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Background: Traumatic brain injury (TBI) is disproportionately prevalent among individuals who intersect or are involved with the criminal justice system (CJS). In the absence of appropriate care, TBI-related impairments, intersecting social determinants of health, and the lack of TBI awareness in CJS settings can lead to lengthened sentences, serious disciplinary charges, and recidivism. However, evidence suggests that most clinical practice guidelines (CPGs) overlook equity and consequently, the needs of disadvantaged groups. As such, this review addressed the research question "To what extent are (1) intersections with the CJS considered in CPGs for TBI, (2) TBI considered in CPGs for CJS, and (3) equity considered in CPGs for CJS?". Methods and findings: CPGs were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of identified CPGs on November 2021 and March 2023 (CPGs for TBI) and May 2022 and March 2023 (CPGs for CJS). Only CPGs for TBI or CPGs for CJS were included. We calculated the proportion of CPGs that included TBI- or CJS-specific content, conducted a qualitative content analysis to understand how evidence regarding TBI and the CJS was integrated in the CPGs, and utilised equity assessment tools to understand if and how equity was considered. Fifty-seven CPGs for TBI and 6 CPGs for CJS were included in this review. Fourteen CPGs for TBI included information relevant to the CJS, but only 1 made a concrete recommendation to consider legal implications during vocational evaluation in the forensic context. Two CPGs for CJS acknowledged the prevalence of TBI among individuals in prison and one specifically recommended considering TBI during health assessments. Both CPGs for TBI and CPGs for CJS provided evidence specific to a single facet of the CJS, predominantly in policing and corrections. The use of equity best practices and the involvement of disadvantaged groups in the development process were lacking among CPGs for CJS. We acknowledge limitations of the review, including that our searches were conducted in English language and thus, we may have missed other non-English language CPGs in this review. We further recognise that we are unable to comment on evidence that is not integrated in the CPGs, as we did not systematically search for research on individuals with TBI who intersect with the CJS, outside of CPGs. Conclusions: Findings from this review provide the foundation to consider CJS involvement in CPGs for TBI and to advance equity in CPGs for CJS. Conducting research, including investigating the process of screening for TBI with individuals who intersect with all facets of the CJS, and utilizing equity assessment tools in guideline development are critical steps to enhance equity in healthcare for this disadvantaged group. Zoe Colclough and co-authors examine how equity is considered in the development of clinical practice guidelines for traumatic brain injury for individuals within the criminal justice system. Author summary: Why was this study done?: Traumatic brain injury (TBI) is more common among individuals involved with the criminal justice system (CJS) than the general population, often resulting in longer prison sentences, serious disciplinary charges, and repeated future conflicts with the CJS. Although individuals with TBI who are involved with the CJS must receive care that meets their needs, studies show that most clinical practice guidelines (CPGs)—designed to guide care—tend to overlook equity and disadvantaged groups, instead focussing on the effectiveness or cost-effectiveness of care. As a first step to improving equitable care, this study assessed existing CPGs for TBI and CPGs for CJS to see if and how (1) evidence regarding individuals who intersect with the CJS is included in CPGs for TBI and evidence regarding TBI is integrated in CPGs for CJS; and (2) equity is considered in CPGs for CJS. What did the researchers do and find?: We used available electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google search, and reference lists for CPGs for TBI and CPGs for CJS. We documented their characteristics, reviewed their content, and assessed whether equity was considered using checklists focused on equity and disadvantaged groups. We found that 14 out of 57 CPGs for TBI referenced individuals who are involved with the CJS and 2 out of 6 CPGs for CJS referenced TBI. Practices to ensure that equity is considered, such as the involvement of disadvantaged groups when developing CPGs were lacking in CPGs for CJS. What do these findings mean?: Findings from this review suggest that consideration of equity is lacking in the development of CPGs for TBI for those within the CJS and provide the foundation to consider CJS involvement in CPGs for TBI and to advance equity in CPGs for CJS. There is a critical need for further research into screening processes for TBI with individuals who intersect with all facets of the CJS, and into the benefits of equity assessment tools in guideline development to enhance equity in healthcare for this disadvantaged group Unfortunately, we cannot comment on how much of the existing evidence regarding TBI or individuals who are involved with the CJS remains unintegrated in existing CPGs, as our search did not include research papers on TBI and the CJS, outside of CPGs. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intimate partner violence (IPV) is a public health crisis affecting one in three women and one in ten men in their lifetimes. Rehabilitation professionals are highly likely to encounter survivors of IPV in their practice; yet, there exists no formal review assessing the relationship between IPV and rehabilitation. Our objective was to understand the types and contexts of rehabilitation care currently available for survivors of IPV, opportunities identified in the literature for rehabilitation care, and IPV awareness and education among rehabilitation providers. A search strategy related to IPV and four rehabilitation professionals of interest (occupational therapy, physiotherapy, speech-language pathology/therapy, and physiatry) was developed across 10 databases and complemented by a gray literature search. Two reviewers independently assessed articles for inclusion. In all, 44 articles met inclusion criteria, ranging from primary research articles (48%) to clinical newsletters. Included articles predominantly focused on opportunities for rehabilitation care (68%) and occupational therapists as a profession (68%). A minority of studies examined specific interventions for IPV survivors (18%) or assessed for knowledge and attitudes about IPV (16%) among rehabilitation professionals. To our knowledge, this is the first scoping review exploring the rehabilitation literature for IPV survivors. These findings show an awareness of IPV among rehabilitation professionals, the importance of identifying IPV in clients, and the ways in which rehabilitation professionals are uniquely situated to support survivors of IPV. There remains an opportunity to explore interventions designed specifically for IPV survivors. [ABSTRACT FROM AUTHOR]

