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Kureshi N, Abidi SSR, Clarke DB, Zeng W, Feng C. Spatial Hotspots and Sociodemographic Profiles Associated With Traumatic Brain Injury in Nova Scotia. J Neurotrauma 2024; 41:844-861. [PMID: 38047531 DOI: 10.1089/neu.2023.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability, primarily caused by falls and motor vehicle collisions (MVCs). Although many TBIs are preventable, there is a notable lack of studies exploring the association of geographically defined TBI hotspots with social deprivation. Geographic information systems (GIS) can be used to identify at-risk neighborhoods (hotspots) for targeted interventions. This study aims to determine the spatial distribution of TBI by major causes and to explore the sociodemographic and economic characteristics of TBI hotspots and cold spots in Nova Scotia. Patient data for TBIs from 2003 to 2019 were obtained from the Nova Scotia Trauma Registry. Residential postal codes were geocoded and assigned to dissemination areas (DA). Area-based risk factors and deprivation status (residential instability [RI], economic dependency [ED], ethnocultural composition [EC], and situational vulnerability [SV]) from the national census data were linked to DAs. Spatial autocorrelation was assessed using Moran's I, and hotspot analysis was performed using Getis-Ord Gi* statistic. Differences in risk factors between hot and cold spots were evaluated using the Mann-Whitney U test for numerical variables and the χ2 test or Fisher's exact test for categorical variables. A total of 5394 TBI patients were eligible for inclusion in the study. The distribution of hotspots for falls exhibited no significant difference between urban and rural areas (p = 0.71). Conversely, hotspots related to violence were predominantly urban (p = 0.001), whereas hotspots for MVCs were mostly rural (p < 0.001). Distinct dimensions of deprivation were associated with falls, MVCs, and violent hotspots. Fall hotspots were significantly associated with areas characterized by higher RI (p < 0.001) and greater ethnocultural diversity (p < 0.001). Conversely, the same domains exhibited an inverse relationship with MVC hotspots; areas with low RI and ethnic homogeneity displayed a higher proportion of MVC hotspots. ED and SV exhibited a strong gradient with MVC hotspots; the most deprived quintiles displayed the highest proportion of MVC hotspots compared with cold spots (ED; p = 0.002, SV; p < 0.001). Areas with the highest levels of ethnocultural diversity were found to have a significantly higher proportion of violence-related hotspots than cold spots (p = 0.005). This study offers two significant contributions to spatial epidemiology. First, it demonstrates the distribution of TBI hotspots by major injury causes using the smallest available geographical unit. Second, we disentangle the various pathways through which deprivation impacts the risk of main mechanisms of TBI. These findings provide valuable insights for public health officials to design targeted injury prevention strategies in high-risk areas.
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Affiliation(s)
- Nelofar Kureshi
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - David B Clarke
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Brain Repair Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Weiping Zeng
- Super GeoAI Technology Inc. Saskatoon, Saskatchewan, Canada
| | - Cindy Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Slykerman RF, Clasby BE, Chong J, Edward K, Milne BJ, Temperton H, Thabrew H, Bowden N. Case identification of non-traumatic brain injury in youth using linked population data. BMC Neurol 2024; 24:82. [PMID: 38429681 PMCID: PMC10908152 DOI: 10.1186/s12883-024-03575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Population-level administrative data provides a cost-effective means of monitoring health outcomes and service needs of clinical populations. This study aimed to present a method for case identification of non-traumatic brain injury in population-level data and to examine the association with sociodemographic factors. METHODS An estimated resident population of youth aged 0-24 years was constructed using population-level datasets within the New Zealand Integrated Data Infrastructure. A clinical consensus committee reviewed the International Classification of Diseases Ninth and Tenth Editions codes and Read codes for inclusion in a case definition. Cases were those with at least one non-traumatic brain injury code present in the five years up until 30 June 2018 in one of four databases in the Integrated Data Infrastructure. Rates of non-traumatic brain injury were examined, both including and excluding birth injury codes and across age, sex, ethnicity, and socioeconomic deprivation groups. RESULTS Of the 1 579 089 youth aged 0-24 years on 30 June 2018, 8154 (0.52%) were identified as having one of the brain injury codes in the five-years to 30 June 2018. Rates of non-traumatic brain injury were higher in males, children aged 0-4 years, Māori and Pacific young people, and youth living with high levels of social deprivation. CONCLUSION This study presents a comprehensive method for case identification of non-traumatic brain injury using national population-level administrative data.
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Affiliation(s)
- Rebecca F Slykerman
- Department of Psychological Medicine, Te Ara Hāro, University of Auckland, Building 507, 22-30 Park Avenue, Auckland, Grafton, 1023, New Zealand.
