HEALTH
B5 Concussions linked to suicide risk
TUESDAY, FEB. 9, 2016
STUDY SAYS LONG-TERM RISK POSSIBLY DUE TO BRAIN CHANGES BY THE CANADIAN PRESS TORONTO — Adults who experience a concussion appear to have a long-term suicide risk three times higher than that of the general population — and that risk rises to four times higher if the traumatic brain injury occurred on a weekend, a study suggests. The study, published Monday in the Canadian Medical Association Journal, also found that having a subsequent concussion was associated with a further increase in the risk that a person would take his or her own life. “We know that a concussion can cause lasting changes in the brain that can alter mood, perhaps resulting in behaviour changes, including impulsivity,” said principal researcher Dr. Donald Redelmeier, an internal medicine specialist and senior scientist at Sunnybrook Health Sciences Centre in Toronto. “It’s possible that we’re seeing greater suicide risk linked to weekend concussions due to risk-taking associated with recreation or misadventure, whereas weekday injuries may be linked to employment hazards.” To conduct the study, researchers analyzed Ontario health records to identify more than 235,000 concussion patients between 1992 and 2012. Over that 20-year period, 667 people with a history of concussion died by their own hands. Those injured on weekdays accounted for 519 suicides, three times the population norm of about nine per 100,000 annually, while those whose brain injuries occurred on weekends accounted for 148 suicides, about four times the population norm. In absolute terms, researchers concluded that 470 of these deaths might not have occurred if patients’ risks had matched those of the general population. “Patients who experienced a concussion were at increased risk of suicide regardless of demographic factors
such as age, sex, socioeconomic status or past psychiatric conditions,” Redelmeier said. The mean age of patients at the time of suicide was 41, men and women were equally affected, most lived in cities, and the average time gap between the concussion and committing suicide was almost six years. “It may not be that the concussion was the cause,” Redelmeier noted. “It may be that they were already predisposed towards self-harm activity and in that way the concussion isn’t a mechanism it is a marker of an underlying tendency. And that certainly could be the case in our study. “But it does leave this lingering question: Were they just predisposed to begin with or was there a direct injury that disrupted serotonin pathways and led to impulsivity and depression and sleep disturbances and irritability?” (Serotonin is a neurotransmitter, or brain chemical, related to mood regulation, pain perception and other physical functions.) “The patients that I see, that’s what they talk about a lot: ‘I’ve never fully recovered from the concussion. I’m just not the same,”’ he said. “For some patients with concussion, it takes so long to get better and you kind of wonder if they fully recover.” Dr. Anthony Phillips, who was not involved in the study, called it a well-conducted research paper, which shows for the first time that weekend concussions seem to carry an even higher risk of long-term suicide than do weekday concussions. “There’s reasons for this — the fact that weekend events may be related to recreation where there might be a more severe injury. It’s a very interesting pattern that’s never been reported before,” said Phillips, scientific director of neurosciences for the Canadian Institutes of Health Research. “There’s no doubt that there are changes, scars that are left in the brain that are subtle and are producing changes in perhaps neurotransmitters
Photo by THE CANADIAN PRESS
Dr. Donald Redelmeier is shown in a 2006 handout photo. Redelmeier is the lead researcher on a new study which has found that adults who experience a concussion have a long-term suicide risk three times higher than that of the general population. or neural connections,” he said Monday from Vancouver. While stressing that the research does not suggest that every person who suffers a concussion “now has a high liability of suicide,” Phillips said the increased risk needs to be taken seriously. “We’ve got to protect our brains, keep them healthy,” he said. “If you’ve had a concussion, you should take extra precautions to make sure you don’t get another one. It’s a matter of prevention and not putting yourself in harm’s way.” Interestingly, the study found that about half the patients had visited a physician for unrelated medical issues in the week prior to taking their own lives. Overall, about 80 per cent had seen their doctors in the month prior
to their suicide. “It was a missed opportunity, at face value. A doctor may not be able to make everything perfect, but is in a position to stop a situation from becoming worse,” said Redelmeier, suggesting that patients should routinely be asked about a history of concussion and suicidal thoughts. “I think an awareness of the association between concussions and suicide is informative not just for public health, but also for practising physicians,” he said. “Understanding how a history of concussion raises the risk of suicide and supporting patients with better screening, treatment and followup for recovery may be important steps in preventing these tragic and avoidable deaths.”
