Prevention of injury and violence in the USA

Are there seasonal patterns for emergency department visits for head injuries in the USA? Findings from the National Electronic Injury Surveillance System-All Injury Program

INTRODUCTION

Previous international research suggests that the incidence of head injuries may follow seasonal patterns. However, there is limited information about how the numbers and rates of head injuries, particularly sports- and recreation-related head injuries, among adults and children evaluated in the emergency department (ED) vary by month in the USA. This information would provide the opportunity for tailored prevention strategies.

METHODS

We analysed data from the National Electronic Injury Surveillance System-All Injury Program from 2016 to 2019 to examine both monthly variation of ED visit numbers and rates for head injuries overall and those due to sports and recreation.

RESULTS

The highest number of head injuries evaluated in the ED occurred in October while the lowest number occurred in February. Among males, children ages 0-4 years were responsible for the highest rates of head injury-related ED visits each year, while in females the highest rates were seen in both children ages 0-4 and adults ages 65 and older. The highest number of head injuries evaluated in the ED due to sports and recreation were seen in September and October. Head injury-related ED visits due to sports and recreation were much more common in individuals ages 5-17 than any other age group.

CONCLUSION

This study showed that head injury-related ED visits for all mechanisms of injury, as well as those due to sports- and recreation-related activities, followed predictable patterns-peaking in the fall months. Public health professionals may use study findings to improve prevention efforts and to optimise the diagnosis and management of traumatic brain injury and other head injuries.

The role of physical activity in the relationship between exposure to community violence and mental health: A systematic review

Community violence is a global public health problem that is associated with mental health disorders. Physical activity can enhance mental health and may play an important role in the relationship between exposure to community violence and mental health. We systematically reviewed the literature to better understand the potential role of physical activity in this relationship. In this review, we searched the databases PubMed, Embase, Web of Science, Cochrane Central, PsycInfo, and SPORTdiscus, and conducted a grey literature search of one clinical trials registry and four organizations' websites. The review included quantitative observational studies, intervention studies, and qualitative studies published by November 30, 2022 and that involved generally healthy individuals across the lifespan. Eligible studies included measures of community violence, mental health, and physical activity. Five studies met the inclusion criteria for the review. Four studies were conducted in high-income countries, only two minority populations were represented in the studies, and none of the studies included older adults or children. Studies defined and measured community violence, mental health, and physical activity in different ways. In most studies, physical activity was not a primary focus but assessed as one item within a larger construct. The role of physical activity was examined differently across the studies and only one study found a significant role (mediator) of physical activity. This review revealed that few studies have specifically examined physical activity's role in the relationship between exposure to community violence and mental health. Further research is needed involving low-income countries, diverse minority populations, and children.

Consensus-based Standards and Indicators to strengthen trauma center injury and violence prevention programs

For decades, the American College of Surgeons Committee on Trauma (ACSCOT) has published Resources for Optimal Care of the Injured Patient, which outlines specific criteria necessary to be verified by the college as a trauma center, including having an organized and effective approach to prevention of trauma. However, the document provides little public health-specific guidance to assist trauma centers with developing these approaches. An advisory panel was convened in 2017 with representatives from national trauma and public health organizations with the purpose of identifying strategies to support trauma centers in the development of a public health approach to injury and violence prevention and to better integrate these efforts with those of local and state public health departments. This panel developed the Standards and Indicators for Model Level I and II Trauma Center Injury and Violence Prevention Programs. The document outlines five, consensus-based core components of a model injury and violence prevention program: (1) leadership, (2) resources, (3) data, (4) effective interventions, and (5) partnerships. We think this document provides the missing public health guidance and is an essential resource to trauma centers for effectively addressing injury and violence in our communities. We recommend the Standards and Indicators be referenced in the injury prevention chapter of the upcoming revision of ACSCOT’s Resources for Optimal Care of the Injured Patient as guidance for the development, implementation and evaluation of injury prevention programs and be used as a framework for program presentation during ACSCOT verification visits.

Evaluation of a population health strategy to reduce distracted driving: Examining all "Es" of injury prevention

BACKGROUND

Cell phone use while driving (CPWD) increases the risk of crashing and is a major contributor to injuries and deaths. The objective of this study was to describe the evaluation of a multifaceted, evidence-based population health strategy for the reduction of distracted driving.