| | - Betony E Clasby
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Jimmy Chong
- Paediatric Rehabilitation Service, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Kathryn Edward
- Paediatric Rehabilitation Service, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Barry J Milne
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Helen Temperton
- Paediatric Rehabilitation Service, Te Whatu Ora, Te Toka Tumai, Auckland, New Zealand
| | - Hiran Thabrew
- Department of Psychological Medicine, Te Ara Hāro, University of Auckland, Building 507, 22-30 Park Avenue, Auckland, Grafton, 1023, New Zealand
| | - Nicholas Bowden
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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Valdivia-Tangarife ER, Morlett-Paredes A, Rizo-Curiel G, Jiménez-Maldonado ME, Ruiz-Sandoval JL, Barba AR, López-Enríquez A, Avilés-Martínez KI, Villaseñor-Cabrera T. Incidence, and factors associated with moderate/severe pediatric traumatic brain injury in children aged 5-15 years in western, Mexico. Eur J Paediatr Neurol 2024; 49:6-12. [PMID: 38278011 DOI: 10.1016/j.ejpn.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE The study objectives were to estimate the standardized incidence and evaluate factors associated with moderate/severe pediatric traumatic brain injury (p-TBI) in children aged 5-15 years in Western, Mexico. METHODS The study was cross-sectional in design. We estimated the standardized incidence of moderate/severe p-TBI using the direct methods of the World Health Organization (WHO) standard populations. We utilized the Glasgow Coma Scale (GCS) to identify moderate/severe p-TBI patients (GCS ≤ 13). Logistic regression analysis was applied to evaluate variables associated with moderate/severe p-TBI. RESULTS The standardized incidence of patients diagnosed with moderate/severe p-TBI was 31.0/100,000 person-years (95 % CI 28.7-33.4). According to age, the moderate/severe TBI group was included. A total of 254 (38.5 %) patients were aged 5-9 years, 343 (52.0 %) were aged 10-14 years, and 62 (9.5 %) were aged 15 years. Factors associated with moderate/severe TBI in the crude analysis were male sex (OR 5.50, 95 % CI 4.16-7.39, p < 0.001), primary school (OR 2.15, 95 % CI 1.62-2.84, p < 0.001), and falls (OR 1.34, 95 % CI 1.02-1.77, p = 0.035). Factors associated with moderate/severe p-TBI in the adjusted analysis were male sex (OR 6.12, 95 % CI 4.53-8.29, p < 0.001), primary school (OR 3.25, 95 % CI 2.31-4.55, p < 0.001), and falls (OR 1.78, 95 % CI 1.28-2.47, p < 0.001). CONCLUSION The incidence of moderate/severe p-TBI in children aged 5-15 years in western Mexico in this study was higher than that in other studies. One of the biggest factors associated with moderate/severe p-TBI was male sex, specifically those with lower education levels and those who were prone to falls.
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Affiliation(s)
| | | | - Genoveva Rizo-Curiel
- Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico
| | - Miriam E Jiménez-Maldonado
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico
| | | | | | | | | | - Teresita Villaseñor-Cabrera
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico.
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Rigney G, Jo J, Williams K, Terry DP, Zuckerman SL. Parental Factors Associated With Recovery After Mild Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2023; 40:2015-2036. [PMID: 37212287 DOI: 10.1089/neu.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
While parental factors have been shown to potentially influence recovery after mild traumatic brain injury (mTBI) in children, both the strength and direction of the relationships remain unclear. We performed a systematic review regarding the association between parental factors and recovery after mTBI. PubMed, CINHL, Embase, PsychINFO, Web of Science, ProQuest, Cochrane Central, and Cochrane databases were queried for articles published between September 1, 1970, and September 10, 2022, reporting any parental factor and its association with recovery after mTBI in children younger than 18 years old. The review included both quantitative and qualitative studies published in English. Regarding the directionality of the association, only studies that assessed the effects of parental factors on recovery after mTBI were included. Study quality was assessed using a five-domain scale created by the Cochrane Handbook and the Agency for Healthcare Research and Quality. The study was prospectively registered with PROSPERO (CRD42022361609). Of 2050 studies queried, 40 met inclusion criteria, and 38 of 40 studies used quantitative outcome measures. Across 38 studies, 24 unique parental factors and 20 different measures of recovery were identified. The most common parental factors studied were socioeconomic status/income (SES; n = 16 studies), parental stress/distress (n = 11), parental level of education (n = 9), pre-injury family functioning (n = 8), and parental anxiety (n = 6). Among all associations between parental factors and recovery reported, having a family history of a neurologic disease (i.e., migraine, epilepsy, neurodegenerative disease; 5/6 significant associations reported, 83%), parental stress/distress (9/11, 82%), parental anxiety (4/6, 67%), parental level of education (5/9, 56%), and SES/income (11/19, 57.9%) were shown to have the strongest evidence reporting significant associations with recovery, while a family history of psychiatric disease (3/6, 50%) and pre-injury family functioning (4/9, 44%) showed mixed results. Evidence regarding other parental factors including parental sex, race/ethnicity, insurance status, parental history of concussion, family litigation status, family adjustment levels, and family psychosocial adversity were limited, as studies investigating such factors were few. The current review highlights literature describing several parental factors that significantly influence recovery from mTBI. It will likely be useful for future studies to incorporate parental SES, education, stress/distress, anxiety, quality of parent-child relationships, and parenting style when examining modifying factors in recovery after mTBI. Future studies should also consider how parental factors may serve as potential interventions or policy levers to optimize sport concussion-related policy and return-to-play guidelines.
