "the fastest grow- made by the emergency physician on call. In addiing winter sport in the world."3 Given the sport's tion, information was gathered on any alpine skier popularity it is noteworthy that there has been only who presented with an injury caused by colliding one published medical study on snowboarding inju- with a snowboarder. Whenever possible, a 23-item questionnaire was ries.4 The study was retrospective and surveyed by the injured snowboarder at either the completed and were who experienced mostly snowboarders hospital or the ski resort. Included were questions on active in competitions. In the late 1980s the Emergency Department at the person's marital status, educational or employMineral Springs Hospital, Banff, Alta., began to ment status, involvement with other sports, perhandle increasing numbers of injured snowboarders. ceived fitness level, degree of snowboard experience This experience led to the suspicion that the sport is and history of snowboarding accidents, as well as the associated with a unique pattern of injuries. A study circumstances of the accident: the snow conditions, was thus conducted between 1988 and 1990 to temperature, traffic on the ski hill, time of the determine the types of injuries seen in snowboarding accident, whether the accident was the snowboardand the factors influencing those injuries and to er's fault and whether any alcohol had been concompare them with the types of injuries seen in sumed before the accident. 1098
CAN MED ASSOC J 1991; 145 (9)
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1
A binomial probability distribution was used to determine the significance of variation in the side of injury among the snowboarders. A two-dimensional table and a test based on the z statistic5 were used to compare the snowboarders and the alpine skiers, with assumed equal variances. The minimum accepted level of statistical significance was 0.01.
Results In all, 115 injured snowboarders (87 males) presented to the Emergency Department during the study period; 73 (63%) completed the questionnaire, and information was gathered from the emergency records for the remaining 42 (37%). The predominant reasons for not completing the questionnaire were other responsibilities or forgetfulness on the part of the emergency staff. None of the snowboarders refused to complete it when asked. The age of the 1 1 5 snowboarders varied from 12 to 35 (mean 20.3) years. Table 1 summarizes the responses of those who completed the questionnaire. There were seven documented cases in which alpine skiers had collided with snowboarders. Most of the skiers' injuries were mild sprains or contusions, although one 18-year-old had a fractured tibia and fibula after reportedly being "cut off" by a snowboarder. Table 2 shows the injuries of the snowboarders. In some cases patients had more than one injury (132 injuries in the 115 snowboarders); thus, the incidence rate of a particular injury was calculated on the basis of all injuries rather than the total number of patients seen. In Table 3 the results of this study are compared with the data from the final 2 years (1986 and 1987) of a large study of alpine ski injuries that was performed over a 15-year period.6 The raw data from the final 2 years, generously provided by the authors, were used to avoid any skewing caused by the changing injury pattern in skiing over the 15-year study period.
Discussion The findings suggest that snowboarding injuries usually involve young, well-conditioned males. This is consistent with other sources, which indicate that snowboarders are predominantly young males.3 Not surprisingly, most of the snowboarders reported that they were also skiers. As with alpine skiing7 most of the injuries occurred in the afternoon, when fatigue was likely. The proportion of snowboarders reporting a history of snowboarding injuries, 26%, is consistent with the proportion of alpine skiers reporting previous skiing injuries.7 NOVEMBER 1, 1991