Video game playing has become a very popular activity among adolescents. Its impact on the mental health and well-being of players is just beginning to be explored. This paper reports on the prevalence of problematic gaming in a representative sample of 2,832 Ontario students in grades 7 to 12. The survey included questions about the school grade, family and school related problems, frequency of video game playing and video game related problems as measured by the Problem Video Game Playing scale (PVP). Most of the students (85%) reported playing video games in the past year and 18.3% reported playing video games daily. Slightly less then 1 in 10 of the students (9.4%) endorsed 5 or more of the PVP items (males 15.1%; females 3.1%). Further research is required to delineate the concept of excessive video game playing, its relation to other addictions, and the impact on adolescents' psychosocial functioning.

Traumatic brain injury (TBI), a leading cause of morbidity and mortality globally, is highly prevalent among individuals who intersect with the criminal justice system (CJS). It is well-established that TBI negatively impacts individuals’ interactions both within the CJS and upon release and is associated with serious disciplinary charges and higher recidivism rates. Although rehabilitation is fundamental to TBI recovery, it is not known to what extent rehabilitation is available to, or used by, individuals who intersect with the CJS. This scoping review explores the availability and extent of rehabilitation for individuals with TBI who intersect with the CJS, based on available literature. A systematic search of electronic databases (MEDLINE, Embase, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, and Proquest Nursing and Allied Health), relevant organizations’ websites, and reference lists of eligible articles identified 22 peer-reviewed articles and 2 gray literature reports that met predetermined eligibility criteria. Extracted data were synthesized through a descriptive numerical summary and qualitative content analysis. This review provides evidence that existing rehabilitation interventions are already serving individuals with TBI with a history of CJS involvement; however, they rarely consider or acknowledge TBI or CJS in their interventions. Findings also suggest opportunities to integrate rehabilitation for individuals with TBI who intersect with the CJS through TBI screening, education on TBI within CJS settings, and linkages to the community to facilitate continuity of care. This review also highlights significant gaps in knowledge regarding sex, gender, and other intersecting factors. Research to understand how these experiences impact the rehabilitation process throughout the CJS is urgently needed to enable timely and appropriate rehabilitation and continuity of care for diverse individuals with TBI who intersect with the CJS. [ABSTRACT FROM AUTHOR]

This study identified the social determinants of health (SDoH) associated with psychological distress in adults with and without a self-reported history of traumatic brain injury (TBI), stratified by sex. Data from the 2014–2017 cycles of the Centre for Addiction and Mental Health Monitor Survey, a representative survey of adults ≥18 years in Ontario, Canada, were analyzed (N = 7,214). The six-item version of the Kessler Psychological Distress Scale was used to determine moderate to severe psychological distress. Self-reported lifetime TBI was defined as a head injury resulting in a loss of consciousness for ≥5 minutes or at least one-night stay in the hospital (16.4%). Among individuals reporting a history of TBI, 30.2% of males and 40.1% of females reported psychological distress (p = 0.0109). Among individuals who did not report a history of TBI, 17.9% of males and 23.5% of females reported psychological distress (p<0.0001). Multivariable logistic regression analyses showed that the SDoH significantly associated with elevated psychological distress were similar between individuals with and without a history of TBI. This included unemployment, student, or 'other' employment status among both males and females; income below the provincial median and age 65+ among males; and rural residence among females. This study highlighted opportunities for targeted population-level interventions, namely accessible and affordable mental health supports for individuals with lower income. Notably, this study presented evidence suggesting adaptations to existing services to accommodate challenges associated with TBI should be explored, given the finite and competing demands for mental health care and resources. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI), a leading cause of both death and disability worldwide, is highly prevalent among individuals who intersect with the criminal justice system. TBI is associated with increased behavioural, psychological, or negative outcomes, such as higher rates of mental health problems, aggression, and violent offending that may lead to negative interactions with the criminal justice system, reincarceration, and recidivism. Although rehabilitation is often recommended and holds promise in addressing TBI-related impairments, there is currently a paucity of reviews on rehabilitation for individuals with TBI who intersect with the criminal justice system (CJS). Concurrently, to the best of our knowledge, there is currently no review that considers rehabilitation among individuals with TBI who intersect with all parts of the CJS (i.e., policing, courts, corrections, and parole). This protocol is for a scoping review to address the above gaps, specifically, to identify the types of rehabilitation interventions and/or programs available to, or used by, individuals with TBI who intersect with all parts of the CJS. Primary research articles that meet pre-defined inclusion criteria will be identified from electronic databases (MEDLINE® ALL, Embase and Embase Classic, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, Nursing and Allied Health, and Dissertation and These Global), reference lists of included articles, and scoping or systematic reviews. Grey literature will also be searched to identify non-peer-reviewed reports. Retrieved articles will be screened by two reviewers and any disagreements will be resolved by a third reviewer. Data will be summarized quantitatively and analyzed using content analytic techniques. Intersecting identities will be charted and considered in the analysis. Stakeholders will be engaged to obtain feedback on preliminary results and the implications of findings. The scoping review will summarize the current state of rehabilitation available to, or used by, individuals with TBI who intersect with all parts of the CJS to (a) inform opportunities to integrate rehabilitation in the criminal justice system for diverse individuals and (b) identify opportunities for future research. [ABSTRACT FROM AUTHOR]

