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1.
J Rehabil Med ; 52(8): jrm00090, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32735022

RESUMO

OBJECTIVE: The German Spinal Cord Injury Survey is part of the International Spinal Cord Injury Survey, which aims to collect data about the life experience of persons with spinal cord injury worldwide. This paper reports on the perceived environmental barriers of the German study population and their associations with quality of life. DESIGN: Cross-sectional explorative observational study using survey data. PARTICIPANTS: A total of 1,479 persons with spinal cord injury aged 18 years and older. METHODS: After descriptive analyses, exploratory factor analysis was used to build groups of environmental barriers. Logistic regressions were performed to assess correlates of perceived environmental barriers. Spearman's correlations were used to analyse the association between perceived barriers and quality of life. RESULTS: Barriers regarding infrastructure had a relatively large impact. Barriers in relation to people's attitudes towards spinal cord injury and the equipment of people with spinal cord injury had a relatively small impact on the lives of people with spinal cord injury. Several subpopulations showed a higher risk in experiencing barriers. Quality of life decreased with increasing experience of barriers. CONCLUSION: The most life-hardening barriers were identified related to infrastructure, a category in which most barriers are modifiable, for example, buildings or transportation.


Assuntos
Meio Ambiente , Qualidade de Vida/psicologia , Traumatismos da Medula Espinal/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
3.
Medicine (Baltimore) ; 99(26): e20929, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590805

RESUMO

Retrospective reviewThe degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown.The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma.Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically.A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio.In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.


Assuntos
Vértebras Cervicais/lesões , Paralisia/etiologia , Canal Vertebral/anatomia & histologia , Traumatismos da Medula Espinal/etiologia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/anatomia & histologia , Feminino , Geriatria/métodos , Humanos , Japão/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Paralisia/epidemiologia , Índice de Gravidade de Doença , Canal Vertebral/patologia , Medula Espinal/anormalidades , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/epidemiologia
4.
J Clin Neurosci ; 78: 135-138, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32536507

RESUMO

Patients with acute traumatic cervical spinal cord injury (ATCSCI) have an increased risk of catheter-associated urinary tract infection (CAUTI). The effectiveness of silver alloy-coated silicone urinary catheters (SACC) in preventing CAUTI in ATCSCI is unknown and was the objective of this study. We performed a quality improvement initiative in an attempt to reduce CAUTI in patients undergoing spine surgery at a single quaternary center. Prior to July 2015, all patients received a latex indwelling catheter (LIC). All patients with ATCSCI with limited hand function (AIS A,B, or C) received a SACC. Incidence of CAUTI, microbiology, duration of infection, antibiotic susceptibility, and catheter-associated adverse events were recorded prospectively. We studied 3081 consecutive patients over the three years, of whom 302 (9.8%) had ATCSCI; 63% of ATCSCI patients were ASIA Impairment Scale (AIS) A or B. The overall rate of CAUTI was 19% (585/3081), and was 38% (116/302) in patients with ATCSCI. Of 178 ATCSCI patients with LIC, 100 (56%) developed a CAUTI compared with 28 of 124 (23%) patients with SACC (p < 0.05). Poly-microbial and gram-positive infection was more common in LIC than in SACC (p < 0.05). Median duration of infection was 9 days in SACC group and 12 days in LIC group (p = 0.08). Resistance to trimethoprim (p < 0.001) and ciprofloxacin (p < 0.05) were more common in LIC group. There was no difference in catheter-associated adverse events or length of stay between the groups. This quality improvement initiative illustrates the effectiveness of antiseptic silver alloy-coated silicone urinary catheters in patients with ATCSCI. In our population, the use of SACC reduces the incidence and the complexity of CAUTI.


