Health
Concussions Linked to Mental Health Issues in Kids – Medpage Today
Concussion in kids was associated with an increased risk of mental health problems compared with orthopedic injury, a 10-year retrospective cohort study from Canada found.
Among over 400,000 youths ages 5 to 18, those who had a concussion were at greater risk for mental health problems (adjusted HR [aHR] 1.39, 95% CI 1.37-1.40), as well as self-harm (aHR 1.49, 95% CI 1.42-1.56) and psychiatric hospitalization (aHR 1.47, 95% CI 1.41-1.53), reported Andrée-Anne Ledoux, PhD, of the Children’s Hospital of Eastern Ontario Research Institute, and colleagues.
The incidence rate of any mental health problem was 11,141 per 100,000 person-years in the concussion group versus 7,960 per 100,000 person-years in the orthopedic injury group, they noted in JAMA Network Open.
“Our findings suggest that during concussion follow-up visits, physicians should assess patients’ mental health,” Ledoux and colleagues wrote. “It has been found that collaborative care and mental health treatment improve outcomes in pediatric concussion with chronic symptoms.”
While one in five Canadian children has a mental health disorder, this proportion was higher among the kids in both study groups. “This may be due to differences in the time period and method of identifying and/or defining mental health problems,” the authors suggested. “It may also reflect the mutual experience of trauma, as it has been reported that individuals with orthopedic injury may have long-lasting behavioral changes after injury.”
“Such a large-scale study highlights associations between concussion and mental health but also raises important unanswered questions,” wrote Talin Babikian, PhD, of the University of California Los Angeles, in an invited commentary. Despite the increased public health concern about the long-term effects of concussions, “the mechanism of this increased risk remains largely elusive.”
Babikian warned of a “dichotomy trap” when discussing the role of concussions in increased mental health problems in youth, with “artificial division of mental vs physical, psychological vs neurological, and organic vs environmental.”
“These divisions are largely remnants of the historical conditioning of our training paradigms,” she explained. “In reality, all of these frames of reference characterize the same system: our intricate nervous system.”
“Youth arrive at a concussion not as a blank slate, but rather as a tapestry of risks and resiliencies — personal, familial, and environmental,” Babikian noted. Therefore, when managing a concussion, it is important to maintain a “sense of safety and agency” and a “sense of connection and belonging.”
The study matched 152,321 children (median age 13, 56.7% boys) who had a concussion with 296,482 who had an orthopedic injury (median age 13, 57.9% boys) from April 2010 through March 2020 in Ontario, Canada.
“Orthopedic injuries have been shown to be a good comparison group, as they share injury-related experiences (e.g., emergency department visit, pain, injury-related stress) and premorbid characteristics,” Ledoux and team noted.
If a patient had more than one concussion or orthopedic injury, the first diagnosed incident was included for the study. Children were excluded from the study if they did not have continuous Ontario Health Insurance Plan coverage in the 5 years before the injury index event, or if they had a mental health diagnosis in the year before the event or a mental health diagnosis code during their index visit.
The study authors acknowledged that their retrospective observational design was an “inherent weakness” to the study. They also noted that their study relied on diagnoses codes and administrative databases, which may introduce misclassification errors and do not account for all mental health services provided.
Disclosures
This study was supported by ICES, a nonprofit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze healthcare and demographic data, without consent, for health system evaluation and improvement.
Ledoux reported no disclosures. One study author reported receiving research grants from the National Football League scientific advisory board, serving on the concussion advisory board for Parachute Canada (a nonprofit injury prevention charity), and being the co-founder, scientific director, and a minority shareholder in 360 Concussion Care.
Babikian reported no disclosures
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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.”
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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Health
CFIA continues surveillance for HPAI in cattle, while sticking with original name for disease – RealAgriculture
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.
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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Health
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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