Traumatic brain injuries (TBI) and mental health or substance use disorders (MHSU) are global public health concerns due to their prevalence and impact on individuals and societies. However, care for individuals with TBI and MHSU remains fragmented with a lack of appropriate services and supports across the continuum of healthcare. This systematic review provided an evidence-based foundation to inform opportunities to mobilize and adapt existing resources to integrate care for individuals with TBI and MHSU by comprehensively summarizing existing integrated activities and reported barriers and facilitators to care integration. MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Sociological Abstracts, and Dissertations & Theses Global were independently reviewed by two reviewers based on pre-determined eligibility criteria. Data on the integration activity, level and type of integration, reported barriers and facilitators, and the strategies aligning with the World Health Organization's (WHO) Framework on Integrated Person-Centred Care were extracted to form the basis for a narrative synthesis. Fifty-nine peer-reviewed articles were included, describing treatments (N = 49), programs (N = 4), or screening activities (N = 7). Studies discussing clinical integration at the micro- (N = 38) and meso- (N = 10) levels, service integration at the micro- (N = 6) and meso- (N = 5) levels, and functional integration at the meso-level (N = 1) were identified. A minority of articles reported on facilitators (e.g., cognitive accommodations in treatment plans; N = 7), barriers (e.g., lack of education on cognitive challenges associated with TBI; N = 2), or both (N = 6), related to integrating care. This review demonstrated that integrated TBI and MHSU care already exists across a range of levels and types. Given the finite and competing demands for healthcare resources, cognitive accommodations across treatment plans to facilitate integrated TBI and MHSU care should be considered. Multidisciplinary teams should also be explored to provide opportunities for education among health professionals so they can be familiar with TBI and MHSU. Trial registration: Prospero Registration: CRD42018108343. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is a public health concern that can occur in a range of contexts. Work-related TBI (wrTBI) is particularly concerning. Despite overall work-related injury claims decreasing, the proportion of claims that are wrTBI have increased, suggesting prevention and support of wrTBI requires ongoing attention.Objectives: This review aimed to provide updated information on the burden and risk factors of wrTBI among the working adult population.Methods: Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a combination of TBI, work, and epidemiology text words and medical subject headings. Two reviewers independently assessed articles for inclusion. Meta-analyses were conducted to estimate prevalence and mortality of wrTBI and a narrative synthesis was conducted to provide additional context.Results: Pooled proportions meta-analyses estimate that 17.9% of TBIs were work-related and 6.3% of work-related injuries resulted in TBI, with 3.6% of wrTBI resulting in death. Populations of wrTBI were predominantly male (76.2%) and were 40.4 years of age, on average. The most commonly reported industries for wrTBI were education and training, healthcare and social assistance, construction, manufacturing, and transportation. Falls, being struck by an object or person, motor vehicle collisions, and assaults were the most commonly reported mechanisms of wrTBI.Conclusions: A better understanding of the epidemiology of wrTBI can inform prevention and management strategies. This review highlights existing gaps, including a notable lack of sex or gender stratified data, to direct future investigation.Prospero Registration Number: CRD42020169642. [ABSTRACT FROM AUTHOR]