Assuntos
Ligas/normas , Melhoria de Qualidade/normas , Silicones/normas , Prata/normas , Traumatismos da Medula Espinal/terapia , Cateteres Urinários/normas , Adulto , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Cateteres de Demora/normas , Cateteres de Demora/tendências , Medula Cervical/lesões , Desenho de Equipamento/normas , Feminino , Humanos , Masculino , Estudos Prospectivos , Melhoria de Qualidade/tendências , Traumatismos da Medula Espinal/epidemiologia , Resultado do Tratamento , Cateteres Urinários/efeitos adversos , Cateteres Urinários/tendências , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle
5.
Accid Anal Prev ; 142: 105571, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32413544

RESUMO

BACKGROUND: Cervical spine injury is a common result of traffic crashes, and such injuries range in severity from minor (i.e. sprain/strain) to moderate (intervertebral disk derangement) to serious and greater (fractures, dislocations, and spinal cord injuries). There are currently no reliable estimates of the number of crash-related spine injuries occurring in the US annually, although several publications have used national crash injury samples as a basis for estimating the frequency of both cervical and lumbar spinal disk injuries occurring in lower speed rear impact crashes. PURPOSE: To develop a reliable estimate of the number of various types of cervical spine injuries occurring in the US by comparing data from national crash injury to national hospital ED and inpatient samples. STUDY DESIGN: Comparative cross-sectional METHODS: Cervical spine injury data were accessed, analyzed, and compared from 3 national databases; the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS), Nationwide Emergency Department Sample (NEDS), and the Nationwide Inpatient Sample (NIS). RESULTS: It is estimated that there are approximately 869,000 traffic crash-related cervical spine injuries seen in hospitals in the US annually, including around 841,000 sprain/strain (whiplash) injuries, 2800 spinal disk injuries, 23,500 fractures, 2800 spinal cord injuries, and 1500 dislocations. Because of a highly restrictive inclusion criteria for both crash and injury types, as well as a very small sample size, the NASS-CDS underestimated all types of crash-related cervical spine injuries seen in US hospital emergency departments by 84 %. The injury type with the largest degree of underestimation in the NASS-CDS was cervical disk injuries, which were estimated at an 88 % lower frequency than in the NEDS. National insurance claim data, which include cases of cervical disk injury diagnosed both in and outside of the ED, indicate that the NEDS likely undercounts cervical disk injuries by 92 %, and thus the NASS-CDS correspondingly undercounts such injuries by 99 % or more. CONCLUSIONS: Because of a limited sample size and restrictive criteria for both crash and injury inclusion, the NASS-CDS cannot be used to estimate the number of crash-related spinal injuries of any type or severity in the US. The most inappropriate use of the database is for estimating the number of spinal injuries resulting from low speed rear impact collisions, as the NASS-CDS samples fewer than 1 in 100,000 of the cervical spine injuries of any type occurring in low speed rear impact collisions.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Bases de Dados Factuais/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Traumatismos da Medula Espinal/epidemiologia , Vértebras Cervicais/lesões , Estudos Transversais , Feminino , Humanos , Escala de Gravidade do Ferimento , Luxações Articulares/epidemiologia , Masculino , Fraturas da Coluna Vertebral/epidemiologia , Estados Unidos/epidemiologia , Traumatismos em Chicotada/epidemiologia
7.
Arch Phys Med Rehabil ; 101(10): 1731-1738, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32473110

RESUMO

OBJECTIVE: To examine whether commonly used comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, the Centers for Medicare and Medicaid Services [CMS] comorbidity tiers) capture comorbidities in the acute traumatic and nontraumatic SCI inpatient rehabilitation population. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: Data were obtained from the Uniform Data System for Medical Rehabilitation from October 1, 2015 to December 31, 2017 for adults with spinal cord injury (SCI) (Medicare-established Impairment Group Codes 04.110-04.230, 14.1, 14.3). This study included SCI discharges (N=66,235) from 833 inpatient rehabilitation facilities. MAIN OUTCOME MEASURES: International Classification of Diseases-10th Revision-Clinical Modifications (ICD-10-CM) codes were used to assess 3 comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, CMS comorbidity tiers). The comorbidity codes that occurred with >1% frequency were reported. The percentages of discharges for which no comorbidities were captured by each comorbidity index were calculated. RESULTS: Of the total study population, 39,285 (59.3%) were men and 11,476 (17.3%) were tetraplegic. The mean number of comorbidities was 14.7. There were 13,939 distinct ICD-10-CM comorbidity codes. There were 237 comorbidities that occurred with >1% frequency. The Deyo-Charlson comorbidity index, Elixhauser comorbidity index, and the CMS tiers did not capture comorbidities of 58.4% (95% confidence interval, 58.08%-58.84%), 29.4% (29.07%-29.76%), and 66.1% (65.73%-66.46%) of the discharges in our study, respectively, and 28.8% (28.42%-29.11%) of the discharges did not have any comorbidities captured by any of the comorbidity indexes. CONCLUSION: Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the SCI rehabilitation population. This work suggests that alternative measures may be needed to capture the complexity of this population.


