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Concussion may increase risk for mental health issues in youth – Healio

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March 10, 2022

2 min read

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Disclosures:
Ledoux and Babikian report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Concussion was linked to increased risk for mental health issues, psychiatric hospitalization and self-harm among youths aged 5 to 18 years, according to results of a population-based retrospective cohort study.

“Few studies have rigorously examined associations between concussion and risk of psychopathology, new onset of psychiatric disorders or long-term [mental health problems],” Andrée-Anne Ledoux, PhD, of the Children’s Hospital of Eastern Ontario Research Institute in Canada, and colleagues wrote.

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“The studies that investigated these associations lacked adequate sample size; had heterogeneous population samples, including more severe [traumatic brain injuries]; or had small or no comparison groups.

“Some studies did not adjust for important covariates, such as prior [mental health problem], making it difficult to discern whether concussions precipitated new mental health symptoms or psychiatric disorders.”

Ledoux and colleagues aimed to examine links between concussion and risk for subsequent mental health problems, psychiatric hospitalizations, self-harm or suicides among youth with a concussion or orthopedic injury that occurred between April 1, 2010, and March 31, 2020, in Ontario. Participants did not have a prior mental health visit in the year before the index event, as well as no prior concussion or traumatic brain injuries in the 5 years before the index visit.

Researchers collected data from provincewide health administrative databases and included participants with concussion (n = 152,321; median age, 13 years; 56.7% male) in the exposed group and those with an orthopedic injury (n = 296,482; median age, 13 years; 57.9% male) in the comparison cohort.

Researchers matched these groups in a 1:2 ratio, respectively, on age and sex. Mental health problems, including psychopathologies and psychiatric disorders, identified from health care visits in EDs, hospitalizations or primary care settings, served as the primary outcome. Psychiatric hospitalizations, self-harm health care visits and death by suicide served as secondary outcomes.

Results showed incidence rates of any mental health problem of 11,141 per 100,000 person-years in the exposed group compared with 7,960 per 100,000 person-years in the unexposed group, with a difference of 3,181 (95% CI, 3,073-3,291) per 100,000 person-years.

Among the exposed group, researchers noted an increased risk for developing a mental health issue (adjusted HR = 1.39; 95% CI, 1.37-1.4), self-harm (aHR = 1.49; 95% CI, 1.42-1.56) and psychiatric hospitalization (aHR = 1.47; 95% CI, 1.41-1.53) after a concussion. They observed no statistically significant difference in death by suicide between exposed and unexposed groups (HR = 1.54; 95% CI, 0.9-2.61).

“Our results suggest that clinicians should assess for preexisting and new mental health symptoms throughout concussion recovery; treat mental health conditions or symptoms or refer the patient to a specialist in pediatric mental health; and assess suicidal ideation and self-harm behaviors during evaluation and follow-up visits for concussion,” Ledoux and colleagues wrote.

In a related editorial, Talin Babikian, PhD, ABPP, of the department of psychiatry and biobehavioral sciences at the University of California, Los Angeles, highlighted the takeaways of this study.

“When drawing on the literature on risk and protective factors associated with mental health, the potent common denominators that percolate to the top and have strong relevance in concussion management include a sense of safety and agency and sense of connection and belonging,” Babikian wrote. “Studies, such as the one presented by Ledoux et al, strengthen the association between mental health and concussion — and likely any other major disruption to a young person’s physiology and environment. The good news is that we are acknowledging this risk and paying attention.”

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RCMP warn about benzodiazepine-laced fentanyl tied to overdose in Alberta – Edmonton Journal

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Grande Prairie RCMP issued a warning Friday after it was revealed fentanyl linked to a deadly overdose was mixed with a chemical that doesn’t respond to naloxone treatment.

The drugs were initially seized on Feb. 28 after a fatal overdose, and this week, Health Canada reported back to Mounties that the fentanyl had been mixed with Bromazolam, which is a benzodiazepine.

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Mounties say this is the first recorded instance of Bromazolam in Alberta. The drug has previously been linked to nine fatal overdoses in New Brunswick in 2022.

The pills seized in Alberta were oval-shaped and stamped with “20” and “SS,” though Mounties say it can come in other forms.

Naloxone treatment, given in many cases of opioid toxicity, is not effective in reversing the effects of Bromazalam, Mounties said, and therefore, any fentanyl mixed with the benzodiazepine “would see a reduced effectiveness of naloxone, requiring the use of additional doses and may still result in a fatality.”

Photo of benzodiazepine-laced fentanyl seized earlier this year by Grande Prairie RCMP after a fatal overdose. edm

From January to November of last year, there were 1,706 opioid-related deaths in Alberta, and 57 linked to benzodiazepine, up from 1,375 and 43, respectively, in 2022.

Mounties say officers responded to about 1,100 opioid-related calls for service, last year with a third of those proving fatal. RCMP officers also used naloxone 67 times while in the field, a jump of nearly a third over the previous year.

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CFIA continues surveillance for HPAI in cattle, while sticking with original name for disease – RealAgriculture

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The Canada Food Inspection Agency will continue to refer to highly pathogenic avian influenza in cattle as HPAI in cattle, and not refer to it as bovine influenza A virus (BIAV), as suggested by the American Association of Bovine Practitioners earlier this month.

Dr. Martin Appelt, senior director for the Canadian Food Inspection Agency, in the interview below, says at this time Canada will stick with “HPAI in cattle” when referencing the disease that’s been confirmed in dairy cattle in multiple states in the U.S.

The CFIA’s naming policy is consistent with the agency’s U.S. counterparts’, as the U.S. Animal and Plant Health Inspection Service has also said it will continue referring to it as HPAI or H5N1.

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Appelt explains how the CFIA is learning from the U.S. experience to-date, and how it is working with veterinarians across Canada to stay vigilant for signs of the disease in dairy and beef cattle.

As of April 19, there has not been a confirmed case of HPAI in cattle in Canada. Appelt says it’s too soon to say if an eventual positive case will significantly restrict animal movement, as is the case with positive poultry cases.

This is a major concern for the cattle industry, as beef cattle especially move north and south across the U.S. border by the thousands. Appelt says that CFIA will address an infection in each species differently in conjunction with how the disease is spread and the threat to neighbouring farms or livestock.

Currently, provincial dairy organizations have advised producers to postpone any non-essential tours of dairy barns, as a precaution, in addition to other biosecurity measures to reduce the risk of cattle contracting HPAI.

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Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star

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Canada has seen a concerning rise in measles cases in the first months of 2024.

By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.

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