Interestingly, 39% of the snowboarders reported "excellent" snow conditions, 59% reported "light" traffic on the ski hill, and only 7% reported alcohol consumption before their injury. These figures suggest that many of the injuries were caused by the individual snowboarder rather than by those factors; Table 1: Characteristics of snowboarders who responded to a questionnaire on the circumstances surrounding their injury
Characteristic Marital status (n 73) Single Married Other Educational or employment status (n = 73) Student Employed Other Other sport involvements (n - 73) Alpine skiing Mountain biking Motorcycling Mountain climbing Scuba diving Perceived fitness level (n 64) Poor Average Above average Excellent Previous experience snowboarding (n -73) First time ever First year More than 1 yr History of snowboarding accidents
(n = 73)
Yes No Snow conditions (n = 72) Excellent Good Fair Poor Temperature conditions (n - 69) Warm (> 0°C) Cold (- 150C to 0°C) Very cold(< - 15C) Traffic on ski hill (n - 70)
Light Moderate Heavy Time of accident (n 69) Before 12 pm After 12 pm Accident was snowboarder's fault
(n = 73)
Yes No Alcohol consumed before the accident (n 73) Yes No
No. (and %) of respondents 65 (89) 6 (8) 2 (3)
35 (48) 35 (48) 3 (4)
60 42 26 15 12
(82) (58) (36) (20)
1 10 33 20
(2) (16) (52) (31)
(16)
26 (36) 18 (25) 29 (40) 19 (26) 54
(74)
28 20 18 6
(39) (28) (25) (8)
34
(49)
31 (45) 4 (6)
41 (59) 24 (34) 5 (7) 12 (17)
57 (83) 64 (88) 9 (12)
=
5 (7) 68 (93)
CAN MED ASSOC J 1991; 145 (9)
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._ ~
this is supported by the finding that 88% stated that though such a high rate of injuries in first-time skiers the accident was their fault. has not been reported. Since most of the snowboardPerhaps most noteworthy is that 36% of those ers were also alpine skiers many novice snowboardsurveyed had never been on a snowboard previously, ers may have exceeded the limits of their skill by and another 25% were in their first year of the sport. snowboarding on terrain that they would have felt This likely reflects the sport's recent popularity, but comfortable on with skis. it also strongly suggests that beginners, particularly those on a board for the first time, are most prone to Snowboarding and alpine skiing injuries injury. Likewise, an increased risk of injury among It seems natural to compare snowboarding injubeginner alpine skiers has been documented,7'8 alTable 2: Snowboarding injuries by type and area of body
Area of body Head and neck Head or face Neck Left arm
4 (3) 1 (1) 2 (2) -1 (1)
1 0 (8) 2 (2)
19 (14) 1 (1) 5 (4)
Right-sided renal contusion Splenic rupture
Death (avalanche) Total
1991; 145 (9)
Dislocation
0
1
4
O
0 0
0 0 0
0 4
3
0
1
O
o
0
O
1
1
0
7
0
1
0
1
0
1
0
o
0
0 01.1
1 (1)
1
2 0 0 4 0 0
O
o
0
^
0
10 (8) 1 (1) 16 (12) 2 (2) 1 (1) 6 (5) 6 (5) 1 (1)
0
4 0
6
O
0 0
2
0 0 2 0 0
O O
0 0
2
0
1
0
0
o
0
4 4
0
49 (37)* 2 (2)
4
(1)
0 2 0
16 (12)* 0 0 6 (5)* 0 9 (7)* 1 (1) 3 (2)
2
2
13 0 20 0
o O 1
7
0
0
0
0
O
0
5
o
a
7 1
2
1
0 0
o
0
o
1 (1) 1 (1)
1 (1)
132
..cm aio of le an ri s 0.001 comparison of left and right side variation.
CAN MED ASSOC J
Fracture
1
1 (1)
15 (11)W 1 (1 ) 28 (21)* 2 (2)
Knee Lower leg Ankle Foot Other
or strain
0
0 0
1
Knee Lower leg Ankle Foot Right leg Hip Thigh
1100
Contusion
6 (5) 2 (2) 4 (3) 23 (17) 3 (2)
Shoulder Upper arm Elbow Forearm Wrist Hand Right arm Clavicle Shoulder Upper arm Elbow Forearm Wrist Hand CJentral body Chest Trunk Back Coccyx or sacrum Pelvis Left leg
*p
Sprain
Total
Clavicle
Hip Thigh
No. (and %/o) of injuries
25 (19)
68 (52)
34 (26)...........................