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Affiliation(s)
- Grant Rigney
- Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob Jo
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen Williams
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas P Terry
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Buh FC, Sumbele IUN, Maas AIR, Motah M, Pattisapu JV, Youm E, Meh BK, Kobeissy FH, Wang KW, Hutchinson PJA, Taiwe GS. Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1558. [PMID: 37763678 PMCID: PMC10535664 DOI: 10.3390/medicina59091558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and Objective: About 14 million people will likely suffer a traumatic brain injury (TBI) per year by 2050 in sub-Saharan Africa. Studying TBI characteristics and their relation to outcomes can identify initiatives to improve TBI prevention and care. The objective of this study was to define the features and outcomes of TBI patients seen over a 1-year period in a level-I trauma centre in Cameroon. Materials and Methods: Data on demographics, causes, clinical aspects, and discharge status were collected over a period of 12 months. The Glasgow Outcome Scale-Extended (GOSE) and the Quality-of-Life Questionnaire after Brain Injury (QoLIBRI) were used to evaluate outcomes six months after TBI. Comparisons between two categorical variables were done using Pearson's chi-square test. Results: A total of 160 TBI patients participated in the study. The age group 15-45 years was most represented (78%). Males were more affected (90%). A low educational level was seen in 122 (76%) cases. Road traffic incidents (RTI) (85%), assaults (7.5%), and falls (2.5%) were the main causes of TBI, with professional bike riders being frequently involved (27%). Only 15 patients were transported to the hospital by ambulance, and 14 of these were from a referring hospital. CT-imaging was performed in 78% of cases, and intracranial traumatic abnormalities were identified in 64% of cases. Financial constraints (93%) was the main reason for not performing a CT scan. Forty-six (33%) patients were discharged against medical advice (DAMA) due to financial constraints. Mortality was 14% (22/160) and high in patients with severe TBI (46%). DAMA had poor outcomes with QoLIBRI. Only four patients received post-injury physical therapy services. Conclusions: TBI in Cameroon mainly results from RTIs and commonly affects young adult males. Lack of pre-hospital care, financial constraints limiting both CT scanning and medical care, and a lack of acute physiotherapy services likely influenced care and outcomes adversely.
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Affiliation(s)
- Franklin Chu Buh
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
| | - Irene Ule Ngole Sumbele
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, 2000 Edegem, Belgium;
| | - Mathieu Motah
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala P.O. Box 2701, Cameroon;
| | - Jogi V. Pattisapu
- Department of Pediatric Neurosurgery, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA;
| | - Eric Youm
- Holo Healthcare, Nairobi 00400, Kenya;
| | - Basil Kum Meh
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
| | - Firas H. Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut P.O. Box 11-0236, Lebanon
| | - Kevin W. Wang
- Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310-1458, USA;
| | | | - Germain Sotoing Taiwe
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
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Rempe G, Petranovich C, Narad ME, Yeates KO, Taylor HG, Stancin T, Wade S. Trajectories of Executive Functions After Early Childhood Traumatic Brain Injury: Teacher Ratings in the Initial 81 Months Postinjury. J Head Trauma Rehabil 2023; 38:E203-E211. [PMID: 36730995 PMCID: PMC10102250 DOI: 10.1097/htr.0000000000000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore teacher-rated trajectories of executive functioning (EF) after early childhood traumatic brain injury (TBI) and to identify injury-related, academic, and family factors associated with growth trajectories using latent class growth analysis. PARTICIPANTS A total of 121 children who sustained a TBI or orthopedic injury (OI) between the ages of 3 and 7 years were recruited from 3 tertiary care children's hospitals and a general hospital in Ohio, including 57 with moderate or severe TBI and 64 with OI. DESIGN Assessments were completed at baseline (0-3 months postinjury) and an average of 6, 12, 18, and 81 months postinjury. Changes in teacher-rated EF were modeled across time and heterogeneity in recovery and moderating factors was examined. MEASURES Study variables included participant demographics, teacher-rated EF (Behavior Rating Inventory of Executive Function), family functioning (McMaster Family Assessment Device), and parenting style (Parenting Practices Questionnaire). RESULTS Analysis of teacher-rated EF yielded 2 trajectories: Normative (64.71%) and At-Risk (35.29%). Traumatic brain injury was a weak predictor of membership in the At-Risk trajectory ( P = .05). Membership in the At-Risk trajectory (compared with Normative category) was associated with a higher incidence of Individualized Education Programs, higher baseline EF concerns, increased endorsement of authoritarian parenting, lower socioeconomic status, and non-White race. CONCLUSION Teacher-rated EF after pediatric TBI differs from OI. Increased EF concerns over time were associated with increased baseline EF and characteristics of the home and school environment. These findings extend previous research on recovery of EF to educational settings and outline potentially modifiable risk factors that can maximize success in the school settings for children who experience early-childhood traumatic injury.
