Concussion may increase risk for mental health issues in youth - Healio | Canada News Media
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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

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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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

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