68 (52)
34 (26)
2 (2)
LE 1 er NOVEMBRE 1991
ries with those seen in alpine skiing, a sport that uses the same facilities and that has a well-documented pattern of injuries.6'9-" It is clear from Table 3 that the patterns of injury caused by snowboarding and skiing are distinctly different. Snowboarding accidents are characterized by wrist, -spinal and ankle injuries, a significant propensity toward injuries to the left rather than the right leg and a low incidence rate of lacerations and thumb injuries. Many of the differences between the injury patterns have likely explanations. It has been well established in alpine skiing that the ski's edge, once the binding has released, is responsible for most lacerations.'2 The fact that no lacerations were noted in the snowboarders is presumably due to the nonreleasable nature of most snowboard binding systems. The ski pole is integral in causing the typical "skier's thumb" injury to the ulnar collateral ligament of the first metacarpophalangeal joint.'3"'4 Since there is usually no pole used in snowboarding it is not surprising that such injuries were absent. Another distinction is the incidence rate of spinal trauma. The manner of riding probably puts snowboarders at greater risk for falling backward and thus for axial-loading injuries, a conclusion also reached by Pino and Colville.4 Such injuries are comparatively less common in alpine skiing, likely because most accidents involve a forward fall.'5 For example, the incidence rate of coccyx injuries is between 0.15% and 0.30% in alpine skiing,'6 as compared with the 4.6% in snowboarding found in this study. Arm injuries are another area that may be
related to the manner of falling, since snowboarders had a high incidence rate of distal forearm fractures. Although there were fewer shoulder dislocations in snowboarding this difference was not significant. However, the sport may prove to have a lower incidence rate of shoulder dislocations than alpine skiing because of the absence of ski poles, which are thought to contribute to some 24% of such injuries in skiers.'7 There is a dramatic difference in the distribution of lower-leg injuries, ankle and foot injuries predominating in the snowboarders and knee and boot-top injuries in the skiers. This difference is best explained by the comparatively reduced protection of the soft boots commonly used by snowboarders. The benefit of such boots is that they likely prevent the significant stress on the leg that causes contusions or fractures. In addition, the fixed binding of both feet to a snowboard likely decreases the possibility of valgus stress on the knee, a frequent cause of medial ligamentous injury in alpine skiing. Many studies have shown a change in the types of lower-leg injuries seen in alpine skiing during the last 50 years.6"'0"'8 '9 This change is related to a move from soft boots and fixed bindings to stiff boots and releasable bindings. In 1942, 46% of alpine skiing injuries involved the foot and ankle; by 1976 the rate had dropped to 7%.10 However, the incidence rate of tibial fractures increased, from 3% in 1942 to 16% in 1964, and then decreased to 6% in 1976, presumably because of refinements in binding systems. The incidence rate of knee injuries from alpine skiing has remained relatively stable through the years,'0 although the pattern has changed dramatically: the
Table 3: Comparison of injuries caused by skiing and snowboarding
Sport; no. (and %) of injuries
Injury Upper body Head injury Spinal injury* Trunk injury Thumb injury* Distal radius fracture* Shoulder dislocation Other* Legs Tibial fracture Boot-top contusion* Knee sprain* Ankle sprain* Foot or ankle fracture*
Laceration*
Skiing6 (n= 697)
320 (46) 32 (5) 29 (4) 25 (4) 67 (10) 6 (1) 17 (2) 84 (12) 377 (54) 21 (3) 29 (4) 187(27) 20 (3) 11 (2) 58 (8)
Snowboarding (n - 132) 66 (50) 2 (2) 16 (12) 4 (3) 1 (1) 13 (10) 1 (1) 27 (20) 65 (49) 1 (1) 0 18(14) 27 (20) 10 (8) 0
*p < 0.01, comparison between the two sports.
NOVEMBER 1, 1991
CAN MED ASSOC J 1991; 145 (9)
1101
incidence rate of anterior cruciate injuries has increased, and there has been a propensity toward complete ligamentous tears.20 One could speculate that the changing pattern of leg injuries in alpine skiing may occur in snowboarding. Although ankle injuries were predominant in snowboarding, this pattern could change if the more rigid boots popular in other countries are substituted for the soft boots currently used in Canada. In addition, snowboard technology is changing rapidly. Should a reliable releasable binding system appear on the market the nature of leg injuries could completely change. Of the 37 ankle injuries caused by snowboarding 28 (76%) occurred on the left side, as did 15 (7 1%) of the 21 knee injuries. This is presumably because most snowboarders use a left-foot lead on the board, and the lead foot is more prone to injury, a conclusion also reached by Pino and Colville.4 (A right lead is known as a "goofy foot" in the vernacular of snowboarding.) Unfortunately, the snowboarders were not questioned regarding their stance, since this factor was not anticipated when the questionnaire was designed. A final area in which the pattern of injuries may differ between snowboarding and alpine skiing is femoral fractures. Such fractures are known to account for 0.6% of alpine ski injuries;2' thus, given the number of injuries seen, one might have expected to see at least one such injury in this study (although its absence is not statistically significant). Interestingly, Pino and Colville4 found no femoral fractures in 1 10
snowboarding injuries. It has been established that the speed of travel directly influences the incidence of femoral fractures in alpine skiing.22 Such injuries may prove to be less common in snowboarding simply because snowboarders often travel at significantly slower speeds than alpine skiers. This could change as more snowboarders become experienced and increase their speed on steeper hills.