To identify determinants of discharge disposition from acute care among survivors of hypoxic-ischemic brain injury (HIBI), stratified by sex. Population-based retrospective cohort study using provincial data in Ontario, Canada. The determinants were grouped into predisposing, need, and enabling factors using the Anderson Behavioral Model. Acute care. Survivors of HIBI aged ≥20 years at the time of hospitalization and discharged alive from acute care between April 1, 2002, and March 31, 2017. There were 7492 patients with HIBI, of whom 28% (N=2077) survived their acute care episode. Not applicable. Discharge disposition from acute care, categorized as complex continuing care (CCC), long-term care (LTC), inpatient rehabilitation (IR), home with support, home without support, and transferred to another acute care. The discharge dispositions for the 2077 survivors were IR 23.4% (n=487), CCC 19.5% (n=404), LTC 6.2% (n=128), home without support 31.2% (n=647), home with support 15.1% (n=314), and other 4.6%. Multinomial multivariable logistic regression analysis using home without support as the reference category revealed that female patients were significantly more likely than male patients to be discharged to LTC/CCC. Those who were older, were frail, and had longer stay in acute care or special care unit (SCU) were more likely to be discharged to LTC/CCC. The only significant determinant for IR was longer stay in acute care. Survivors with cardiac-related injury were less likely to be discharged to LTC/CCC. Income was a significant factor for male patients but not for female patients in the sex-stratified analysis. The following variables were investigated but were not significant determinants in this study: need factors (comorbidity score, prior psychiatric disorders, health care utilization) and enabling factors (income quintile, rural area of residence). Predisposing (age, sex) and need factors (frailty, acute care days, SCU days, type of injury) were significant determinants of discharge disposition from acute care after HIBI. In spite of a system with universal coverage, sex differences were found, with more female patients being discharged to CCC/LTC rather than IR, controlling for age and other confounders. These findings should be considered in appropriate discharge planning from acute care for survivors of HIBI. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this paper is to examine factors associated with discharge destination after acquired brain injury in a publicly insured population using the Anderson Behavioral Model as a framework. Methods We utilized a retrospective cohort design. Inpatient data from provincial acute care records from fiscal years 2003/4 to 2006/7 with a diagnostic code of traumatic brain injury (TBI) and non-traumatic brain injury (nTBI) in Ontario, Canada were obtained for the study. Using multinomial logistic regression models, we examined predisposing, need and enabling factors from inpatient records in relation to major discharge outcomes such as discharge to home, inpatient rehabilitation and other institutionalized care. Results Multinomial logistic regression revealed that need factors were strongly correlated with discharge destinations overall. Higher scores on the Charlson Comorbidity Index were associated with discharge to other institutionalized care in the nTBI population. Length of stay and special care days were identified as markers for severity and were both strongly positively correlated with discharge to other institutionalized care and inpatient rehabilitation, compared to discharge home, in both nTBI and TBI populations. Injury by motor vehicle collisions was found to be positively correlated with discharge to inpatient rehabilitation and other institutionalized care for patients with TBI. Controlling for need factors, rural location was associated with discharge to home versus inpatient rehabilitation. Conclusions These findings show that need factors (Charlson Comorbidity Index, length of stay, and number of special care days) are most significant in terms of discharge destination. However, there is evidence that other factors such as rural location and access to supplemental insurance (e.g., through motor vehicle insurance) may influence discharge destination outcomes as well. These findings should be considered in creating more equitable access to healthcare services across the continuum of care.

Objective: To understand how pre-injury health status present five-years preceding traumatic brain injury (TBI) affects direct medical cost two years post-injury. Methods: Patients age ≥19 years in the emergency department (ED) or acute care for a TBI between April 1, 2007 and March 31, 2014 in Ontario, Canada (N = 55,669) were identified from population-based health administrative data. Forty-three factors of pre-injury health status (i.e., comorbidities and personal, social, and environmental factors) that were internally validated for the TBI population were assessed in this study. The outcome of interest was direct medical cost within two years of discharge. Sex-specific multivariable linear regressions were conducted to understand the associations between direct medical cost within two years of discharge and pre-injury health status. Results: Patients who received care in the ED (81.9% of total sample) incurred a median cost of $2,492/male patient (average $12,342/patient) and $3,508/female patient (average $65,285/patient) within two years of injury; 37 pre-injury factors were significantly associated with increased direct medical costs. Patients who first received care for their TBI in acute care (18.1%) incurred a median cost of $25,081/male patient (average $63,060/patient) and $30,277/female patient (average $65,285/patient) within two years of injury; 21 factors were significantly associated with increased direct medical costs. Among more prevalent factors, those associated with increased medical cost by at least 50% included mental health disorders, substance abuse, disorders or medical conditions frequently observed among the elderly, cardiovascular disorders, stroke and emergencies involving the brain, metabolic disorders and abdominal symptoms, conditions and symptoms of abdomen and pelvis, genitourinary disorders and disorders of prostate, and pulmonary abdominal and other emergencies. Conclusions: Direct medical costs two years post-TBI differed significantly between patients with and without adverse pre-existing health status. Interdisciplinary teams to promote early identification of pre-existing health conditions and appropriate management and integration of these conditions in TBI care across the continuum of healthcare may be opportunities to reduce direct medical costs post-injury. [ABSTRACT FROM AUTHOR]