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Affiliation(s)
- Gary Rempe
- Neuropsychological Services of New Mexico, Albuquerque, New Mexico (Dr Rempe); Children's Hospital Colorado and the University of Colorado School of Medicine, Department of Rehabilitation Medicine, Aurora, Colorado (Dr Petranovich); Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Narad); Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Alberta, Calgary (Dr Yeates); Abigail Wexner Research Institute, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); Department of Rehabilitation, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Wade)
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7
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Socioeconomic Characteristics of Pediatric Traumatic Brain Injury Patients. Clin Neurol Neurosurg 2022; 221:107404. [DOI: 10.1016/j.clineuro.2022.107404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/20/2022]
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8
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Yehene E, Zukerman H, Goldzweig G, Gerner M, Brezner A, Landa J. Perfectionism, Big Five and biopsychosocial functioning among parents of children with and without acquired brain injury (ABI). Brain Inj 2022; 36:860-867. [PMID: 35727894 DOI: 10.1080/02699052.2022.2077443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Personality factors are often investigated in the context of parenting but are rarely studied in relation to coping with child disabilities like pediatric acquired brain injury (pABI). This study (1) compares Biopsychosocial functioning (BPSF), Big Five personality traits, and dimensions of perfectionism of parents of children with and without pABI, and (2) examines the role personality factors play in parental BPSF in each group. METHOD 57 parents of children who sustained a significant pABI and 50 parents of typically developing children participated in this cross-sectional study. Parents completed scales measuring Multidimensional Perfectionism, Big Five inventory, and BPSF. RESULTS Among the pABI group, multivariate analysis indicated significantly poorer BPSF, higher levels of neuroticism, socially prescribed perfectionism, and lower levels of openness, than controls. Regression analysis showed that personality explained 60.5% of the variance in parental BPSF post pABI. In both samples, neuroticism and socially prescribed perfectionism appeared as two prominent personality factors with a significant negative effect on parental BPSF, while self-perfectionism appeared prominent only in the pABI group, indicating a significant positive effect. IMPLICATIONS pABI may result in changes to parents` personality. Personality characteristics significantly contribute to parental BPSF post-injury and should be addressed in clinical practice.
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Affiliation(s)
- Einat Yehene
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.,Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Hadas Zukerman
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Maya Gerner
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Amichai Brezner
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel
| | - Jana Landa
- Pediatric Rehabilitation Department Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Remat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Singh TK, Khan M, Tansley G, Chan H, Brubacher JR, Staples JA. Neighborhood Socioeconomic Deprivation and Youth Assault Injuries in Vancouver, Canada. J Pediatr 2022; 240:199-205.e13. [PMID: 34480918 DOI: 10.1016/j.jpeds.2021.08.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/12/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the degree to which neighborhood socioeconomic deprivation influences the risk of youth assault injury. STUDY DESIGN Population-based retrospective study of youth aged 10-24 years seeking emergency medical care between 2012 and 2019 at 14 hospitals in Vancouver, Canada. Neighborhood material and social deprivation were examined as independent predictors of assault injury, accounting for spatial autocorrelation and controlling for neighborhood drinking establishment density. RESULTS Our data included 4166 assault injuries among 3817 youth. Male sex, substance use, and mental health disorders were common among victims of assault. Relative to the least deprived quintile of neighborhoods, assault injury risk was 2-fold higher in the most materially deprived quintile of neighborhoods (incidence rate ratio per quintile increase, 1.17; 95% CI 1.06-1.30; P < .05), and risk in the most socially deprived quintile was more than 3-fold greater than in the least deprived quintile (incidence rate ratio per quintile increase, 1.35; 95% CI 1.21-1.50; P < .001). Assault risk was 147-fold greater between 2 and 3 AM on Saturday relative to the safest hours of the week. CONCLUSIONS Neighborhood socioeconomic deprivation substantially increases the risk of youth assault injury. Youth violence prevention efforts should target socioeconomically deprived neighborhoods.
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Affiliation(s)
- Tanjot K Singh
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gavin Tansley
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - John A Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada.
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Mitchell HK, Reddy A, Perry MA, Gathers CA, Fowler JC, Yehya N. Racial, ethnic, and socioeconomic disparities in paediatric critical care in the USA. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:739-750. [PMID: 34370979 DOI: 10.1016/s2352-4642(21)00161-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
In an era of tremendous medical advancements, it is important to characterise and address inequities in the provision of health care and in outcomes. There is a large body of evidence describing such disparities by race or ethnicity and socioeconomic position in critically ill adults; however, this important issue has received less attention in children and adolescents (aged ≤21 years). This Review presents a summary of the available evidence on disparities in outcomes in paediatric critical illness in the USA as a result of racism and socioeconomic privilege. The majority of evidence of racial and socioeconomic disparities in paediatric critical care originates from the USA and is retrospective, with only one prospective intervention-based study. Although there is mixed evidence of disparities by race or ethnicity and socioeconomic position in general paediatric intensive care unit admissions and outcomes in the USA, there are striking trends within some disease processes. Notably, there is evidence of disparities in management and outcomes for out-of-hospital cardiac arrest, asthma, severe trauma, sepsis, and oncology, and in families' perceptions of care. Furthermore, there is clear evidence that critical care research is limited by under-enrolment of participants from minority race or ethnicity groups. We advocate for rigorous research standards and increases in the recruitment and enrolment of a diverse range of participants in paediatric critical care research to better understand the disparities observed, including the effects of racism and poverty. A clearer understanding of when, where, and how such disparities affect patients will better enable the development of effective strategies to inform practice, interventions, and policy.
