Background and objective: There is an increasing risk of type 1 diabetes mellitus (T1D) among children in Croatia. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with T1D, with cerebral edema as the most severe complication. Since early recognition of cerebral edema leads to a better outcome, it is important that patients with moderate or severe DKA are closely monitored and treated in pediatric intensive care units (PICUs). The aim of this study is to investigate clinical and laboratory parameters, as well as complications in children treated in PICUs because of DKA. Materials and methods: Patients treated due to DKA in the PICU of the University Hospitals of Split and Osijek from 2013 to 2017 were included in this study. Retrospectively collected data included age, gender, clinical signs and symptoms, and various laboratory parameters. After dividing subjects into two groups: Newly diagnosed with T1D (NT1D) and previously diagnosed with T1D (PT1D), collected data were compared between the two groups. Results: A total of 82 patients were enrolled. Those with NT1D were more often treated in the PICU, with two of them developing cerebral edema. Dehydration was the most frequent clinical sign, found in 95% of patients at admission. Decreased consciousness level was found in 41.5% of patients, with majority of them being somnolent. No difference was found between NT1D and PT1D. Additionally, there was no significant difference regarding laboratory data at admission. Conclusions: More children with NT1D required treatment in the PICU due to DKA with two of them developing cerebral edema. Since cerebral edema is a life-threatening condition, treatment of patients with moderate or severe DKA in PICUs will provide necessary monitoring enabling early recognition, treatment, and better treatment outcome. To minimize the incidence of DKA among patients with NT1D, it is important to continuously carry out public health education programs aimed at early identification of signs and symptoms of T1D.

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We describe a peer-led mental health (MH) workshop that was held at the Michael G. DeGroote School of Medicine (Niagara Regional Campus) in collaboration with Student Affairs. Workshop aims included facilitating discussions among peers and engaging in case-based learning about MH experiences in medical school. Post-workshop, attendees reported increased comfort in talking to classmates about personal MH, recognizing MH crises, and asking for help from peers. We believe that engaging medical learners in MH discussions early on in medical education is critical, and that peer-led workshops may aid in decreasing future MH difficulties and burnout. Due to the low-cost of holding peer-led workshops, this event could be easily replicated at other training sites.

Introduction: People experiencing homelessness have complex psychiatric and medical presentations, and have poor access to primary care. Thus, emergency departments (EDs) often become their main point of healthcare contact. Using routinely collected administrative data from EDs, we examine the ED utilization, health and reasons for presentations of people experiencing homelessness.. Methods: All routinely collected administrative health data from EDs located within Ontario, Canada from 2010-2017 were analyzed. Individuals experiencing homelessness were identified by a marker that was adopted in 2009 replacing their recorded postal code with an XX designation. Outcomes include number of unique patients, number of visits and repeat visits, CTAS scores, ambulance utilization, and type of ICD-10 presentation. Results: 640,897 visits to the ED over 10 years were made by 39,525 unique individuals experiencing homelessness. A visit to an ED by a homeless patient resulted in repeat presentation on the same day 5% of the time. The median repeat presentation to an ED was 14 days. In people experiencing homelessness, the most prevalent category of presentations were primary mental health diagnoses, accounting for 34.8% of visits (n = 223,392). Under mental health conditions, psychoactive substance use presentations made up more than 54% of the presentations (n = 121,112). Alcohol was by far the most common cause of substance use/induced disorders (n = 84,805). Conclusion: Applications of administrative data presents a novel method of measuring health and healthcare outcomes for marginalized populations. We found people experiencing homelessness are presenting to ED more frequently in Ontario, with significant mental health and addiction problems. Our study identifies several important health vulnerabilities within the population, which may serve as potential targets for future interventions.

Introduction: Despite the visibility of the homeless population, there is limited data on the information of this patient population. Point-in-time counts and survey data from selected samples (such as those admitted to emergency shelter) have primarily been used. This literature suggests that this hard-to-reach population has high rates of presentation at emergency departments (EDs), and as such, EDs often become their main point of contact for health and social services. Leveraging this fact and administrative data we construct a crude census of homeless persons within Ontario. We further examine demographic characteristics of patients experiencing homelessness, and compare this data to findings from previous literature. Methods: All routinely collected administrative health data from EDs located within Ontario, Canada from 2010-2017 were analyzed to examine patient characteristics. Individuals experiencing homelessness were identified by a marker that was adopted in 2009 replacing their recorded postal code with an XX designation. s. Aggregating by LHIN, date and week of year, we examine the overall number of patients experiencing homelessness and number by LHIN location and seasonality. Demographic outcomes examined include age and sex. Results: 640,897 visits to the ED over 7 years were made by 39,525 unique individuals experiencing homelessness. Number of ED visits has steadily increased over 10 years in all of Ontario, despite decline in shelter use for individuals. Presentations were concentrated in large urban centres like Toronto, Ottawa and Hamilton. Fewer presentations occur in the spring and summer months and rise in the winter. Male patients presented older and in greater numbers than female patients. The modal female age of presentation is in the 20-24 age category. The modal male age of presentation is in the 25-29 age category. Older male patients were more likely to have multiple presentations. Conclusion: The utilization of administrative health data offers a novel, cost-effective method to measure demographic characteristics of people experiencing homelessness. Identifying characteristics of homeless patients through this method allows for a more complete understanding of the characteristics of a hard-to-reach population, which will allow policy makers to develop appropriate services for this sub-group. Furthermore, through analysis of trends of demographics over time, changes in the homeless population can be tracked in real-time to allow for coordination and implementation of services in a time-sensitive manner.