To understand how health status preceding traumatic brain injury (TBI) affects relative functional gain after inpatient rehabilitation using a data mining approach. Population-based, sex-stratified, retrospective cohort study using health administrative data from Ontario, Canada (39% of the Canadian population). Inpatient rehabilitation. Patients 14 years or older (N=5802; 63.4% male) admitted to inpatient rehabilitation within 1 year of a TBI-related acute care discharge between April 1, 2008, and March 31, 2015. Not applicable. Relative functional gain (RFG) in percentage, calculated as ([discharge FIM−admission FIM]/[126−admission FIM]×100). Health status prior to TBI was identified and internally validated using a data mining approach that categorized all International Classification of Diseases, 10th revision, codes for each patient. The average RFG was 52.8%±27.6% among male patients and 51.6%±27.1% among female patients. Sex-specific Bonferroni adjusted multivariable linear regressions identified 10 factors of preinjury health status related to neurology, emergency medicine, cardiology, psychiatry, geriatrics, and gastroenterology that were significantly associated with reduced RFG in FIM for male patients. Only 1 preinjury health status category, geriatrics, was significantly associated with RFG in female patients. Comorbid health conditions present up to 5 years preceding the TBI event were significantly associated with RFG. These findings should be considered when planning and executing interventions to maximize functional gain and to support an interdisciplinary approach. Best practices guidelines and clinical interventions for older male and female patients with TBI should be developed given the increasingly aging population with TBI. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors of in-hospital mortality following Hypoxic-Ischemic Brain Injury (HIBI) using the Anderson Behavioral Model. Design and Setting: Population based retrospective cohort study in Ontario, Canada with data collected between 1 April 2002 and 31 March 2017. Patients: Adult patients aged 20 years and older with HIBI-related acute care admission were identified in the health administrative data. Multivariable cox proportional hazard regression models were used to identify predisposing, need and enabling factors that predict in-hospital mortality. Results: Of the 7492 patients admitted to acute care with HIBI, the in-hospital mortality rate was 71%. The predisposing factors associated with mortality were female sex (HR, 1.16; 95% CI, 1.10–1.23) and older age (65–79 vs. 20–34: HR, 1.17; 95% CI, 1.02–1.35). The need factors associated with mortality were the presence of COPD (HR, 1.10; 95% CI, 1.02–1.17), psychiatric illness (HR, 1.13; 95% CI, 1.05–1.20) injury due to cardiac illness (HR, 1.19; 95% CI, 1.12–1.26) and longer emergency department length of stay. Having spending any time in an alternate level of care and the application of tracheotomy procedures were found to reduce mortality.Conclusions: The acute/critical care centers need to consider these findings to adopt prevention strategies targeting reduced in-hospital mortality. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives Comorbidity in traumatic brain injury (TBI) has been recognised to alter the clinical course of patients and influence short-term and long-term outcomes. We synthesised the evidence on the effects of different comorbid conditions on early and late mortality post-TBI in order to (1) examine the relationship between comorbid condition(s) and all-cause mortality in TBI and (2) determine the influence of sociodemographic and clinical characteristics of patients with a TBI at baseline on all-cause mortality. Design Systematic review. Data sources Medline, Central, Embase, PsycINFO and bibliographies of identified articles were searched from May 1997 to January 2019. Eligibility criteria for selecting studies Included studies met the following criteria: (1) focused on comorbidity as it related to our outcome of interest in adults (ie, ≥18 years of age) diagnosed with a TBI; (2) comorbidity was detected by any means excluding self-report; (3) reported the proportion of participants without comorbidity and (4) followed participants for any period of time. Data extraction and synthesis Two independent reviewers extracted the data and assessed risk of bias using the Quality in Prognosis Studies tool. Data were synthesised through tabulation and qualitative description. Results A total of 27 cohort studies were included. Among the wide range of individual comorbid conditions studied, only low blood pressure was a consistent predictors of post-TBI mortality. Other consistent predictors were traditional sociodemographic risk factors. Higher comorbidity scale, scores and the number of comorbid conditions were not consistently associated with post-TBI mortality. Conclusions Given the high number of comorbid conditions that were examined by the single studies, research is required to further substantiate the evidence and address conflicting findings. Finally, an enhanced set of comorbidity measures that are suited for the TBI population will allow for better risk stratification to guide TBI management and treatment. [ABSTRACT FROM AUTHOR]

To estimate change in motor, cognitive, and overall functional performance during inpatient rehabilitation (IR) and to identify potential determinants of these outcomes among patients with hypoxic-ischemic brain injury (HIBI). Population-based retrospective cohort study using Ontario's health administrative data. Inpatient rehabilitation. Survivors of HIBI 20 years and older discharged from acute care between fiscal years 2002-2003 and 2010-2011 and admitted to IR within 1 year of acute care discharge (N=159). Not applicable. Functional status as measured by FIM, total, and scores on motor and cognitive subscales. A higher proportion (77%) of HIBI patients in the study were male and 28% were older than 65 years. We observed material improvements in FIM total, motor, and cognitive scores from across the IR episode. Potential determinants of total FIM gain were living in rural location (β, 10.4; 95% CI, 0.21-21), having shorter preceding acute care length of stay (15-30 vs >60 days β, 10.4; 95% CI, 1.4-19.5), and failing to proceed directly to IR following acute care discharge (β, 8.7; 95% CI, 1.8-15.5). Motor FIM gain had similar identified potential determinants. Identified potential determinants of cognitive FIM gain were shorter (ie, 31-60 vs >60 days) preceding acute care, longer IR and length of stay, and proceeding directly to IR. There were no sex differences in functional gain. Inpatient rehabilitation is beneficial to HIBI survivors. Timely access to these services may be crucial in achieving optimal outcomes for these patients. [ABSTRACT FROM AUTHOR]