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Affiliation(s)
- Hannah K Mitchell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Anireddy Reddy
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
| | - Mallory A Perry
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cody-Aaron Gathers
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica C Fowler
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
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Allonsius F, De Kloet AJ, Van Markus-Doornbosch F, Meesters JJL, Kromme CH, Vliet Vlieland TPM, Van Der Holst M. Parent-reported family impact in children and young adults with acquired brain injury in the outpatient rehabilitation setting. Brain Inj 2021; 35:563-573. [PMID: 33734919 DOI: 10.1080/02699052.2021.1891287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To increase knowledge/awareness on family impact (FI) after acquired brain injury (ABI) in rehabilitation settings, it is essential to investigate the associations between patient-functioning and impact on families. This has been explored in hospital-based cohorts, but not in rehabilitation settings.Methods: A cross-sectional, multi-center study among parents of children/young adults (aged 5-24 years) with ABI referred to rehabilitation was performed. Patient/injury/family-characteristics were noted, and parents completed the PedsQL™Family-Impact-Module and PedsQL™generic-core-4.0 to assess FI and health-related quality of life (HRQoL). Univariate- and multivariable-regression analyses were performed to investigate associations between HRQoL/patient/injury/family-related factors and FI.Results: 246 families participated; patients' median age was 14 year (IQR 11-16), 65 had non-traumatic-brain-injury (nTBI) (26%), 127 were female. FI was found to be considerable (median FIM-score 71.9, IQR:60-85). Especially referral to rehabilitation >6 months after onset, diminished patients' mental/emotional health and HRQoL (child/family factors), and premorbid problems were associated with higher FI.Conclusions: In this rehabilitation cohort, pediatric ABI caused considerably higher FI than in hospital-based studies with referral to rehabilitation >6 months, diminished child/family factors and presence of premorbid problems increasing FI. Assessing and monitoring FI and its associated factors enables professionals to individualize treatment, psychoeducation, support and follow-up.
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Affiliation(s)
- F Allonsius
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - A J De Kloet
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Centre of Expertsie in Health Innovations, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - F Van Markus-Doornbosch
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - J J L Meesters
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Centre of Expertsie in Health Innovations, The Hague University of Applied Sciences, The Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - C H Kromme
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands
| | - T P M Vliet Vlieland
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - M Van Der Holst
- Basalt Rehabilitation, Department of Innovation, Quality and Research, Leiden and the Hague, The Netherlands.,Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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12
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Transport Time and Mortality in Critically Ill Patients with Severe Traumatic Brain Injury. Can J Neurol Sci 2021; 48:817-825. [PMID: 33431101 DOI: 10.1017/cjn.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Severe traumatic brain injury (TBI) is a major cause of morbidity and mortality in critically ill patients. Pre-hospital care and transportation time may impact their outcomes. METHODS Using the British Columbia Trauma Registry, we included 2,860 adult (≥18 years) patients with severe TBI (abbreviated injury scale head score ≥4), who were admitted to an intensive care unit (ICU) in a centre with neurosurgical services from January 1, 2000 to March 31, 2013. We evaluated the impact of transportation time (time of injury to time of arrival at a neurosurgical trauma centre) on in-hospital mortality and discharge disposition, adjusting for age, sex, year of injury, injury severity score (ISS), revised trauma score at the scene, location of injury, socio-economic status and direct versus indirect transfer. RESULTS Patients had a median age of 43 years (interquartile range [IQR] 26-59) and 676 (23.6%) were female. They had a median ISS of 33 (IQR 26-43). Median transportation time was 80 minutes (IQR 40-315). ICU and hospital length of stay were 6 days (IQR 2-12) and 20 days (IQR 7-42), respectively. Six hundred and ninety-six (24.3%) patients died in hospital. After adjustment, there was no significant impact of transportation time on in-hospital mortality (odds ratio 0.98, 95% confidence interval 0.95-1.01). There was also no significant effect on discharge disposition. CONCLUSIONS No association was found between pre-hospital transportation time and in-hospital mortality in critically ill patients with severe TBI.
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13
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Characteristics and outcome of severe traumatic brain injuries based on occupational status. Eur J Trauma Emerg Surg 2020; 47:2035-2041. [PMID: 32306121 PMCID: PMC8629783 DOI: 10.1007/s00068-020-01372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/06/2020] [Indexed: 11/17/2022]
Abstract
Purpose The association of TBI with socioeconomic characteristics of patients has not been studied extensively. The objective of this study was to analyse the differences in injury characteristics and outcome in TBI patients based on their occupational status. Methods Data on patients from 13 centres based in Austria, Croatia, Slovakia, Bosnia and Herzegovina, and Macedonia were included in the analysis. Demographic characteristics, injury characteristics, treatment and outcome at various post-injury stages were compared according to occupational status. Logistic regression was used to adjust for the effect of co-variates. ICU mortality, hospital mortality, 6 months mortality, and outcome at 6 months were used as dependent variables. Results Overall, 886 patients were analysed with a mean age of 45.5 years. High-level falls were most prevalent in the blue-collar group (19%), most low-level falls occurred in the retired group. Traffic accidents were most common in students. The injuries were most severe in the blue-collar group and students. Highest mortalities and unfavourable outcomes were in the retired, students and white-collar workers had the best outcomes. Compared to retired patients, all groups had higher odds of favourable outcome at 6 months after adjusting for co-variates—OR from 2.2 (95% CI 1.1–4.6) for entrepreneurs to 3.6 (95% CI 1.8–7.2) for the blue-collar group. Conclusion Our paper provides clues pertaining specifically to variations in patterns and outcomes of TBI according to occupational status which can inform prevention and planning of services and can serve to plan priorities for further research.