Assuntos
Comorbidade , Indicadores Básicos de Saúde , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/reabilitação , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/organização & administração , Centros de Reabilitação/organização & administração , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
8.
PLoS One ; 15(4): e0231649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315373

RESUMO

INTRODUCTION: Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up. METHODS: Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D-3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses. RESULTS: A total of 4,883 patients participated (median age 68 (Interquartile range 53-80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively. DISCUSSION: HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02508675.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Traumatismos da Medula Espinal/psicologia , Ferimentos e Lesões/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/fisiopatologia , Ansiedade/psicologia , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/fisiopatologia , Estudos de Coortes , Depressão/epidemiologia , Depressão/fisiopatologia , Depressão/psicologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes , Estudos Prospectivos , Qualidade de Vida , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/patologia , Inquéritos e Questionários , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/fisiopatologia
9.
World Neurosurg ; 139: 151-157, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305599

RESUMO

OBJECTIVE: Paralysis (paraplegia or quadriplegia) after posterior fossa surgery is a rare but devastating complication. We investigated previous reports of this complication to examine similarities among patients, risk factors, and methods by which it may be prevented. METHODS: A systematic review was completed according to PRISMA guidelines. Electronic databases were searched until November 2019 using keywords "paraplegia," "quadriplegia," or "spinal cord injury" added to "posterior fossa surgery." RESULTS: Thirteen case reports published between 1996 and 2019 were included. Five (38.5%) involved quadriplegia/quadriparesis and 8 (61.5%) involved paraplegia after surgery. Ten cases (76.9%) were tumor resections and 3 (23.1%) were posterior fossa decompressions (2 for Chiari malformations and 1 for Morquio syndrome). Seven surgeries (53.8%) were performed in the sitting position and 6 (46.2%) were prone. Proposed mechanisms of paralysis involved cervical hyperflexion yielding spinal cord ischemia in 8 patients (61.5%), arterial hypotension in 2 patients (15.4%), spinal cord compression from hematoma in 1 patient (7.7%), and decreased cardiac output in 1 patient (7.7%) (1 study did not propose a cause). Cervical hyperflexion was equally likely in the sitting and prone positions (4 patients each). Only 3 patients (23.1%) involved intraoperative complications (all cardiopulmonary in nature). CONCLUSIONS: Paralysis after posterior fossa surgery often involves spinal cord infarction apparently caused by cervical hyperflexion. Extreme care during patient positioning is needed in both the sitting or prone positions. Electrophysiologic monitoring might enable early identification of spinal cord dysfunction to minimize or avoid this complication.


Assuntos
Fossa Craniana Posterior/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Quadriplegia/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Isquemia do Cordão Espinal/epidemiologia , Malformação de Arnold-Chiari/cirurgia , Neoplasias Encefálicas/cirurgia , Humanos , Neoplasias Infratentoriais/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Paraplegia/etiologia , Posicionamento do Paciente , Complicações Pós-Operatórias/etiologia , Decúbito Ventral , Quadriplegia/etiologia , Postura Sentada , Traumatismos da Medula Espinal/etiologia , Isquemia do Cordão Espinal/etiologia
10.
Bone Joint J ; 102-B(4): 519-523, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228070

RESUMO

AIMS: The purpose of this study was to evaluate the incidence and analyze the trends of surgeon-reported complications following surgery for adolescent idiopathic scoliosis (AIS) over a 13-year period from the Scoliosis Research Society (SRS) Morbidity and Mortality database. METHODS: All patients with AIS between ten and 18 years of age, entered into the SRS Morbidity and Mortality database between 2004 and 2016, were analyzed. All perioperative complications were evaluated for correlations with associated factors. Complication trends were analyzed by comparing the cohorts between 2004 to 2007 and 2013 to 2016. RESULTS: Between 2004 and 2016, a total of 84,320 patients were entered into the database. There were 1,268 patients associated with complications, giving an overall complication rate of 1.5%. Death occurred in 12 patients (0.014%). The three most commonly reported complications were surgical site infection (SSI) (441 patients; 0.52%), new neurological deficit (293; 0.35%), and implant-related complications (172; 0.20%). There was a statistically significant but weak correlation between the occurrence of a SSI and the magnitude of the primary curve (r = 0.227; p < 0.001), and blood loss in surgery (r = 0.111; p = 0.038), while the occurrence of a new neurological deficit was correlated statistically significantly but weakly with age at surgery (r = 0.147; p = 0.004) and magnitude of the primary curve (r = 0.258; p < 0.001). The overall complication rate decreased from 4.95% during 2004 to 2007 to 0.98% during 2013 to 2016 (p = 0.023). CONCLUSION: An overall complication rate of 1.5% was found in our series after surgery for AIS, with a reduction of complication rates found in the second period of the analysis. Cite this article: Bone Joint J 2020;102-B(4):519-523.


