Differential profiles for patients with traumatic and non-traumatic brain injury.

OBJECTIVE: To profile the demographic, clinical and environmental characteristics of persons with acquired brain injury receiving inpatient rehabilitation services in Canada. DESIGN: This study utilizes data from the Canadian Institute for Health Information's National Rehabilitation Reporting System, between April 2001 and March 2006. The data were collected from publicly insured institutions providing inpatient rehabilitation across Canada. The main outcome measures examined were demographic and clinical characteristics. PARTICIPANTS: Adults with brain injury by traumatic (n=2675) vs non-traumatic causes (n=2759). RESULTS: Approximately half of acquired brain injury patients receiving inpatient rehabilitation had non-traumatic causes of brain injury. Traumatic brain injury patients were more likely to be younger, male, from rural areas, and to make greater gains in rehabilitation. Differences were found in the types and numbers of comorbidities. However, patients from these 2 groups had similar lengths of rehabilitation stay. CONCLUSION: These findings support a differential profile of patients by brain injury aetiology. This has relevance for staff training, resource allocation and future research.

Who waits for inpatient rehabilitation services in Canada after neurotrauma? A population based-study.

OBJECTIVE: This study examined characteristics of patients with acquired brain injury associated with wait times for inpatient rehabilitation compared with a control population of patients with acquired spinal cord injury. METHODS: This cross-sectional study was based on 9458 patients captured in the National Rehabilitation Reporting System in Canada. RESULTS: Waiting for inpatient rehabilitation was found to be associated with language, geographical location, informal support, pre-admission living arrangement and payer source. The median differences in wait time, however, were at most a few days. Persons already receiving care had the longest median wait times. CONCLUSION: The data reflect only the perspective of providers, and further research needs to examine days to inpatient admission using data from acute care.

Maternal insulin sensitivity during pregnancy predicts infant weight gain and adiposity at 1 year of age.

Emerging evidence suggests that fetal environmental exposures impact on future development of obesity. The objectives of this study were to assess the relationships between (i) maternal insulin sensitivity and glucose tolerance status in pregnancy and (ii) early infant weight gain and adiposity in the first year of life. In this prospective cohort study, 301 women underwent oral glucose tolerance testing for assessment of glucose tolerance status and insulin sensitivity (IS(OGTT)) in pregnancy. Their infants underwent anthropometric assessment at 12 months of age, including determination of weight gain in the first year of life and sum of skinfold thickness (SFT), a measure of infant adiposity. Infant weight gain and sum of SFT at 12 months did not differ according to maternal glucose tolerance status. On univariate analyses, weight gain from 0 to 12 months and sum of SFT were negatively associated with maternal IS(OGTT) during pregnancy. On multiple linear regression analysis, negative independent predictors of weight gain from 0 to 12 months were maternal IS(OGTT) during pregnancy (t = -2.73; P = 0.007), infant female gender (t = -3.16; P = 0.002), and parental education (t = -1.98; P = 0.05), whereas white ethnicity was a positive independent predictor (t = 2.68; P = 0.008). Maternal IS(OGTT) (t = -2.7; P = 0.008) and parental education (t = -2.58; P = 0.01) were independent negative predictors of sum of SFT at 12 months. Independent of maternal glucose tolerance status, maternal insulin resistance during pregnancy is associated with increased infant weight gain and adiposity over the first year of life. Further longitudinal study to evaluate obesity in this group of children will increase our understanding of the contribution of the intrauterine environment to their long-term health.

Traumatic brain injuries in the construction industry.

OBJECTIVE: This study analyses factors associated with work-related traumatic brain injury (TBI), specifically in the construction industry in Ontario, Canada. METHODS: This cross-sectional study utilized data extracted from the Ontario Workplace Safety and Insurance Board (WSIB) records indicating concussion/intracranial injury that resulted in days off work in 2004-2005. RESULTS: Analyses of 218 TBI cases revealed that falls were the most common cause of injury, followed by being struck by or against an object. Mechanisms of injury and the temporal profile of injury also varied by age. For instance, a significantly higher proportion of injuries occurred in the mornings for young workers compared to older workers. CONCLUSIONS: The results of this study provide important information for prevention of TBI which suggest important age-specific strategies for workers in the construction industry.