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14
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Guberman GI, Robitaille MP, Larm P, Ptito A, Vitaro F, Tremblay RE, Hodgins S. A Prospective Study of Childhood Predictors of Traumatic Brain Injuries Sustained in Adolescence and Adulthood. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:36-45. [PMID: 31623445 PMCID: PMC6966253 DOI: 10.1177/0706743719882171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Traumatic brain injuries (TBIs) are sustained by approximately 17% of males in the general population, many of whom subsequently present mental disorders, cognitive, and physical problems. Little is known about predictors of TBIs and how to prevent them. The present study aimed to determine whether inattention-hyperactivity and/or all externalizing problems presented by boys at age 10 predict subsequent TBIs to age 34 after taking account of previous TBIs and family social status (FSS). METHOD 742 Canadian males were followed, prospectively, from age 6 to 34. Diagnoses of TBIs were extracted from health files, parents-reported sociodemographic and family characteristics at participants' age 6, and teachers-rated participants' behaviors at age 10. Separate logistic regression models predicted TBIs sustained from age 11 to 17 and from age 18 to 34. For each age period, two models were computed, one included previous TBIs, inattention-hyperactivity, FSS, and interaction terms, the second included previous TBIs, externalizing problems, FSS, and interaction terms. RESULTS In models that included inattention-hyperactivity, TBIs sustained from age 11 to 17 were predicted by age 10 inattention-hyperactivity (odds ratio [OR] = 1.46, 1.05 to 2.05) and by TBIs prior to age 11 (OR = 3.50, 1.48 to 8.24); TBIs sustained from age 18 to 34 were predicted by age 10 inattention-hyperactivity (OR = 1.31, 1.01 to 170). In models that included all externalizing problems, TBIs from age 11 to 17 were predicted by prior TBIs (OR = 3.66, 1.51 to 8.39); TBIs sustained from age 18 to 34 were predicted by age 10 externalizing problems (OR = 1.45, 1.12 to 1.86). Neither FSS nor interaction terms predicted TBIs in any of the models. CONCLUSIONS Among males, using evidence-based treatments to reduce inattention-hyperactivity and externalizing problems among boys could, potentially, decrease the risk of TBIs to age 34. Further, boys who sustain TBIs in childhood require monitoring to prevent recurrence in adolescence.
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Affiliation(s)
- Guido I Guberman
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Marie-Pier Robitaille
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada
| | - Peter Larm
- School of Health, Care and Social Welfare, Mälardalens University, Västerås, Sweden
| | - Alain Ptito
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Frank Vitaro
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada
| | - Richard E Tremblay
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Quebec, Canada.,School of Public Health, University College Dublin, Ireland
| | - Sheilagh Hodgins
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada.,Centre de Recherche, Institut Universitaire de Santé Mentale de Montréal, Département de Psychiatrie et Addictologie, Université de Montréal, Quebec, Canada
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15
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Mahboob A, Richmond SA, Harkins JP, Macpherson AK. Childhood unintentional injury: The impact of family income, education level, occupation status, and other measures of socioeconomic status. A systematic review. Paediatr Child Health 2019; 26:e39-e45. [PMID: 33542777 DOI: 10.1093/pch/pxz145] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES. Methods A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017-representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance. Results Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures. Conclusion Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.
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Affiliation(s)
- Afifa Mahboob
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario
| | - Sarah A Richmond
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Joshua P Harkins
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario
| | - Alison K Macpherson
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario
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16
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Bellesi G, Barker ED, Brown L, Valmaggia L. Pediatric traumatic brain injury and antisocial behavior: are they linked? A systematic review. Brain Inj 2019; 33:1272-1292. [DOI: 10.1080/02699052.2019.1641621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Giulia Bellesi
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Edward D. Barker
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
| | - Laura Brown
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Lucia Valmaggia
- King’s College London, Institute of Psychology, Psychiatry, and Neuroscience, Department of Psychology, London, UK
- South London and Maudsley NHS Trust, London, UK
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17
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Rajabali F, Zheng A, Turcotte K, Zhang LR, Kao D, Rasali D, Oakey M, Pike I. The association of material deprivation component measures with injury hospital separations in British Columbia, Canada. Inj Epidemiol 2019; 6:20. [PMID: 31240169 PMCID: PMC6556949 DOI: 10.1186/s40621-019-0198-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study examines social disparities across neighbourhood levels of income, education and employment in relation to overall injury hospital separations in the province of British Columbia, Canada. Further, the study examines the relationships of social disparities to a set of three injury prevention priorities in British Columbia, namely, transport (motor vehicle occupant, pedestrian and cyclist), falls among older adults, and youth self-harm. The goal being to better understand area-based injury incidence with a view to precision prevention initiatives, particularly for more vulnerable populations. Methods Acute hospital separations from the Discharge Abstract Database were identified for all causes of injury and the three BC injury prevention priorities for the period April 1, 2009 to March 31, 2014, inclusive. An ecological approach was applied where each hospital separation case was attributed with the income, education and employment level according to the injured individual’s area of residence, derived from the 2011 CensusPlus data. Results Injury hospital separation data were available for 191 Forward Sortation Areas in BC. Between April 1, 2009 and March 31, 2014, there was a total of 177,861 injury-related hospital separations, averaging 35,572 hospital separations per year and an annual rate of 779 injury hospital separations per 100,000 population. Injury hospital separation rates varied with the measured neighbourhood area socioeconomic status variables. Injury hospital separation rates demonstrated an inverse relationship with neighbourhood levels of income and education. Neighbourhood area socioeconomic status differences were also associated with the injury hospital separation rates for falls among older adults, motor vehicle crashes involving motor vehicle occupants, pedestrians, cyclists and young drivers, and youth self-harm. Conclusions The study results show that neighbourhood levels of income, education and employment are associated with the risk of injury hospital separation. In particular, low education levels in FSAs was associated with increased risk of injury hospital separation, mainly for motor vehicle occupants, pedestrians, young drivers, and youth self-harm. The results of this study provide useful information for implementing injury prevention initiatives and interventions in BC to align with the provincial public health system and road safety strategy goals, particularly for identified priorities.