Assuntos
Complicações Pós-Operatórias/etiologia , Escoliose/cirurgia , Adolescente , Criança , Bases de Dados Factuais , Feminino , Hong Kong/epidemiologia , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Próteses e Implantes/efeitos adversos , Escoliose/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Raízes Nervosas Espinhais/lesões , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia
11.
Harefuah ; 159(3): 191-194, 2020 Mar.
Artigo em Hebraico | MEDLINE | ID: mdl-32186790

RESUMO

INTRODUCTION: Spinal cord injury (SCI) etiology can be either traumatic or non-traumatic. Non-traumatic SCI is of growing importance, with studies indicating increased incidence, partly because of population aging. Approximately 9% of these injuries are secondary to an infectious cause. SCI has significant implications on the patient's quality of life. A successful rehabilitation process focuses on maximizing independence and setting achievable goals according to the patient's needs and desires. The medical staff should be familiar with the natural history of such injuries while taking into consideration the existing support systems available to the patient and minimizing the damage to life cycles as best possible with the aid of a transdisciplinary team approach. In this article, we will review the main viral causes of SCI injury. We will discuss the epidemiology, clinical aspects and the unique meanings of this subgroup in the rehabilitation process.


Assuntos
Traumatismos da Medula Espinal/virologia , Viroses/epidemiologia , Humanos , Incidência , Infecções , Qualidade de Vida , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Viroses/complicações
12.
Acta fisiátrica ; 27(1): 11-19, mar. 2020.
Artigo em Português | LILACS | ID: biblio-1129939

RESUMO

A pesquisa InSCI (International spinal cord injury) foi desenvolvida para descrever a saúde e o bem-estar de indivíduos com lesão medular (LM) em relação à comunidade local. Por isto, objetivo deste estudo será descrever as características pessoais, fatores ambientais, de saúde, de qualidade de vida, de trabalho dos indivíduos que vivem com lesão medular no Brasil e comparar os dados com outros países participantes da pesquisa. Este estudo deverá ser de caráter transversal observacional. Os indivíduos com LM serão recrutados no Instituto de Medicina Física e de Reabilitação (IMREA) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, na Rede de Reabilitação Lucy Montoro (IRLM) e na Associação Fluminense de Reabilitação (AFR). Participarão do estudo 400 indivíduos de ambos os sexos com idade igual ou superior a 18 anos com diagnóstico de lesão medular de origem traumática cujo tempo de lesão esteja superior a 3 meses. Os voluntários realizarão uma avaliação inicial por meio de questionário com 125 perguntas sobre problemas de saúde, atividade e participação, independência nas atividades de vida diária, trabalho, fatores ambientais e pessoais, serviços de saúde e qualidade de vida. As associações entre as variáveis serão feitas testes de correlação de Pearson ou Spearman. Modelos simples de regressão linear ou logística também poderão ser usados de acordo com os dados obtidos. Os procedimentos de processamento e ajuste de dados obedecerão às recomendações das Diretrizes Cross-Cultural Survey (CCSG) e ao fortalecimento do Relatório de Estudos Observatórios em Epidemiologia (STROBE).