METHODS

A multipronged campaign was undertaken from 2014 to 2016 for 16- to 44-year-olds, based on epidemiology, focused on personal stories and consequences, using the "Es" of injury prevention (epidemiology, education, environment, enforcement, and evaluation). Education consisted of distracted driving videos, informational cards, a social media AdTube campaign, and a movie theater trailer, which were evaluated with a questionnaire regarding CPWD attitudes, opinions, and behaviors. Spatial analysis of data within a geographic information system was used to target advertisements. A random sample telephone survey evaluated public awareness of the campaign. Increased CPWD enforcement was undertaken by police services and evaluated by ARIMA time series modeling.

RESULTS

The AdTube campaign had a view rate of >10% (41,101 views), slightly higher for females. The top performing age group was 18- to 24-year-olds (49%). Our survey found 61% of respondents used handheld CPWD (14% all of the time) with 80% reporting our movie trailer made them think twice about future CPWD. A stakeholder survey and spatial analysis targeted our advertisements in areas of close proximity to high schools, universities, near intersections with previous motor vehicle collisions, high traffic volumes, and population density. A telephone survey revealed that 41% of the respondents were aware of our campaign, 17% from our print and movie theater ads and 3% from social media. Police enforcement campaign blitzes resulted in 160 tickets for CPWD. Following campaign implementation, there was a statistically significant mean decrease of 462 distracted driving citations annually (p = 0.001).

CONCLUSION

A multifaceted, evidence-based population health strategy using the Es of injury prevention with interdisciplinary collaboration is a comprehensive method to be used for the reduction of distracted driving.

LEVEL OF EVIDENCE

Therapeutic, level IV.

Young Adult Knowledge and Readiness to Engage in Advance Care Planning Behaviors

Although advance care planning (ACP) has increased in importance and discussion, little is known about young adults' engagement in ACP. The purpose of this study was to identify associations among college-age students' characteristics, knowledge of ACP, and readiness to engage in ACP-related behaviors. One hundred forty-seven students at the University of Texas at Austin (aged 18-26 years) participated in an online survey regarding ACP knowledge, perceptions, and behavior engagement. Although 98% of the students had no advance directive, 85% rated themselves as "pro" ACP. Regarding ACP behaviors, at least 83% of participants had never considered completing a living will or health care proxy, but 33% and 45% of participants had talked with loved ones about being kept alive on machines or about quality of life, respectively. Greater knowledge of ACP correlated weakly with a favorable view of ACP (P = .002). Young adults should be made aware of their ability to dictate the care they want to receive in situations in which they are incapacitated, as well as advocate for their family members to engage in ACP. Discovering characteristics associated with readiness to engage in ACP can enable hospice and palliative care nurses to tailor discussions with young adults regarding ACP.

Effectiveness of trauma centers verification: Protocol for a systematic review

BACKGROUND

The implementation of trauma systems in many high-income countries over the last 50 years has led to important reductions in injury mortality and disability in many healthcare jurisdictions. Injury organizations including the American College of Surgeons and the Trauma Association of Canada as well as the World Health Organization provide consensus-based recommendations on resources and processes for optimal injury care. Many hospitals treating trauma patients seek verification to demonstrate that they meet these recommendations. This process may be labeled differently across jurisdictions. In Canada for example, it is called accreditation, but it has the same objective and very similar modalities. The objective of the study described in this protocol is to systematically review evidence on the effectiveness of trauma center verification for improving clinical processes and patient outcomes in injury care.

METHODS

We will perform a systematic review of studies evaluating the association between trauma center verification and hospital mortality (primary outcome), as well as morbidity, resource utilization, and processes of care (secondary outcomes). We will search CINAHL, EMBASE, HealthStar, MEDLINE, and ProQuest databases, as well as key injury organization websites for gray literature. We will assess the methodological quality of studies using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) assessment tool. We are planning to conduct a meta-analysis if feasible based on the number of included studies and their heterogeneity. We will evaluate the quality of cumulative evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group methodology.

DISCUSSION

This review will provide a synthesis of the body of evidence on trauma center verification effectiveness. Results could reinforce current verification modalities and may suggest ways to optimize them. Results will be published in a peer-reviewed journal and presented at an international clinical conference.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018107083.