Introduction In the most populous province of Canada, one in five adults and one in six students report a lifetime history of traumatic brain injury (TBI). These individuals were also more likely to report elevated psychological distress and use illicit substances compared with those without TBI. The need for integrated health services has been recognised globally, yet efforts to develop more comprehensive and effective care for TBI and mental health and/or addictions (MHA) continue to be challenged by the siloing of the two systems. This protocol is for a systematic review that describes the current types of integrated care for TBI and MHA and identifies the barriers and facilitators to integrating healthcare for these populations. Methods and analysis This review will systematically search MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Sociological Abstracts, and Dissertations & Theses Global. References of eligible articles will also be searched for additional relevant studies. The search strategy will include the use of text words and subject headings relevant to the concepts 'TBI,' 'substance abuse, gambling, or mental health,' 'integrated healthcare,' 'barriers and facilitators,' and 'healthcare access.' Two reviewers will independently screen all articles based on predetermined inclusion and exclusion criteria and perform quality assessment on eligible studies. A narrative synthesis will be conducted using the data abstracted by the two reviewers. Ethics and dissemination Findings from the systematic review will be published in peer-reviewed journals, presented at scientific meetings, and summarised for key stakeholders in the field of TBI and/or MHA. This protocol will form a systematic review that holds the potential to impact policy and planning in the development of integrated person-centred care for TBI and MHA and addresses a recognised gap in TBI care. [ABSTRACT FROM AUTHOR]

Background: The cervical spine region can be especially vulnerable to concurrent injury in concussion, with research suggesting that females may be at greater risk due to their weaker and anatomically distinct necks. The main objective of our research was to study sex differences in the rate of neck injury comorbidity across the life span among patients with a concussion diagnosis in the emergency department (ED) setting, by cause of injury (motor vehicle collisions [MVC] and sports). Materials and Methods: All patients with a first concussion-related ED visit between fiscal years 2002/2003 and 2011/2012 (inclusive) in Ontario were identified in population-based health administrative data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) codes. Age-dependent odds ratios of comorbid neck injury for sex were estimated using polynomial multivariable logistic regression models, adjusting for sociodemographic characteristics. Results: Females with a concussion had significantly higher odds of sustaining a comorbid neck injury between the ages of 5–49 years for all concussion-related ED visits, 15–49 years for MVC-related concussion ED visits, and 10–39 years for sports-related concussion ED visits, holding all other covariates in the model constant. Conclusions: These results support the consideration of increased screening for comorbid neck injuries, particularly for females, to allow for early intervention. Furthermore, the increased risk of comorbid neck injury in females with a concussion-related ED visit was age-dependent, with the interaction between sex and age following a nonlinear trend. As such, future studies on concussions should consider linear and nonlinear sex and age interactions. [ABSTRACT FROM AUTHOR]

Background: Readmission to acute care is common and is associated with indicators of suboptimal care and health system inefficiencies. The objective of this study was to identify independent determinants of readmission following survival of hypoxic ischemic brain injury. Methods: We conducted a population-based retrospective cohort study using Ontario's administrative health data. Survivors of hypoxic ischemic brain injury aged 20 years or more discharged from acute care between fiscal years 2002/03 and 2010/11 were included. Multivariable negative binomial regression was used to identify independent determinants of both number of readmissions and cumulative duration of hospital stay(s) within 1 year after the index discharge. Results: Of the 593 patients with hypoxic ischemic brain injury, 233 (39.3%) were readmitted within 1 year of the index acute care discharge. The number of readmissions was associated with age (35–49 yr v. 65–79 yr: rate ratio [RR] 0.57, 95% confidence interval [CI] 0.38–0.85; ≥ 80 yr v. 65–79 yr: RR 0.58, 95% CI 0.34–0.97) and higher comorbidity score (Johns Hopkins Aggregated Diagnosis Groups score > 30 v. < 10: RR 1.60, 95% CI 1.11–2.31). Cumulative readmission stay was associated with increased index acute care length of stay (31–90 d v. ≥ 90 d: RR 4.17, 95% CI 1.38–12.64), prior use of health care services (minimal v. very high: RR 0.15, 95% CI 0.05–0.49) and discharge disposition (home v. continuing/long-term care: RR 0.44, 95% CI 0.21–0.91). Interpretation: The findings indicate a high readmission rate in the first year after the index acute care admission for survivors of hypoxic ischemic brain injury, reflecting care gaps and system inefficiencies. This suggests that bolstered discharge and home care planning and support are needed to address the specific needs of those with hypoxic ischemic brain injury. [ABSTRACT FROM AUTHOR]