An International Spinal Cord Injury survey was developed to describe health and to be well subject to spinal cord injuries in relation to the local community. The objective of this study will be well subject to spinal cord injuries in relation to the local community. The objective of this study will be to describe how personal resources, environmental, health, quality of life, work conditions of individuals who suffer from spinal cord injury in Brazil and data comparison with other countries participating in the research. This study must be of an observational cross-sectional character. Individuals will be recruited at the Institute of Physical Medicine and Rehabilitation of the Hospital de Clínicas of the Faculty of Medicine of the University of São Paulo, the Lucy Montoro Rehabilitation Network and the Fluminense Rehabilitation Association. Participate in the study 400 individuals with both sexes aged 18 years or older diagnosed with traumatic spinal cord injury whose injury time is longer than 3 months. The volunteers will carry out an initial evaluation through a questionnaire with 125 questions about health problems, activity and participation, independence in activities of daily living, work, environmental and personal factors, health services and quality of life. Variations between variables can be made using Pearson or Spearman correlation. Simple linear or logistic regression models can also be used according to the data obtained. The procedures for processing and adjusting data obey the recommendations of the Intercultural Research of Guidelines and the strengthening of the Report on Observatory Studies in Epidemiology.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Qualidade de Vida , Traumatismos da Medula Espinal/epidemiologia , Inquéritos Epidemiológicos , Traumatismos da Medula Espinal/fisiopatologia , Trabalho , Brasil , Atividades Cotidianas , Estudos Transversais , Acesso aos Serviços de Saúde
13.
N Z Med J ; 133(1509): 47-57, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32027638

RESUMO

AIM: To investigate the epidemiology of traumatic spinal cord injury (TSCI) in New Zealand over a 10-year period. METHODS: Ambispective data of all new patients admitted to New Zealand's two spinal rehabilitation units between January 2007 and December 2016 (n=929) were collated. Variables assessed included age at injury, gender, ethnicity, date of injury, aetiology, length of hospital stay, injury level, neurological status on discharge and discharge destination. RESULTS: The incidence of TSCI averaged 22 (95% CI 21-24) per million, increasing 6% a year. The average incidence for Maori (29 per million people (95% CI 25-34)) was 1.8 times higher than New Zealand European (16 per million people (95% CI 15-18)), and show an increase of 14% a year. The median age of TSCI increased from 43 to 48 years. Overall, falls (32%), transport (32%) and sports (22%) were the most common causes of TSCI. Cervical TSCI (54%) were most common, particularly in older adults (70% over 75 years) and Maori (61%) and Pacific Island (72%) patients. Surgical rates remained stable (77%) but length of stay in hospital decreased over the study period. CONCLUSIONS: The demographic of TSCI is changing in New Zealand. The median age of patients is increasing, as is the incidence, particularly for women, older adults and Maori patients.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Traumatismos em Atletas/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Violência/estatística & dados numéricos , Atividades Cotidianas , Adolescente , Adulto , Distribuição por Idade , Idoso , Vértebras Cervicais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sistema de Registros , Distribuição por Sexo , Traumatismos da Medula Espinal/etnologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas , Adulto Jovem
14.
Arch Phys Med Rehabil ; 101(4): 633-641, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31958428

RESUMO

OBJECTIVE: To investigate the association between prescriptions for bisphosphonates; calcium and vitamin D supplements; and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury (SCI) or disorder (SCID). DESIGN: Propensity-matched case-control analyses. SETTING: United States Veterans Affairs (VA) facilities. PARTICIPANTS: A total of 7989 men and 849 women with an SCID included in VA administrative databases between October 1, 2005 and October 1, 2015 were identified (N=8838). Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to 4 controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incident lower extremity fractures. RESULTS: There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.62-1.77) or women (OR, 1.02; 95% CI, 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR, 1.25; 95% CI, 0.73-2.16), were concomitant users of vitamin D and calcium and a bisphosphonate (OR, 1.05; 95% CI, 0.57-1.96), had more than 1 fracture on different dates during the study period (OR, 0.13; 95% CI, 0.02-1.16) and in those who had undergone DXA testing prior to the date of the bisphosphonate prescription and incident fracture (OR, 1.26; 95% CI, 0.69-2.32). CONCLUSIONS: In men with a traumatic SCI and women with a traumatic SCID, bisphosphonate therapies for osteoporosis do not appear to significantly affect fracture risk. Adequately powered randomized controlled trials are needed to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population. There is a compelling need to identify new medications to prevent fractures in this high-risk population.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Extremidade Inferior/lesões , Fraturas por Osteoporose/epidemiologia , Doenças da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Absorciometria de Fóton , Cálcio/administração & dosagem , Estudos de Casos e Controles , Bases de Dados Factuais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/prevenção & controle , Pontuação de Propensão , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Vitamina D/administração & dosagem
15.
Curr Sports Med Rep ; 19(1): 17-23, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31913919