Biomarkers in aggression

Aggressive behavior exerts an enormous impact on society remaining among the main causes of worldwide premature death. Effective primary interventions, relying on predictive models of aggression that show adequate sensitivity and specificity are currently lacking. One strategy to increase the accuracy and precision of prediction would be to include biological data in the predictive models. Clearly, to be included in such models, biological markers should be reliably associated with the specific trait under study (i.e., diagnostic biomarkers). Aggression, however, is phenotypically highly heterogeneous, an element that has hindered the identification of reliable biomarkers. However, current research is trying to overcome these challenges by focusing on more homogenous aggression subtypes and/or by studying large sample size of aggressive individuals. Further advance is coming by bioinformatics approaches that are allowing the integration of inter-species biological data as well as the development of predictive algorithms able to discriminate subjects on the basis of the propensity toward aggressive behavior. In this review we first present a brief summary of the available evidence on neuroimaging of aggression. We will then treat extensively the data on genetic determinants, including those from hypothesis-free genome-wide association studies (GWAS) and candidate gene studies. Transcriptomic and neurochemical biomarkers will then be reviewed, and we will dedicate a section on the role of metabolomics in aggression. Finally, we will discuss how biomarkers can inform the development of new pharmacological tools as well as increase the efficacy of preventive strategies.

Effectiveness of a collaborative, student-run campaign to increase safety belt use among adolescents

Background

MVCs are the leading cause of death among adolescents. Seat belts have been shown to decrease MVC-related death. The purpose of this retrospective cohort study was to evaluate the effectiveness of a community-supported, student-run campaign to increase safety belt use among adolescents in Southwest Florida.

Methods

We reviewed results of campaigns at 14 high schools from 2012 to 2018. The primary outcome was change in rates of student-driver seat belt use over the course of each campaign. Secondary outcomes included trends in seat belt use and MVC-related fatalities over the study period. Wilcoxon signed-rank test was used to compare rates of seat belt use before and after each intervention and over the course of the study period. Multivariate logistic regression was used to estimate the independent effects of demographic covariates on outcomes.

Results

Altogether, 85 campaigns were reviewed. A total of 8500 preintervention and 8500 postintervention observations of student seat belt use were assessed. The median rate of seat belt use increased from 82% prior to the intervention to 87% following the intervention (p<0.001). We did not detect a sustained trend in seat belt use or MVC-related fatalities over the study period. On multivariate analysis, schools with a higher proportion of minority students were less likely to experience a substantial increase in seat belt use following the intervention (OR=0.17, 95% CI 0.03 to 0.84, p=0.030).

Conclusion

This collaborative campaign resulted in a modest, short-term increase in seat belt use among high school students. Future studies should evaluate which interventions are most effective and how short-term increases in seat belt use can be sustained.

Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study

OBJECTIVE

This study investigated patient- and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm.

METHOD

Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n = 480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm.

RESULTS

Self-harm patients (n = 5539) were significantly more likely than control patients (n = 16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk.

CONCLUSIONS

A range of patient- and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.

Are paediatric stabbings in London related to socioeconomic status?

Introduction

Paediatric stabbings are on the increase across the United Kingdom, especially in large urban centres. Many London trauma centres are reporting a significant annual rise in the cases of penetrating trauma. Studies have shown victims with a lower socioeconomic status have an increased risk of paediatric penetrating trauma. This study aims to determine whether high depravity of an area increases the risk of paediatric stabbings in West London. We hypothesise that more deprived areas are likely to have a higher incidence of paediatric stabbings.

Methods

A retrospective review of data from the emergency department at a major trauma centre in West London was conducted using patient <18 years with a stabbing injury between March 2015 and July 2017. Gender, age, incident postcode and home postcode were collected. Socioeconomic status was measured using the 2015 English index of multiple deprivation. Incident postcode and home postcode were matched to an index of multiple deprivation decile, with 1 being the most deprived. Data were analysed using SPSS© Statistics 24.

Results

One hundred seventy-four cases were included; 97.7% of the cases were male and the mean age was 16 years. The location of the stabbings had a median index of multiple deprivation score of 3 (interquartile range = 3) with 61% of the cases occurring in areas with an index of multiple deprivation decile of 3 or less. Index of multiple deprivation decile from incident location and frequency of stabbing were strongly negatively associated (r = −0.85, p = 0.002). The victim’s home location had a median index of multiple deprivation score of 3 (interquartile range = 3) and 59.3% of victims living in areas with an index of multiple deprivation decile of less than 3. Again, they were strongly negatively associated (r = −0.85, p = 0.002).

