Sexual health after spinal cord injury: a longitudinal study.

OBJECTIVES: To clarify sexuality issues after spinal cord injury (SCI) and to identify the appropriate timing of sexual health interventions. DESIGN: Longitudinal analysis of the survey responses of persons with SCI at 4 intervals between initial inpatient rehabilitation and 18 months postdischarge. SETTING: Spinal Cord Injury Model Systems inpatient center and home-based setting. PATIENTS: A volunteer sample of 40 individuals (32 men, 8 women) from a consecutive population of persons with recent SCI admitted for initial inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Responses to the Sexual Health Needs Survey. RESULTS: By 6 months postdischarge, individuals in the study group had made the significant changes in sexual activity and sexual interest that they would achieve during the study period. The respondents' greatest concerns remained their partners' and their own sexual satisfaction. A more realistic recognition of decline in their sexual activity, function, and interest corresponded with more requests for sexual health interventions during the interval from inpatient rehabilitation and 6 months postdischarge. CONCLUSIONS: The interval between inpatient rehabilitation to 6 months postdischarge appeared to be the critical period for function and realization about sexuality. Readily accessible sexual health interventions at about 6 months after inpatient rehabilitation and the inclusion of sexual partners in the intervention process appear warranted.

Objective testing and quality-of-life evaluation in surgical candidates with chronic rhinosinusitis.

BACKGROUND: Discordance has been reported between patient symptoms and objective measures of disease in chronic sinusitis, such as radiographic evaluation. The objective of this study was to evaluate the association between presurgical objective studies and presurgical quality of life (QOL). This work was designed as a cross-sectional study of 90 consecutive patients presenting to a tertiary rhinology practice for surgical management of sinonasal disease. METHODS: QOL assessment was performed using disease-specific instruments (Chronic Sinusitis Survey and Rhinosinusitis Disability Index). Computed tomography (CT) scans were scored according to the Lund-Mackay CT scoring system and endoscopy evaluation was scored by the system proposed by Lund and Kennedy. RESULTS: Ninety surgical candidates were enrolled and included in the analysis. Correlation between the QOL total scores and subscale scores was excellent (r = 0.39; p = 0.0001) as was the correlation between CT and endoscopy scores (r = 0.59; p = 0.0001). In contrast, correlation between QOL and objective measures was poor. These results were not significantly influenced by subgroup analysis by diagnosis, comorbidity, and other patient factors. CONCLUSION: Preoperative objective measures of CRS disease show little, if any, correlation with disease-specific QOL measures in surgical candidates. It is likely that CT and endoscopy are measuring a different aspect of CRS disease than the QOL measures. In addition, it is possible that preoperative QOL, either alone or in combination with CT and endoscopy, may prove important in selecting patients most likely to benefit from surgery.