Traumatic Brain Injury and Its Risk Factors in a Homeless Population.

OBJECTIVE: To characterize the traumatic brain injury (TBI) profile and its associated risk factors in homeless individuals in Santa Clara County, CA. DESIGN: Observational cohort study. SETTING: Two homeless shelter health clinics in Santa Clara County, CA. PARTICIPANTS: Currently or recently homeless individuals seeking health care at 2 homeless shelter health clinics between August 2013 and May 2014. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, TBI incidence and characteristics. RESULTS: The findings indicate that TBI history in the homeless population was higher (79.7%) than in the general population (12%). Almost half of the population (49.2%) reported that their TBI occurred before the age of 18. Of the participants, 68.2% reported sustaining a TBI with loss of consciousness. TBI caused by violence (60%) was lower in this cohort than other homeless cohorts but was the main cause of injury regardless of age. Alcoholism was a risk factor for having more TBIs. No differences in TBI profile were found between sexes. CONCLUSIONS: Our findings underscore the need for more research on the lifetime risk factors associated with TBI to prevent and reduce the number of brain injuries in homeless populations.

Patient choice: deciding between psychotropic medication and physical restraints in an emergency.

The legal requirement to use least restrictive interventions in emergency psychiatric treatment does not stipulate whether physical restraints or medication is least restrictive. There is no current consensus about how to determine least restrictive interventions in a generalizable manner. In this study patients who were clients in a public psychiatric emergency service were anonymously surveyed and asked to state their preferences for specific interventions in a psychiatric emergency. In a choice between physical restraints versus psychotropic medication, 64 percent of clients preferred medication; 36 percent preferred seclusion or restraint. The rank order of preferred modality was 1) benzodiazepines--31 percent, 2) neuroleptics--26 percent, 3) seclusion--24 percent, 4) restraints--10 percent. The rank order of last choice was different. Patients preference is an important factor in determining the appropriate intervention in an emergency. Patient participation offers an opportunity reconcile to clinical and legal objectives, to i improve compliance, and to enhance patient and staff safety.