Conclusion

The location of paediatric stabbings is associated with areas of high depravity and with victims from a more deprived background. To prevent paediatric stabbings, a multifactorial approach is required to increase the socioeconomic status of these areas.

Falls and Social Isolation of Older Adults in the National Health and Aging Trends Study

A longitudinal secondary analysis of 2 years of data from the National Health and Aging Trends Study was undertaken to determine the extent to which social isolation predicts falls in older adults. Social isolation during Year 1 (baseline) was operationalized as a multiple-indicator measure based on Social Network Index participation domains. Falling during the previous year was self-reported using Year 2 data. Logistic regression models revealed social isolation significantly predicted falls (odds ratio [OR] = 1.11; 95% confidence interval [CI] [1.05, 1.17]). The relationship remained significant after adjusting for age, gender, and education (OR = 1.08; 95% CI [1.02, 1.14]). The relationship weakened after adjusting for self-reported general health, depression risk, and worry about falling (OR = 1.02; 95% CI [0.96, 1.08]). Adjusting for Short Physical Performance Battery (SPPB), assistive mobility device, and activities of daily living further weakened the relationship (OR = 0.99; 95% CI [0.94, 1.04]). SPPB demonstrated the strongest correlation with social isolation (r = -0.42; p < 0.01). Fall prevention intervention studies specifically targeting social isolation may incorporate physical performance as a shorter-term and cost-effective proxy outcome for falls. [Res Gerontol Nurs. 2018; 11(2):61-70.].

Building the Child Safety Collaborative Innovation and Improvement Network: How does it work and what is it achieving?

OBJECTIVE

This study investigated whether the Child Safety Collaborative Innovation and Improvement Network (CS CoIIN) framework could be applied in the field of injury and violence prevention to reduce fatalities, hospitalizations and emergency department visits among 0-19 year olds.

SAMPLE

Twenty-one states/jurisdictions were accepted into cohort 1 of the CS CoIIN, and 14 were engaged from March 2016 through April 2017. A quality improvement framework was used to test, implement and spread evidence-based change ideas (strategies and programs) in child passenger safety, falls prevention, interpersonal violence prevention, suicide and self-harm prevention and teen driver safety.

PROCEDURES

Outcome and process measure data were analyzed using run chart rules. Descriptive data were analyzed for participation measures and descriptive statistics were produced. Qualitative data were analyzed to identify key themes.

RESULTS

Seventy-six percent of CS CoIIN states/jurisdictions were engaged in activities and used data to inform decision making. Within a year, states/jurisdictions were able to test and implement evidence-based change ideas in pilot sites. A small group showed improvement in process measures and were ready to spread change ideas. Improvement in outcome measures was not achieved; however, 25% of states/jurisdictions identified data sources and reported on real-time outcome measures.

CONCLUSIONS

Evidence indicates the CS CoIIN framework can be applied to make progress on process measures, but more time is needed to determine if this will result in progress on long-term outcome measures of fatalities, hospitalizations and emergency department visits. Seventeen states/jurisdictions will participate in cohort 2.

The Development of Severe and Chronic Violence Among Youth: The Role of Psychopathic Traits and Reward Processing

Psychopathic traits are a manifestation of a personality pathology that comprises a core affective-interpersonal dysfunction (callous-unemotional traits) and an impulsive-antisocial behavioral component. Of particular importance, psychopathic traits are associated with the perpetration of some of the most severe acts of violence, and they appear to indicate a subset of youth at risk for earlier onset, greater frequency, and persistence of violent offending. Although these youth represent a minority of the population, they commit a significant proportion of the violence in the general community. In our review, we highlight evidence of a unique neurobiological predisposition that underlies the core affective deficits and describe contemporary accounts for the developmental processes leading to the antisocial behavior associated with psychopathy. Current evidence suggests that, for this subset of youth, the structure and function of neural circuitry supporting emotion processing, reward learning, decision making, and the development of emotion related to empathy may be crucial to understanding why they are at risk for violence. In particular, a reward dominant pattern of neurobehavioral conditioning may explain how these youth progress to some of the most severe and persistent forms of violence. However, this pattern of conditioning may also be essential to the primary prevention of such deleterious behavior. We suspect that effective strategies to prevent such violence may ultimately be informed by understanding these affective and motivational mechanisms.

