Stumblers and Tumblers: Two Pathways to "Unintentional" Fall-Related Traumatic Brain Injury.

Traumatic brain injury (TBI), including concussion, is the commonest neurological condition in high-income countries and is the second commonest condition next to migraines. Although most of these injuries are unintentional, substance abuse and age-related physiological factors have been implicated as causal factors of fall-related TBIs. Our study used qualitative methods and a life course perspective to examine whether life events and psychosocial antecedents, such as early adverse childhood experiences, play a role in the occurrence of non-intentional fall-related TBI. In-depth interviews were conducted with 27 patients who sustained a TBI due to unintentional falls. Transcripts were qualitatively analyzed to explore factors related to their prior life experiences that may have been related to the reasons that led to their falls. The results reveal that childhood family conflict and peer-influenced risky behaviors may have contributed to poorer mental and physical health in adulthood, which in turn contributed to injuries. Respondents whose behaviors did not play a direct role in their injury event were labeled "Stumblers." These patients' falls were seen as being related to unfortunate unique environmental and situational factors and could colloquially be described as "accidental falls." We also identified a distinct group of patients who had a cumulative life experience starting in early childhood that contributed to a pattern of riskier behaviors, ultimately culminating in a fall-related TBI. The second group of patients were labeled "Tumblers" as they chose to participate in risky activities, regardless of whether they considered them to be risky, which ultimately led to the fall-related TBI. This group was identified by a purposeful volitional state that sought out the "opportunity for accidental fall." Childhood family conflict and peer-influenced risky behaviors were important precursors to mental and physical health states in this group.

The Temporal Relations of Traumatic Brain Injury, Victimization, Aggression, and Homelessness: A Developmental Trajectory.

Traumatic brain injury (TBI) occurs more frequently in homeless persons than the general public. Both homelessness and TBI have been linked to experiences of violence (e.g., aggression and victimization). This study aimed to understand the temporal occurrences of events over the life course that contribute to vulnerabilities to TBI, victimization, aggression, and homelessness. A life-course perspective was used in this thematic analysis of in-person interviews with homeless persons. A total of 33 homeless persons met the inclusion criteria. Twenty-five of 33 (76%) participants had a self-reported history of TBI. Seventy-six percent of TBI events occurred before the onset of homelessness. Assault was the most common mechanism of TBI. During childhood, TBI was a frequently reported event, and parent- or guardian-related physical and sexual abuse were also accentuated with peer abuse, which may have contributed to a unique developmental trajectory. Aggressive behaviors were reported more commonly in persons who previously endured physical, sexual, and emotional victimization early in childhood. The cumulative effect of early adverse events, including TBI and other forms of victimization, subsequent aggression, and further TBI occurring later in life, may create an "at-risk" or vulnerable state preceding homelessness. Precipitating events during adulthood may contribute to a state of homelessness. Homelessness itself may facilitate the context for recurring physical and emotional injury, some of which may be preventable. Future studies should examine the temporality of events related to victimization by physical trauma, such as TBI, aggression, and homelessness.

Beyond description: Understanding gender differences in problem gambling.

Background and aims Though women make up roughly one third of all problem gamblers, research has typically focused on male problem gamblers. Recent research has started to shift its attention toward the importance of gender. However, studies rarely attempt to understand gender differences in problem gambling or subject these differences to thorough multivariate analyses. To address some of the gaps in our knowledge of gender differences, we examine whether patterns of gambling behavior and psychological factors mediate the relationship between gender and problem gambling. Methods We use logistic multiple regression to analyze two large Canadian datasets - the 2005 Ontario Prevalence Survey and the 2007 Canadian Community Health Survey. Results Variables found to mediate the relationship between gender and problem gambling are the type(s) of game(s) played (in the 2005 Ontario Prevalence Survey) and the number of games played (in the 2007 Canadian Community Health Survey). Conclusions Men are more likely to be problem gamblers than women, and this gender difference is understandable in terms of differences in patterns of gambling behavior. We conclude that men experience problems because they play riskier games and women experience problems because they prefer chance-based games, which are associated with significantly higher odds of problem gambling. We specify the three main ways that women's reasons for gambling - to escape or for empowerment - translate into chance-based games.