Introduction Reports on the association between comorbidity and functional status and risk of death in patients with traumatic brain injury (TBI) have been inconsistent; it is currently unknown which additional clinical entities (comorbidities) have an adverse influence on the evolution of outcomes across the lifespan of men and women with TBI. The current protocol outlines a strategy for a systematic review of the current evidence examining the impact of comorbidity on functional status and early-term and late-term mortality, taking into account known risk factors of these adverse outcomes (ie, demographic (age and sex) and injury-related characteristics). Methods and analysis A comprehensive search strategy for TBI prognosis, functional (cognitive and physical) status and mortality studies has been developed in collaboration with a medical information specialist of the large rehabilitation teaching hospital. All peer-reviewed English language studies with longitudinal design in adults with TBI of any severity, published from May 1997 to April 2017, found through Medline, Central, Embase, Scopus, PsycINFO and bibliographies of identified articles, will be considered eligible. Study quality will be assessed using published guidelines. Ethics and dissemination The authors will publish findings from this review in a peer-reviewed scientific journal(s) and present the results at national and international conferences. This work aims to understand how comorbidity may contribute to adverse outcomes in TBI, to inform risk stratification of patients and guide the management of brain injury acutely and at the chronic stages postinjury on a population level. [ABSTRACT FROM AUTHOR]

To understand the types and contexts of rehabilitation care currently available for survivors of IPV, opportunities identified in the literature for rehabilitation care, and IPV awareness and education of rehabilitation care providers. Ten databases were comprehensively searched to identify articles related to IPV and the rehabilitation professions of interest. This search was complimented by a grey literature search of relevant IPV, gender-based violence, and rehabilitation organizations. Searches were not limited by language, year of publication, or geographic location. Two reviewers independently assessed articles for inclusion based on the following criteria: (1) Describe or evaluate a rehabilitation intervention or opportunity for intervention, or an educational or awareness intervention for rehabilitation professionals; AND (2) focus on selected rehabilitation professionals (occupational therapist, physiotherapist, speech language pathologists, physiatrists); AND (3) focus on interventions for or about adult survivors of IPV. One researcher independently extracted data which was peer reviewed by a second reviewer. Extracted information included publication details (author, year, location), study details (objective, design, setting), and information on study populations, interventions, and outcomes, when appropriate. Included articles ranged from primary research articles to clinical newsletter articles. While all rehabilitation professionals of interest were represented in the included articles, most focused on occupational therapy (>70%). A large majority of articles (>70%) suggested opportunities for rehabilitation professionals to support survivors of IPV. Most provided an overview of IPV followed by recommendations for rehabilitation professionals in supporting survivors. The remaining examined specific interventions for IPV survivors (< 15%) or assessed for knowledge, attitudes, or beliefs about IPV (< 15%). To our knowledge, this is the first scoping review addressing the rehabilitation literature for IPV survivors. Though still preliminary, these findings suggest there is an awareness of IPV among rehabilitation professionals, the importance of identifying IPV in clients, and the ways in which rehabilitation professionals are uniquely situated to support survivors of IPV. There remains opportunity to explore interventions designed specifically for IPV survivors. The authors have no conflicts to disclose. [ABSTRACT FROM AUTHOR]

Objective: Comorbid disorders influence the course and outcomes of rehabilitation following traumatic brain injury (TBI), yet sex- and age-related disparities in the frequency distribution of these disorders remain poorly understood. We aimed to describe comorbid disorders by the International Classification of Diseases in patients with TBI undergoing inpatient rehabilitation in Ontario, Canada over a 3-year period, by sex and age, and discuss their potential impact on rehabilitation outcomes. Results: The percentage of TBI patients with one or more comorbid disorder is higher among older (≥65 years) men and women than among those who are younger or middle-aged (<65 years). Among younger and middle-aged patients, multiple injuries and trauma, mental health conditions, and nervous system disorders were the most prevalent comorbidities. In older patients, circulatory, endocrine, nutritional, metabolic, and immune disorders were the most prevalent comorbidities. Our results suggest that a multisystem view of rehabilitation of men and women with TBI across age categories is needed to reflect the complex clinical profile of TBI patients undergoing rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Delayed discharge, captured as alternate-level-of-care days, represents inefficient use of high-demand acute care resources and results in potentially poorer patient outcomes. We performed a study to determine the extent of alternate-level-of-care days among patients who survived hypoxic--ischemic brain injury in inpatient hospital care in Ontario and to identify predictors of alternate-level-of-care use in this population. Methods: A population-based cohort of acute care survivors of hypoxic--ischemic brain injury aged 20 years or more from 2002/03 through 2011/12 was identified. We used 2 case definitions, the more specific identifying patients with a most responsible diagnosis of "anoxic brain damage," and the more sensitive capturing additional likely causative conditions as the most responsible diagnosis. Multivariable zero-inflated negative binomial regression was used to estimate independent effects on the relative incidence of alternatelevel- of-care days. Results: We identified 491 patients using the specific case definition and 669 patients using the extended case definition. After deaths were excluded, 232 patients (47.2%) and 278 patients (41.6%), respectively, had at least 1 alternate-level-of-care day (median 20 and 19 d, respectively). In both cohorts, decreasing age, no special care unit hours and acute care episode earlier in the study period were predictive of increased alternate-level-of-care days relative to length of stay. Discharge disposition and psychiatric/ behavioural comorbidity were most predictive of having any alternate-level-of-care days. Interpretation: Patients with hypoxic--ischemic brain injury had a greater proportion of alternate-level-of-care days than has been reported for patients with other types of acquired brain injury. This finding suggests that substantial barriers to appropriate discharge exist for this population. Predictors of increased alternate-level-of-care days were also shown to be unique. Further study of care deficits among patients with hypoxic--ischemic brain injury is warranted. [ABSTRACT FROM AUTHOR]