Increases in United States life expectancy through reductions in injury-related death

BACKGROUND

During the previous century the average lifespan in the United States (US) increased by over 30 years, with much of this increase attributed to public health initiatives. This report examines further gains that might be achieved through reduced occurrence of injury-related death.

METHODS

US life tables and injury death rate data were used to estimate potential increases in life expectancy assuming various reductions in the rate of fatal injuries. Corresponding numbers of deaths potentially averted annually were also estimated; unit (per death) medical and lifetime work loss costs were employed to estimate total costs potentially averted annually.

RESULTS

Through elimination of injury as a cause of death, average US life expectancy at birth could be increased by approximately 1.5 years, with notable variations by sex, ethnicity, and race. More conservatively, average life expectancy at birth could be increased by 0.41 years assuming that the national injury death rate could be brought into line with the lowest state-specific rate. Under this more conservative but plausible assumption, an estimated 48,400 injury deaths and $61 billion in medical and work loss costs would be averted annually.

CONCLUSIONS

Increases in life expectancy of the magnitude considered in this report are arguably attainable based on long-term historical reductions in the US injury death rate, as well as significant continuing reductions seen in other developed countries. Contemporary evidence-based interventions can play an important role in reducing injury-related deaths, such as those due to drug overdoses and older adult falls, as well as suicides.

The Structure of Policy Networks for Injury and Violence Prevention in 15 US Cities

OBJECTIVES

Changes in policy can reduce violence and injury; however, little is known about how partnerships among organizations influence policy development, adoption, and implementation. To understand partnerships among organizations working on injury and violence prevention (IVP) policy, we examined IVP policy networks in 15 large US cities.

METHODS

In summer 2014, we recruited 15 local health departments (LHDs) to participate in the study. They identified an average of 28.9 local partners (SD = 10.2) working on IVP policy. In late 2014, we sent survey questionnaires to 434 organizations, including the 15 LHDs and their local partners, about their partnerships and the importance of each organization to local IVP policy efforts; 319 participated. We used network methods to examine the composition and structure of the policy networks.

RESULTS

Each IVP policy network included the LHD and an average of 21.3 (SD = 6.9) local partners. On average, nonprofit organizations constituted 50.7% of networks, followed by government agencies (26.3%), schools and universities (11.8%), coalitions (11.2%), voluntary organizations (9.6%), hospitals (8.5%), foundations (2.2%), and for-profit organizations (0.7%). Government agencies were perceived as important by the highest proportion of partners. Perceived importance was significantly associated with forming partnerships in most networks; odds ratios ranged from 1.07 (95% CI, 1.02-1.13) to 2.35 (95% CI, 1.68-3.28). Organization type was significantly associated with partnership formation in most networks after controlling for an organization's importance to the network.

CONCLUSIONS

Several strategies could strengthen local IVP policy networks, including (1) developing connections with partners from sectors that are not well integrated into the networks and (2) encouraging indirect or less formal connections with important but missing partners and partner types.

Technical Packages in Injury and Violence Prevention to Move Evidence Into Practice: Systematic Reviews and Beyond

Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. "Technical packages," developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence.

Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study

This study investigated the prevalence of suicidal behavior and psychological distress in university students across 12 nations. A total of 5,572 university students from 12 countries were surveyed about suicide ideation, suicide attempts, and psychological distress by means of a self-administered questionnaire. Almost 29% of the samples reported having contemplated suicide and 7% reported attempting suicide. Of the total sample, 51.1% scored above the General Health Questionnaire-12 ≥ 3 cut-off points, 41.6% above the GHQ-12 ≥ 4 cut-off points, and 33.8% scored above the GHQ-12 ≥ 5 cut-off points. While odds of suicide ideation were elevated in Austria and the UK, reduced ORs were detected for China, Italy, Saudi Arabia, Tunisia, and Turkey. Similarly, while odds of suicide attempt were high in Jordan, Palestine, Saudi Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the United States. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia, and Turkey but reduced ORs were noted in Austria, China, Iran, Italy, and the United States. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt, and psychological distress are common in university students but their rates vary depending on the sociocultural context. Due attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.