RESUMO

Equestrian sports represent a variety of activities involving a horse and rider. Due to the unpredictable nature of horses, their height, and potential high speeds involved, equestrian athletes are at risk of head and spinal injuries. This review describes the epidemiology, injury mechanisms, and risk factors for equestrian sports-related head and spinal injuries. Traumatic brain injuries, including concussions, are more common than spinal injuries. Both injury types are most commonly related to a rider fall from a horse. Spinal injuries are less common but are associated with potentially significant neurological morbidity when spinal cord injury occurs. An improved understanding of preventable injury mechanisms, increased certified helmet use, improved helmet technologies, and educational outreach may help to address the risk of head and spinal injuries in equestrian sports.


Assuntos
Traumatismos em Atletas/prevenção & controle , Lesões Encefálicas Traumáticas/prevenção & controle , Traumatismos da Medula Espinal/prevenção & controle , Animais , Traumatismos em Atletas/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Dispositivos de Proteção da Cabeça , Cavalos , Fatores de Risco , Traumatismos da Medula Espinal/epidemiologia , Esportes
16.
Rehabilitation (Stuttg) ; 59(4): 205-213, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31962349

RESUMO

PURPOSE: Multiple organizations like UN and WHO call for the collection of internationally comparable data on living and supply conditions of people with disabilities. Furthermore, reliable national data are necessary for ensuring appropriate care. Regarding patients with Spinal Cord Injury (SCI) in Germany, only data on diagnostics or therapeutic interventions is currently available. The International Spinal Cord Injury Survey aims at collecting reliable data of people with SCI in 21 countries and developing recommendations for actions to be taken by policy-makers and other decision-makers. METHODS: In 2017, eight specialized SCI-centers across Germany sent a standardized questionnaire to their patients who had diagnosis of SCI, and were older than 18 years (n=5,598). The questionnaire could be completed paper-based or online. RESULTS: 1,479 patients participated in the study and were included in data analysis. On average, participants were 55.3 years (SD=14.6) old, ¾ were male. The mean time of onset of paralysis was 13.9 years. Two thirds of the spinal cord injury causes were traumatic. In 51.2% SCI was classified as paraplegia. The most frequently cited health problem was sexual dysfunction. Medical treatment for this problem was rarely used. Serious environmental barriers were the inadequate accessibility of private households and public places. 42.5% of the respondents in working age were employed, which is 10% less than in Switzerland. DISCUSSION: Serious problems in environmental barriers, medical care and labor market participation were identified for people with SCI. The results will be reported to and discussed with political decision makers and further actors to create solutions. This requires extensive efforts, like modification in building law and home support.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Qualidade de Vida , Traumatismos da Medula Espinal/reabilitação , Adolescente , Adulto , Distribuição por Idade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários
17.
Arch Phys Med Rehabil ; 101(4): 658-666, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31891714

RESUMO

OBJECTIVE: Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors associated with MDD diagnosis; (3) time at which MDD is diagnosed post-spinal cord injury (SCI); and (4) interaction of inferred mobility status (IMS) in a commercially insured population over 3 years. DESIGN: Retrospective longitudinal cohort design. SETTING: A commercial insurance claims database from January 1, 2010 to December 31, 2013. PARTICIPANTS: Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history of MDD ≤30 days pre-SCI (N=1409). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A stratified survival analysis using IMS, based upon durable medical equipment (DME) claims, was also completed. RESULTS: Post-SCI, 294 out of 1409 (20.87%) were diagnosed with new-onset MDD. Significant (P<.05) risk factors included: employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, and 2 of 5 IMS comparisons. Median time to MDD was 86 days. Survival analysis demonstrated a significant difference between 6 of 10 IMS comparisons. Regarding new-onset or recurring MDD, 432 out of 1409 (30.66%) were diagnosed post-SCI. Significant risk factors included: female, employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, MDD>30 days pre-SCI, catheter claims, and 2 of 5 IMS comparisons. Median time to MDD was 74 days. Survival analysis demonstrated a significant difference between 4 of 10 IMS comparisons. CONCLUSIONS: Prevalence of MDD post-SCI is greater than the general population. Stratification by IMS illustrated that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Traumatismos da Medula Espinal/psicologia , Adolescente , Adulto , Estudos de Coortes , Transtorno Depressivo Maior/diagnóstico , Pessoas com Deficiência/psicologia , Emprego , Feminino , Serviços Hospitalares de Assistência Domiciliar , Humanos , Tempo de Internação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Centros de Reabilitação , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Instituições de Cuidados Especializados de Enfermagem , Traumatismos da Medula Espinal/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
18.
Dig Dis Sci ; 65(4): 1197-1205, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31468268