Background: Children and youth with non-traumatic brain injury (nTBI) are often overlooked in regard to the need for post-injury health services. This study provided population-based data on their burden on healthcare services, including data by subtypes of nTBI, to provide the foundation for future research to inform resource allocation and healthcare planning for this population.Methods: A retrospective cohort study design was used. Children and youth with nTBI in population-based healthcare data were identified using International Classification of Diseases Version 10 codes. The rate of nTBI episodes of care, demographic and clinical characteristics, and discharge destinations from acute care and by type of nTBI were identified.Results: The rate of pediatric nTBI episodes of care was 82.3 per 100,000 (N = 17,977); the average stay in acute care was 13.4 days (SD = 25.6 days) and 35% were in intensive care units. Approximately 15% were transferred to another inpatient setting and 6% died in acute care. By subtypes of nTBI, the highest rates were among those with a diagnosis of toxic effect of substances (22.7 per 100,000), brain tumours (18.4 per 100,000), and meningitis (15.4 per 100,000). Clinical characteristics and discharge destinations from the acute care setting varied by subtype of nTBI; the proportion of patients that spent at least one day in intensive care units and the proportion discharged home ranged from 25.9% to 58.2% and from 50.6% to 76.4%, respectively.Conclusions: Children and youth with nTBI currently put an increased demand on the healthcare system. Active surveillance of and in-depth research on nTBI, including subtypes of nTBI, is needed to ensure that timely, appropriate, and targeted care is available for this pediatric population. [ABSTRACT FROM AUTHOR]

Introduction: Many encephalitis survivors can benefit from rehabilitation. However, there is currently no comprehensive review describing rehabilitation intervention outcomes among children and adults with infectious encephalitis. This is a protocol for a systematic review that will summarise the current literature on outcomes following rehabilitative interventions among children and adults with infectious encephalitis. With a sufficient sample size, a sexstratified analysis of the findings will also be presented, as variability between male and female patients with neurological disorders, including encephalitis, regarding outcomes after rehabilitative interventions has been noted in the literature. Methods and analysis: This review will systematically search MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Central Register of Controlled Trials, and PsycINFO using the concepts 'encephalitis' and 'rehabilitation'. Grey literature will be searched using Grey Matters: A practical search tool for evidence-based medicine and the Google search engine. In addition, reference lists of eligible articles will be screened for any relevant studies. 2 reviewers will independently evaluate the retrieved studies based on predetermined eligibility criteria and perform a quality assessment on eligible studies. Ethics and dissemination: The results from this review hold the potential to advance our knowledge on the value of rehabilitative interventions targeting children and adults with infectious encephalitis and any sex differences among patients with regard to rehabilitative intervention outcomes. The authors will publish findings from this review in a peer-reviewed scientific journal (electronic and in-print) and present the results at national and international conferences. [ABSTRACT FROM AUTHOR]

Background: There is currently no active surveillance of metastatic and non-malignant brain tumours in Canada as well as data on the health service use of children and youth with brain tumours. The objective of this study was to identify pediatric primary, metastatic, benign, and unspecified brain tumours in Ontario, Canada and to describe their health service use from a population based perspective.Methods: The population based healthcare administrative databases National Ambulatory Care Reporting System and the Discharge Abstract Database were used. Patients with malignant (primary and metastatic), benign, and unspecified brain tumours in acute care between fiscal year 2003/04 and 2009/10 were identified using specified International Classification of Diseases version ten codes.Results: Between fiscal year 2003/04 and 2009/10, there were 4022 brain tumour episodes of care (18.4 per 100,000 children and youth). Malignant brain tumors had the highest rates of episodes of care (14.9 times higher than that of benign and 5.7 times higher than that of unspecified brain tumours). Compared to patients with malignant brain tumours, those with benign brain tumours spent a longer period of time in acute care (p < .05) and patients with unspecified brain tumours stayed in the intensive care units for a longer period of time (p < .0001) with a lower proportion were discharged home (p < .0001).Conclusion: Despite higher rates of malignant brain tumour episodes of care, patients with benign and unspecified brain tumours also use acute care services and post-acute services that are currently not taken into account in healthcare planning and resource allocation. Active surveillance and research of metastatic and non-malignant brain tumours that can inform the planning of healthcare services and resource allocation for this population is encouraged. [ABSTRACT FROM AUTHOR]