Using the public health model to address unintentional injuries and TBI: A perspective from the Centers for Disease Control and Prevention (CDC)

Traumatic brain injury (TBI) can have long term effects on mental and physical health, and can disrupt vocational, educational, and social functioning. TBIs can range from mild to severe and their effects can last many years after the initial injury. CDC seeks to reduce the burden of TBI from unintentional injuries through a focus on primary prevention, improved recognition and management, and intervening to improve health outcomes after TBI. CDC uses a 4-stage public health model to guide TBI prevention, moving from 1) surveillance of TBI, 2) identification of risk and protective factors for TBI, 3) development and testing of evidence-based interventions, to 4) bringing effective intervention to scale through widespread adoption. CDC's unintentional injury prevention activities focus on the prevention of sports-related concussions, motor vehicle crashes, and older adult falls. For concussion prevention, CDC developed Heads Up - an awareness initiative focusing on ways to prevent a concussion in sports, and identifying how to recognize and manage potential concussions. In motor vehicle injury prevention, CDC has developed a tool (MV PICCS) to calculate the expected number of injuries prevented and lives saved using various evidence-based motor vehicle crash prevention strategies. To help prevent TBI related to older adult falls, CDC has developed STEADI, an initiative to help primary care providers identify their patients' falls risk and provide effective interventions. In the future, CDC is focused on advancing our understanding of the public health burden of TBI through improved surveillance in order to produce more comprehensive estimates of the public health burden of TBI.

A Case of Transient Global Amnesia: A Review and How It May Shed Further Insight into the Neurobiology of Delusions

Transient global amnesia is a clinical syndrome characterized by the sudden onset of anterograde amnesia, accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, without compromise of other neurologic function. Neuroimaging after an acutetransient global amnesia event often shows transient perturbation of specific hippocampal circuits that are involved in memory processing. Critical clinical distinctions, such as between transient global amnesia and other forms of transient amnesic episodes, as well as important clues to the underlying pathophysiologies are herein reviewed. Finally, we discuss the role of hippocampal insufficiency in the neurobiology of delusions.

Risk of suicide after a concussion

BACKGROUND

Head injuries have been associated with subsequent suicide among military personnel, but outcomes after a concussion in the community are uncertain. We assessed the long-term risk of suicide after concussions occurring on weekends or weekdays in the community.

METHODS

We performed a longitudinal cohort analysis of adults with diagnosis of a concussion in Ontario, Canada, from Apr. 1, 1992, to Mar. 31, 2012 (a 20-yr period), excluding severe cases that resulted in hospital admission. The primary outcome was the long-term risk of suicide after a weekend or weekday concussion.

RESULTS

We identified 235,110 patients with a concussion. Their mean age was 41 years, 52% were men, and most (86%) lived in an urban location. A total of 667 subsequent suicides occurred over a median follow-up of 9.3 years, equivalent to 31 deaths per 100,000 patients annually or 3 times the population norm. Weekend concussions were associated with a one-third further increased risk of suicide compared with weekday concussions (relative risk 1.36, 95% confidence interval 1.14-1.64). The increased risk applied regardless of patients' demographic characteristics, was independent of past psychiatric conditions, became accentuated with time and exceeded the risk among military personnel. Half of these patients had visited a physician in the last week of life.

INTERPRETATION

Adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends. Greater attention to the long-term care of patients after a concussion in the community might save lives because deaths from suicide can be prevented.

Time for Lifestyle Medicine to Take Injury Prevention Seriously

Over 2 decades ago, the United States National Academy of Sciences described injuries as “the most under-recognized major public health problem facing the nation.” Our progress since then has been limited. Injuries still account for nearly 1 out of every 10 deaths in the world, and the global burden of injury is projected to increase over the next decade, predominately in low- and middle-income countries. Despite this, injury prevention receives scant attention from legislators, the education system, and, most strikingly, the health care system. The lifestyle medicine community, however, is beginning to focus on injury prevention and will play an increasing role in helping control the burden of injury. Lifestyle medicine practitioners are in a tremendous position to promote injury prevention. Physical activity and positive lifestyle changes can be accompanied with an increased focus on preventing injury. Lifestyle medicine can prevent injuries by supporting legislation, advancing medical advocacy, providing community education, and linking clinical care with injury prevention.