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Affiliation(s)
- Fahra Rajabali
- 1Department of Pediatrics, University of British Columbia, Vancouver, British Columbia Canada.,2BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia Canada
| | - Alex Zheng
- 1Department of Pediatrics, University of British Columbia, Vancouver, British Columbia Canada.,2BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia Canada
| | - Kate Turcotte
- 1Department of Pediatrics, University of British Columbia, Vancouver, British Columbia Canada.,2BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia Canada
| | - Li Rita Zhang
- 3BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia Canada
| | - Diana Kao
- 3BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia Canada
| | - Drona Rasali
- 3BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia Canada.,4Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan Canada
| | - Megan Oakey
- 3BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia Canada
| | - Ian Pike
- 1Department of Pediatrics, University of British Columbia, Vancouver, British Columbia Canada.,2BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia Canada
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18
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Shafi R, Smith PM, Colantonio A. Assault predicts time away from work after claims for work-related mild traumatic brain injury. Occup Environ Med 2019; 76:471-478. [PMID: 31126965 PMCID: PMC6585268 DOI: 10.1136/oemed-2018-105621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/13/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Workplace violence carries a substantial economic loss burden. Up to 10% of all traumatic brain injury (TBI) admissions result from physical assault. There remains a paucity of research on assault as a mechanism of injury, taking into account sex, and its association with work re-entry. OBJECTIVES The aim of this study was to characterise, by sex, the sample of workers who had sustained a work-related mild TBI (wr-mTBI) and to assess the independent influence of assault, as a mechanism of injury, on time away from work. METHODS A population-based retrospective cohort of workers' compensation claimants in Australia (n=3129) who had sustained a wr-mTBI was used for this study. A multivariable logistic regression analysis assessed whether workers who had sustained wr-mTBI as a result of assault (wr-mTBI-assault) were more likely to claim time off work compared with workers who had sustained a wr-mTBI due to other mechanisms. RESULTS Among claimants who sustained a wr-mTBI, 9% were as a result of assault. The distribution of demographic and vocational variables differed between the wr-mTBI-assault, and not due to assault, both in the full sample, and separately for men and women. After controlling for potential confounding factors, workers who sustained wr-mTBI-assault, compared with other mechanisms, were more likely to take days off work (OR 2.14, 95% CI 1.53 to 2.99) within a 3-month timeframe. CONCLUSION The results have policy-related implications. Sex-specific and workplace-specific prevention strategies need to be considered and provisions to support return-to-work and well-being within this vulnerable cohort should be examined.
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Affiliation(s)
- Reema Shafi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Smith
- Institute for Work & Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela Colantonio
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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19
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Healthcare Utilization and Missed Workdays for Parents of Children With Traumatic Brain Injury. J Head Trauma Rehabil 2019; 34:257-267. [PMID: 30608307 DOI: 10.1097/htr.0000000000000458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We enrolled patients in a prospective study in which we obtained estimates of the direct and indirect burden for families of children with traumatic brain injury (TBI) relative to a control group of families of children with orthopedic injury (OI). METHODS Parents were surveyed at 3 time points following injury: 3, 6, and 12 months. At each follow-up contact, we asked parents to list the number of workdays missed, number of miles traveled, amount of travel-related costs, and whether their child had an emergency department (ED) visit, hospital admission, any over-the-counter (OTC) medications, and any prescription medications during that time period. We assessed the difference in these outcomes between the TBI and OI groups using multivariable logistic and 2-part regression models to account for high concentrations of zero values. RESULTS Children with TBI had significantly greater odds of having an ED visit (3.04; 95% CI, 1.12-8.24), OTC medications (1.98; 95% CI, 1.34-2.94), and prescription medications (2.34; 95% CI, 1.19-4.59) than those with OI. In addition, parents of children with TBI missed significantly more days of work (19.91 days; 95% CI, 11.64-28.17) overall during the 12 months following injury than their OI counterparts. CONCLUSION Extrapolating our results to the entire country, we estimate that pediatric TBI is associated with more than 670 000 lost workdays annually over the 12 months following injury, which translates into more than $150 million in lost productivity. These missed workdays and lost productivity may be prevented through safety efforts to reduce pediatric TBI.
