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BMJ Open ; 7(12): e017369, 2017 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-29275339


OBJECTIVE: To investigate associations of objective caregiver burden, subjective caregiver burden and positive aspects of caregiving with self-reported health indicators in caregiving partners of persons with a severe physical disability (spinal cord injury). DESIGN: Cross-sectional, observational. SETTING: Community, Switzerland. PARTICIPANTS: Caregiving partners of persons with spinal cord injury (n=118, response rate 19.7%). OUTCOME MEASURES: General health, role limitations due to physical health, role limitations due to mental health, pain intensity, mental health and vitality were assessed using items from the 36-Item Short Form Health Survey (SF-36). Three items were used to assess the frequency of different types of sleep problems. RESULTS: Subjective caregiver burden was associated to all self-reported health indicators. A high subjective burden was linked to poorer general health (OR 6.5, 95% CI 2.0 to 21.5), more role limitations due to physical health (OR 4.2, 95% CI 1.4 to 12.8), more role limitations due to mental health (OR 3.6, 95 % CI 1.1 to 11.7), higher pain intensity (OR 4.0, 95% CI 1.4 to 11.5), poorer mental health (coefficient -17.9, 95% CI -24.5 to -11.2), lower vitality (coefficient -20.3, 95% CI -28.4 to -12.1), and more frequent sleep problems (OR 5.3, 95% CI 1.6 to 18.4). Partners who indicated positive aspects of caregiving further reported better mental health (coefficient 6.5, 95% CI 0.2 to 12.8). Objective burden was not related to any health indicator. CONCLUSIONS: Subjective burden and lack of positive aspects of caregiving were associated with poorer physical and mental health. Caregiver health may be promoted through the strengthening of psychological and psychosocial resources.

Cuidadores/psicologia , Efeitos Psicossociais da Doença , Pessoas com Deficiência , Qualidade de Vida , Traumatismos da Medula Espinal/enfermagem , Adaptação Psicológica , Adulto , Compreensão , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Autorrelato , Suíça
Swiss Med Wkly ; 147: w14430, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28488262


INTRODUCTION: Inferences from population-based cohort studies may be inaccurate as a result of biased coverage of the target population. We investigated the presence of absolute coverage error and selection bias in the Swiss Spinal Cord Injury (SwiSCI) cohort study, using a secondary, nationally representative data source. The proposed methodology is applicable to future Swiss cohort studies aiming to assess their cover-age error. METHODS: ICD-10 codes relating to traumatic spinal cord injuries (TSI) (S14.0, S14.1, S24.0, S24.1, S34.0, S34.1, S34.3, T.060, T.061, T.093, and T91.3) were used to identify incident TSCI cases in 2012 and 2013 from nationwide, administrative hospital discharge data collected by the Swiss Federal Statistical Office. The hospital discharge data were compared with SwiSCI data, and factors associated with receiving rehabilitation in a SwiSCI centre were statistically investigated. Age- and sex-specific incidence rates (IRs) were estimated using hospital discharge data. Different ICD-10 coding combinations were used in sensitivity analyses. Severity of spinal cord injury was characterised by lesion level (paraplegia or tetraplegia) and lesion completeness (complete or incomplete). RESULTS: In total, 621 administrative cases, compared with 213 SwiSCI cases, were identified. The hospital discharge data differed from SwiSCI data with respect to age (p <0.01). The annual overall IR ranged between 19.9 and 49.7 per one million population, depending on the selection criteria used. Overall, IRs were elevated for men (compared with women), older age groups (compared with 16-30 year olds) and paraplegia (com-pared with tetraplegia). Men, younger persons and people with high tetraplegia (cervical vertebrae C1-C4) were more likely to visit a specialised rehabilitation centre. CONCLUSION: There is undercoverage of incident TSCI cases in specialised rehabilitation centres in Switzerland, particularly among the elderly and persons with less severe TSCIs. The extent of coverage error indicated in the ICD-10-based sensitivity analyses can inform future modelling scenarios of national epidemiological estimates of TSCI.

Viés , Interpretação Estatística de Dados , Seleção de Pacientes , Traumatismos da Medula Espinal/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Estudos Retrospectivos , Fatores Sexuais , Suíça/epidemiologia
Inj Epidemiol ; 2(1): 28, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26550554


BACKGROUND: Traumatic spinal cord injury (TSCI) has a high personal and socio-economic impact. Effective public health prevention policies that aim to reduce this burden are reliant on contemporary information of the risk and underlying causes of TSCI. This study contextualizes Swiss annual incidence rates within the European context, and provides detailed estimates by age, gender and etiology towards informing targeted intervention strategies. METHODS: TSCI cases that occurred in the years 2005 to 2012 were identified as part of the Swiss Spinal Cord Injury (SwiSCI) cohort study through a rehabilitation-based study of local medical files. RESULTS: The crude annual incidence rate (IR) estimate of TSCI for the study period was 18.0 (95 % confidence interval 16.9-19.2) per one million population; standardized to the WHO world population IR was 21.7 (20.3-23.1) population. The injury rate of TSCI in Switzerland was intermediate in comparison to estimates for other European countries, which ranged from around 8.3 in Denmark to 33.6 per million in Greece. Males exhibited consistently higher IRs than females, with a highest IR ratio (IRR) of 3.9 (2.8-5.5) in young adults (aged 16 to 30). Sports and leisure and transport-related injuries were the predominant causes of TSCI in the youngest age group (aged 16 to 30); falls were the predominant cause among the oldest age group (76 years or over). With increasing age, a greater proportion of fall-related TSCIs were due to low-level falls, with more than 80 % of fall-related TSCIs due to low-level falls in the oldest age group. CONCLUSIONS: Evidence suggests sports/leisure- and transport-related injuries in young men and falls among the elderly as prime targets for prevention policies and programs.

BMC Infect Dis ; 11: 31, 2011 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-21272350


BACKGROUND: Loss to follow-up is a major challenge of antiretroviral treatment (ART) programs in sub-Saharan Africa. Our objective was to a) determine true outcomes of patients lost to follow-up (LTFU) and b) identify risk factors associated with successful tracing and deaths of patients LTFU from ART in a large public sector clinic in Lilongwe, Malawi. METHODS: Patients who were more than 2 weeks late according to their last ART supply and who provided a phone number or address in Lilongwe were eligible for tracing. Their outcomes were updated and risk factors for successful tracing and death were examined. RESULTS: Of 1800 patients LTFU with consent for tracing, 724 (40%) were eligible and tracing was successful in 534 (74%): 285 (53%) were found to be alive and on ART; 32 (6%) had stopped ART; and 217 (41%) had died. Having a phone contact doubled tracing success (adjusted odds ratio, aOR = 2.1, 95% CI 1.4-3.0) and odds of identifying deaths [aOR = 1.8 (1.2-2.7)] in patients successfully traced. Mortality was higher when ART was fee-based at initiation (aOR = 2.3, 95% CI 1.1-4.7) and declined with follow-up time on ART. Limiting the analysis to patients living in Lilongwe did not change the main findings. CONCLUSION: Ascertainment of contact information is a prerequisite for tracing, which can reveal outcomes of a large proportion of patients LTFU. Having a phone contact number is critical for successful tracing, but further research should focus on understanding whether phone tracing is associated with any differential reporting of mortality or LTFU.

Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Perda de Seguimento , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Adulto Jovem