Risk of snowboarding-related injury
accidents resulting in more than very minor injuries, the rate of injury per 1000 snowboarder-days was 8.0 to 16.0. Although this rate is higher than the corresponding rate of 2 to 7 injuries per 1000 alpine skier-days'0 it was calculated on the basis of limited data. This study suffered from several design limitations. More specific questions regarding speed, boot type, foot position and injury mechanisms would have strengthened the findings. The absence of this information results in some of the above conclusions being speculative. In addition, a method of determining the total number of snowboarders at a resort over a specific period, correlated with the number of injuries, would provide a more accurate estimate of the injury rate.
Conclusions This study represents the first known analysis of the types, patterns and causes of injuries in recreational snowboarders. Snowboarding is clearly associated with a different pattern of injuries than alpine skiing, and this pattern may change with the evolution of the sport. The boots, boards and binding systems used in snowboarding have changed a great deal during the last 5 years and will probably continue to do so. In addition, many ski areas are constructing "half pipes" (specialized runs for aerial manoeuvres) for use by experienced snowboarders. These changes, along with an expected decrease in the proportion of novice snowboarders, may well influence the types, patterns and incidence of injuries. The evidence suggests that snowboarding is associated with a higher risk of injury than alpine skiing; however, this could be attributed to the proportionally greater number of novice snowboarders. The need remains for a large study to assess accurately the risk of injury in snowboarding, though it is certainly clear that there is a high risk of injury during one's first day on a snowboard. Lessons before one attempts snowboarding could reduce this risk and should be encouraged. As with any new sport further research will help to provide a better understanding of snowboarding injuries. Research could be directed toward determining the exact mechanism of accidents and the variation in injury types and patterns with changes in equipment, rider ability and technique. Further knowledge could influence equipment design, snowboarder training and ski resort regulations in order to ensure that snowboarding is both safe and enjoyable.
It seems commonly assumed that the manner of riding a snowboard, without ski poles or a releasable binding system, leads to an increased risk of injury. The true risk is difficult to assess, since for various reasons most ski resorts do not record the daily number of snowboarders. On the basis of information from the ski industry and snowboard merchants estimates of the average number of snowboarders at the three ski resorts in the Banff area during the study period varied from 20 to 40 per day (7200 to 14 400 snowboarderdays). Given the number of accidents this study I thank the medical, nursing, administrative and health identified, which probably represents most of the records staff of the Mineral Springs Hospital for making 1102
CAN MED ASSOC J 1991; 145 (9)
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this study possible. I also thank the ski patrol staff at Sunshine Village, Lake Louise and Mount Norquay, Edward Shihadeh for his statistical assistance and Dr. Christopher Evans for his proofreading and buggestions.
References 1. Sims' scrapbook. Transworld Snowboarding 1988; winter. 36 2. Kinnear K: Burton scrapbook. Transworld Snowboarding 1989; 2 (3): 36 3. Industry Statistics Sheet, National Snowboard Inc, Englewood, Colo, 1990 4. Pino EC, Colville MR: Snowboard injuries. Am J Sports Med 1989; 17: 778-781