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20
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Lasry O, Liu EY, Powell GA, Ruel-Laliberté J, Marcoux J, Buckeridge DL. Epidemiology of recurrent traumatic brain injury in the general population: A systematic review. Neurology 2017; 89:2198-2209. [PMID: 29070664 DOI: 10.1212/wnl.0000000000004671] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/05/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To comprehensively assess recurrent traumatic brain injury (rTBI) risk and risk factors in the general population. METHODS We systematically searched MEDLINE, EMBASE, and the references of included studies until January 16, 2017, for general population observational studies reporting rTBI risk or risk factors. Estimates were not meta-analyzed due to significant methodologic heterogeneity between studies, which was evaluated using meta-regression. RESULTS Twenty-two studies reported recurrence risk and 11 reported on 27 potential risk factors. rTBI risk was heterogeneous and varied from 0.43% (95% confidence interval [CI] 0.19%-0.67%) to 41.92% (95% CI 34.43%-49.40%), with varying follow-up periods (3 days-55 years). Median time to recurrence ranged from 0.5 to 3.8 years. In studies where cases were ascertained from multiple points of care, at least 5.50% (95% CI 4.80%-6.30%) of patients experienced a recurrence after a 1-year follow-up. Studies that used administrative data/self-report surveys to ascertain cases tended to report higher risk. Risk factors measured at time of index traumatic brain injury (TBI) that were significantly associated with rTBI in more than one study were male sex, prior TBI before index case, moderate or severe TBI, and alcohol intoxication. Risk factors reported in a single study that were significantly associated with rTBI were epilepsy, not seeking medical care, and multiple factors indicative of low socioeconomic status. CONCLUSIONS rTBI is an important contributor to the general population TBI burden. Certain risk factors can help identify individuals at higher risk of these repeated injuries. However, higher quality research that improves on rTBI surveillance methodology is needed.
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Affiliation(s)
- Oliver Lasry
- From the Department of Epidemiology, Biostatistics and Occupational Health (O.L., E.Y.L., G.A.P., D.L.B.), and Department of Neurology and Neurosurgery, McGill University Health Centre (O.L., J.M.), McGill University, Montreal; and Faculty of Medicine (J.R.-L.), Université Laval, Canada.
| | - Erin Y Liu
- From the Department of Epidemiology, Biostatistics and Occupational Health (O.L., E.Y.L., G.A.P., D.L.B.), and Department of Neurology and Neurosurgery, McGill University Health Centre (O.L., J.M.), McGill University, Montreal; and Faculty of Medicine (J.R.-L.), Université Laval, Canada
| | - Guido Antonio Powell
- From the Department of Epidemiology, Biostatistics and Occupational Health (O.L., E.Y.L., G.A.P., D.L.B.), and Department of Neurology and Neurosurgery, McGill University Health Centre (O.L., J.M.), McGill University, Montreal; and Faculty of Medicine (J.R.-L.), Université Laval, Canada
| | - Jessica Ruel-Laliberté
- From the Department of Epidemiology, Biostatistics and Occupational Health (O.L., E.Y.L., G.A.P., D.L.B.), and Department of Neurology and Neurosurgery, McGill University Health Centre (O.L., J.M.), McGill University, Montreal; and Faculty of Medicine (J.R.-L.), Université Laval, Canada
| | - Judith Marcoux
- From the Department of Epidemiology, Biostatistics and Occupational Health (O.L., E.Y.L., G.A.P., D.L.B.), and Department of Neurology and Neurosurgery, McGill University Health Centre (O.L., J.M.), McGill University, Montreal; and Faculty of Medicine (J.R.-L.), Université Laval, Canada
| | - David L Buckeridge
- From the Department of Epidemiology, Biostatistics and Occupational Health (O.L., E.Y.L., G.A.P., D.L.B.), and Department of Neurology and Neurosurgery, McGill University Health Centre (O.L., J.M.), McGill University, Montreal; and Faculty of Medicine (J.R.-L.), Université Laval, Canada
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21
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Amram O, Walker BB, Schuurman N, Pike I, Yanchar N. Disparities in Paediatric Injury Mortality between Aboriginal and Non-Aboriginal Populations in British Columbia, 2001-2009. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E651. [PMID: 27399748 PMCID: PMC4962192 DOI: 10.3390/ijerph13070651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 01/04/2023]
Abstract
Injury is the leading cause of death among children and youth in Canada. Significant disparities in injury mortality rates have been observed between Aboriginal and non-Aboriginal populations, but little is known about the age-, sex-, and mechanism-specific patterns of injury causing death. This study examines paediatric mortality in British Columbia from 2001 to 2009 using comprehensive vital statistics registry data. We highlight important disparities in Aboriginal and non-Aboriginal mortality rates, and use the Preventable Years of Life Lost (PrYLL) metric to identify differences between age groups and the mechanisms of injury causing death. A significantly greater age-adjusted mortality rate was observed among Aboriginal children (OR = 2.08, 95% CI: 1.41, 3.06), and significantly higher rates of death due to assault, suffocation, and fire were detected for specific age groups. Mapped results highlight regional disparities in PrYLL across the province, which may reflect higher Aboriginal populations in rural and remote areas. Crucially, these disparities underscore the need for community-specific injury prevention policies, particularly in regions with high PrYLL.
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Affiliation(s)
- Ofer Amram
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Blake Byron Walker
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Ian Pike
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
- BC Injury Research and Prevention Unit, Child and Family Research Institute, BC Children's Hospital, Vancouver, BC V5Z 4H4, Canada.
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada.
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