Almost half of homeless men had traumatic brain injury in their lifetime

Almost half of all homeless men who took part in a study by St. Michael’s Hospital had suffered at least one traumatic brain injury in their life and 87 per cent of those injuries occurred before the men lost their homes.While assaults were a major cause of those traumatic brain injuries, or TBIs, (60 per cent) many were caused by potentially non-violent mechanisms such as sports and recreation (44 per cent) and motor vehicle collisions and falls (42 per cent).The study, led by Dr. Jane Topolovec-Vranic, a clinical researcher in the hospital’s Neuroscience Research Program, was published today in the journal CMAJ Open.Dr. Topolovec-Vranic said it’s important for health care providers and others who work with homeless people to be aware of any history of TBI because of the links between such injuries and mental health issues, substance abuse, seizures and general poorer physical health.The fact that so many homeless men suffered a TBI before losing their home suggests such injuries could be a risk factor for becoming homeless, she said. That makes it even more important to monitor young people who suffer TBIs such as concussions for health and behavioural changes, she said.Dr. Topolovec-Vranic looked at data on 111 homeless men aged 27 to 81 years old who were recruited from a downtown Toronto men’s shelter. She found that 45 per cent of these men had experienced a traumatic brain injury, and of these, 70 per cent were injured during childhood or teenage years and 87 per cent experienced an injury before becoming homeless.In men under age 40, falls from drug/alcohol blackouts were the most common cause of traumatic brain injury while assault was the most common in men over 40 years old.Recognition that a TBI sustained in childhood or early teenage years could predispose someone to homelessness may challenge some assumptions that homelessness is a conscious choice made by these individuals, or just the result of their addictions or mental illness, said Dr. Topolovec-Vranic.This study received funding from the Canadian Institutes of Health Research and the Ontario Neurotrauma Foundation.Separately, a recent study by Dr. Stephen Hwang of the hospital’s Centre for Research on Inner City Health, found the number of people who are homeless or vulnerably housed and who have also suffered a TBI may be as high as 61 per cent — seven times higher than the general population.Dr. Hwang’s study, published in the Journal of Head Trauma Rehabilitation, is one of the largest studies to date investigating TBI in homeless populations. …

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Extremely preterm infants and risk of developing neurodevelopmental impairment later in childhood

Aug. 26, 2013 — A meta-analysis of previously reported studies by Gregory P. Moore, M.D., F.R.C.P.C., of The Ottawa Hospital, Ontario, Canada, and colleagues examined the rate of moderate to severe and severe neurodevelopmental impairment by gestational age in extremely preterm survivors followed up between ages 4 and 8 years, and determined whether there is a significant difference in impairment rates between the successive weeks of gestation of survivors.Share This:The search of English-language publications found nine studies that met inclusion criteria of being published after 2004, a prospective cohort study, follow-up rate of 65 percent or more, use of standardized testing or classification for impairment, reporting by gestation, and meeting prespecified definitions of impairment. Researchers then extracted data using a structured data collection form and investigators were contacted for data clarification.According to the study results, all extremely preterm infant survivors have a substantial likelihood of developing moderate to severe impairment. Wide confidence intervals at the lower gestations (eg. at 22 weeks, 43 percent) and high heterogeneity at the higher gestations (eg. at 25 weeks, 24 percent) limit the results. There was a statistically significant absolute decrease in moderate to severe impairment between each week of gestation.”Knowledge of these data, including the limitations, should facilitate discussion during the shared decision-making process about care plans for these infants, particularly in centers without their own data,” the study concludes.Share this story on Facebook, Twitter, and Google:Other social bookmarking and sharing tools:|Story Source: The above story is based on materials provided by American Medical Association (AMA), via Newswise. Note: Materials may be edited for content and length. For further information, please contact the source cited above. …

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Topical analgesic may provide pain-free ‘skin glue’ repair of cuts in children

July 29, 2013 — More than 50% of children who were given a topical analgesic had no pain during wound repair with “skin glue,” according to the results of a randomized controlled trial reported in CMAJ (Canadian Medical Association Journal).Tissue adhesive or “skin glue” is regularly used in pediatrics to repair minor cuts but can cause pain or a burning sensation.Researchers conducted a randomized controlled trial to determine whether preapplication of lidocaine-epinephrine-tetracaine would decrease pain in children undergoing repair of minor cuts with tissue adhesive. The trial involved 221 children aged 3 months to 17 years who sought care at an academic hospital’s pediatric emergency department in 2011 and 2012.Children aged 7 or older rated their own pain using the Faces Pain Scale — Revised, a scale that helps children communicate pain using images with facial expressions; parents or guardians rated the perceived pain of younger children. In the treatment group, 51% of children reported no pain compared with 28% in the placebo group.”Perhaps the most meaningful outcome for parents and children facing acute pain in the emergency department is how likely a procedure is to be completely pain free,” writes Dr. Stuart Harman, Division of Emergency Medicine, University of Ottawa and the Ottawa Hospital Research Institute. “More than half of the patients who received lidocaine-epinephrine-tetracaine in our study (or their parents or guardians) reported no pain during adhesive application, which was nearly double the proportion of pain-free procedures reported in the placebo group.”As well, wound hemostasis was rated complete by physicians in 78% of the treatment group compared with 59% in the placebo group.The authors suggest early application of the analgesic to all minor cuts regardless of whether they need sutures or tissue adhesives.”Taken together with our finding that this analgesic reduces pain in tissue repairs using adhesive and improves the likelihood of a painless procedure, early application of lidocaine-epinephrine-tetracaine to all minor lacerations awaiting definitive physician repair could be a practical method of decreasing children’s pain during these procedures,” write the authors.

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