Researching better Japan to set targets to fight heavy drinking brain tumour treatments BY ADVOCATE NEWS SERVICES
‘DREAM TEAM’ PUT TOGETHER TO SEEK BETTER TREATMENTS, FOCUS ON STEM CELLS BY THE CANADIAN PRESS TORONTO — A “dream team” of top Canadian scientists has been named to mount a new attack on aggressive brain cancers in children and adults by focusing on the stem cells that spur their growth. Dr. Peter Dirks, a neurosurgeon and researcher at Toronto’s Hospital for Sick Children, will head the Stand Up to Cancer (SU2C) team, which will employ genomic and molecular profiling technologies to analyze brain cancer stem cells. “Brain tumours in children and adults contain a small number of cells called stem cells that resist treatment and continually regenerate, driving tumour growth and recurrence after initial responses to treatment,” said Dirks, the first scientist to identify cancer stem cells in brain tumours in 2003. “Our team will conduct multiple analyses of brain cancer stem cells, profiling their biological makeup to identify drugs that are likely to block the uncontrolled growth of the tumours, and carry out clinical trials across Canada to find the safest and most effective drugs to treat these cancers,” he said in a statement Thursday. The researchers will focus on two types of brain tumours: glioblastomas in adults and children, and posterior fossa ependymomas in infants, both of which have limited treatment options
and poor survival statistics. Less than 10 per cent of adults live five years following a glioblastoma diagnosis. Malignancies of the brain and central nervous system are the No. 1 cancer killers of children. Brain tumour stem cells are similar to nerve stem cells that mature during normal brain development. However, abnormal programming in these cancer stem cells promotes tumour recurrence and drug resistance. “It’s like a Peter Pan syndrome, in which the immature cell, the stem cell, never grows up,” said Dr. Michael Taylor, a neurosurgeon and scientist at SickKids who specializes in cancer genomics. “Our objective is to take those cancer stem cells and convince them to quit multiplying and leave the rest of the brain alone.” Their objective is to understand the abnormalities in the cancer stem cells, with the goal of developing drugs to effectively attack their vulnerabilities. The 12-member team has received $11.7 million in grants over four years from a consortium of funding organizations, including SU2C Canada, Genome Canada and the Canadian Institutes of Health Research. It is the second dream team announced by SU2C Canada. The first was a collaboration of top researchers formed last year to investigate new treatments for different kinds of breast cancer.
Alberta Health Services shuts down Calgary tattoo shop for no sterilization BY THE CANADIAN PRESS CALGARY — Alberta Health Services says a Calgary residential tattoo operation did not have proper sterilization or sanitation processes in place. It says anyone who got tattoos at Discount Tattoo (224 7A St. N.E.) by Ryan Kinsella may have been exposed to viruses, including hepatitis B and C and HIV. Dr. Judy MacDonald, medical officer of health for the Calgary zone, says anyone who had services done at Discount Tattoo can call Health Link at 811 to arrange for testing for the viruses. AHS ordered the residential opera-
tion to close on Jan. 28. AHS says the order will not be lifted until the operator has addressed all violations noted in the closure order, and is capable of providing tattoo services in accordance with all regulations and legislation in Alberta. The operator is not permitted to offer tattoo services while the closure order is in place. “It is the responsibility of all tattoo facility operators — whether residential or otherwise — to ensure all regulations are met and operations are compliant,” said MacDonald. “This applies not only before opening a tattoo operation but also while operating, always. Our health inspectors support these businesses to operate safely. We are here as a resource.”
The Japanese government will introduce numerical targets in a bid to reduce the number of excessive drinkers, according to the draft of a plan to deal with alcohol-related health problems. The draft plan says the government will establish at least one medical institution specializing in alcoholism, or a consultation center for the disease, per prefecture. It will also introduce numerical targets to lower the rate of excessive drinkers, who are highly likely to develop lifestyle-related diseases. According to the draft plan, the government aims to reduce the percentage of excessive drinkers among male adults to 13 percent by fiscal 2020, from 15.8 percent in 2014. It also seeks to lower the percentage among female adults to 6.4 percent by the same fiscal year from 8.8 percent in 2014. The yardstick for excessive drinking is at least two “go” (one go equals 180 milliliters - about 6 ounces) of sake
for men every day, and one go or more daily of sake for women, according to the draft. The government plans to endorse the basic plan at a Cabinet meeting in May. It will also urge each prefectural government to formulate original plans based on the particular situation in its area. The government aims to promote the spread of knowledge about the risks of drinking. For example, excessive drinking can increase the risk of high blood pressure, diabetes and cancer, and women tend to become alcoholics more quickly than their male counterparts. As one measure to deal with alcoholism, the government plans to establish within five years local mental health and welfare centers, and local public health centers, as consultation bases where people with alcohol-related problems and their family members can easily seek advice at an early stage of the disease.
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