RESUMO

BACKGROUND: Cancer is a major cause of death in patients with spinal cord injury (SCI). Preventive strategies, such as colonoscopy, deal with higher burdens that may lead to lower quality. AIMS: The primary objective was to evaluate the adenoma detection rate. Secondary objectives were to investigate other quality indicators regarding bowel preparation, sedation, and endoscopy. METHODS: Consecutive SCI patients who had undergone colonoscopy from 2003 to 2014 were assigned to a control group matched for age, gender, and year of procedure and reviewed retrospectively. RESULTS: Bowel preparation lasted longer (3.6 ± 1.5 vs. 1.2 ± 0.6 days, p = 0.001), achieved unsatisfactory cleansing results more often (23.7 vs. 3.6%) and caused more adverse events in 236 SCI compared to 414 control patients. Colonoscopy needed a longer time (36.9 vs. 25.0 min) and remained incomplete more often (24.6 vs. 4.6%), resulting in more re-colonoscopies (14.8 vs. 4.3%). Endoscopy- and sedation-related adverse events were equal. However, neither overall nor size-dependent polyp (30.9 vs. 34.8%), adenoma (21.2 vs. 21.0%), advanced adenoma (6.8 vs. 7.2%), or cancer (1.7 vs. 2.0%) detection rates differed. CONCLUSION: Despite intensified protocols, bowel preparation shows inferior results in SCI patients; colonoscopy needs more effort to succeed but achieves a comparable quality.


Assuntos
Adenoma/epidemiologia , Colonoscopia/tendências , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/tendências , Traumatismos da Medula Espinal/epidemiologia , Adenoma/diagnóstico , Adulto , Idoso , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico
19.
Asian J Androl ; 22(1): 28-33, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31489848

RESUMO

Inflatable penile prostheses are an important tool in the treatment of medically refractory erectile dysfunction. One of the major complications associated with these prostheses is infections, which ultimately require device explanation and placement of a new device. Over the past several decades, significant work has been done to reduce infection rates and optimize treatment strategies to reduce patient morbidity. This article reviews the current state of knowledge surrounding penile prosthesis infections, with attention to the evidence for methods to prevent infection and best practices for device reimplantation.


Assuntos
Disfunção Erétil/cirurgia , Implante Peniano/métodos , Prótese de Pênis , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Antibioticoprofilaxia/métodos , Bandagens , Portador Sadio/diagnóstico , Portador Sadio/tratamento farmacológico , Clorexidina/uso terapêutico , Materiais Revestidos Biocompatíveis , Remoção de Dispositivo , Diabetes Mellitus/epidemiologia , Disfunção Erétil/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/imunologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Infecções por Bactérias Gram-Negativas/terapia , Remoção de Cabelo/métodos , Humanos , Hospedeiro Imunocomprometido/imunologia , Masculino , Cuidados Pré-Operatórios/métodos , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/imunologia , Infecções Relacionadas à Prótese/terapia , Reoperação , Fatores de Risco , Traumatismos da Medula Espinal/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Staphylococcus epidermidis , Campos Cirúrgicos , Instrumentos Cirúrgicos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/imunologia , Infecção da Ferida Cirúrgica/terapia
20.
Am J Obstet Gynecol ; 222(1): 27.e1-27.e32, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31306650

RESUMO

BACKGROUND: Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications. OBJECTIVE: A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications. STUDY DESIGN: Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies. RESULTS: The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation. CONCLUSION: Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.


Assuntos
Paralisia Cerebral/epidemiologia , Perda Auditiva/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Complicações na Gravidez/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Transtornos da Visão/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Comorbidade , Deficiências do Desenvolvimento/epidemiologia , Pessoas com Deficiência , Síndrome de Down/epidemiologia , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Humanos , Deficiência Intelectual/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Transtornos Puerperais/epidemiologia
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