5. Fienberg SE: The Analysis of Cross-Classified Categorical Data, 2nd ed, MIT Pr, Cambridge, Mass, 1981: 8-9 6. Johnson RJ, Ettlinger CF, Shealy JE: Skier injury trends. In Skiing Trauma and Safety: Seventh International Symposium (standard tech publ 1022), American Society for Testing and Materials, Philadelphia, 1989: 25-31 7. Young LR, Oman CM, Crane H et al: The etiology of ski injuries: an 8 year study of the skiier and his equipment. Orthop Clin North Am 1976; 7: 15-18
8. Johnson RJ, Ettlinger CF, Campbell RJ et al: Trends in skiing injuries: analysis of a 6-year study (1972-1978). Am J Sports Med 1980; 8: 106-113 9. Eriksson E: Ski injuries in Sweden: a one year survey. Orthop Clin North Am 1976; 7: 3-9
10. Johnson RJ, Ettlinger CF: Alpine ski injuries: changes through the years. Clin Sports Med 1982; 1: 181-197 11. Tapper EM: Ski injuries from 1939 to 1976: the Sun Valley experience. Am J Sports Med 1978; 6: 114-121 12. Colmey TG, Eck FJ: Skiing lacerations: preventability by the use of ski breaks. JAMA 1980; 244: 1699-1700 13. Primiano GA: Skiers' thumb injuries associated with flared ski pole handles. Am J Sports Med 1985; 13: 425-427 14. Gerber C, Senn E, Matter P: Skier's thumb. Am J Sports Med 1981; 9: 171-177 15. Marshall JL, Johnson RJ: Mechanisms of the most common ski injuries. Physician Sportsmed 1977; 5 (12): 49-54
16. Frymoyer JW, Pope MH, Kristianses T: Skiing and spinal trauma. Clin Sports Med 1982; 1: 309-318 17. Weaver JK:. Skiing-related injuries to the shoulder. Clin Orthop 1987; 216: 24-28 18. Matter P, Ziegler WJ, Holzach P: Skiing accidents in the past 15 years. J Sports Sci 1987; 5: 319-326 19. Genelin A, Horbst W: 25 years of alpine skiing. Aktuel Traumatol 1986; 16 (6): 213-220 20. Johnson RJ, Incavo SJ: Alpine Skiing Injuries. Winter Sports Medicine, Davis Co, Philadelphia, 1990: 351-358 21. Sahlin Y: Alpine skiing injuries. Br J Sports Med 1989; 23: 241-244 22. Yvars MF, Kanner MR: Ski fractures of the femur. Am J Sports Med 1984; 12: 386-390 NOVEMBER 1, 1991
Conferences continued from page 1096 Mar. 10-12, 1992: The Lyon Conference The Computer as a Partner: Human-Machine Interactions Lyon, France Solange Dubeauclard, 1030 N Glenhurst, Birmingham, MI 48009; (313) 647-7833 Mar. 30-Apr. 3, 1992: 8th World Conference on Tobacco OR Health - Building a Tobacco-Free World (cosponsors include the Canadian Cancer Society and the American Medical Association) Sheraton Buenos Aires Hotel, Buenos Aires, Argentina Secretariat, American Cancer Society, 1599 Clifton Rd. NE, Atlanta, GA 30329-4251; (404) 329-7638, fax (404) 325-2217 Apr. 3-5, 1992: 3rd International Conference on Geriatric Nephrology and Urology Royal York Hotel, Toronto
Abstract deadline is Jan. 15, 1992. Dr. D.G. Oreopoulos, Toronto Hospital (Western Division), 399 Bathurst St., Toronto, ON M5T 2S8; (416) 364-9974, fax (416) 360-8127 Du 7 au 9 mai 1992: ACOP '92 - La Recherche de la qualite de vie chez les patients, familles et professionels Universite Queen's, Kingston (Ont.) Association canadienne d'oncologie psychosociale, a/s Wendy Stewart, Centre regional de cancer a Kingston, rue King ouest, Kingston, ON K7L 2V7; (613) 544-8968, fax (613) 544-9708
May 7-9, 1992: CAPO '92 - The Quest for Quality of Life for Patients, Families and Professionals Queen's University, Kingston, Ont. Canadian Association of Psychosocial Oncology, c/o Wendy Stewart, Kingston Regional Cancer Centre, King Street W, Kingston, ON K7L 2V7; (613) 544-8968, fax (613) 544-9708 May 9-12, 1992: Council of Biology Editors 36th Annual Meeting Westin William Penn Hotel, Pittsburgh Council of Biology Editors, 200- 111 East Wacker Dr., Chicago, IL 60601-4298; (312) 616-0800 May 10-12, 1992: Canadian Life Insurance Medical Officers Association 47th Annual Meeting L'Hotel, Toronto Dr. L. Terence Scully, Confederation Life Insurance Co., 321 Bloor St. E, Toronto, ON M4W 1 H 1; (416) 323-8036 May 10-13, 1992: Canadian Long Term Care Association Annual Conference Holiday Inn Crowne Plaza, Winnipeg Canadian Long Term Care Association, 302-260 St. Patrick St., Ottawa, ON KIN 5K5; (613) 237-9837, fax (613) 237-6592
continued on page 1121 CAN MED ASSOC J 1991; 145 (9)
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