Racial differences in serological markers across the first year of injury in spinal cord injury: a retrospective analysis of a multi-center interventional study.

STUDY DESIGN: Secondary analysis of a randomized, multi-center, placebo-controlled study(Sygen®). OBJECTIVES: To evaluate racial differences in serological markers in individuals with spinal cord injury(SCI) across the first year of injury. SETTING: Hospitals in North America. METHODS: Serological markers (e.g.,cell count, liver, kidney, and pancreatic function, metabolism, and muscle damage) were assessed among 316 participants (247 White, 69 Black) at admission, weeks 1, 2, 4, 8, and 52 post-injury. Linear mixed models were employed to explore the main effects of time, race (Black vs. White), and their interaction, with adjustment of covariates such as study center, polytrauma, injury (level, completeness), treatment group, and sex. RESULTS: A main effect of race was observed where White individuals had higher alanine transaminase, blood urea nitrogen(BUN), BUN/Creatinine ratio, sodium, and chloride, while Black individuals had higher calcium, total serum protein, and platelets. For markers with interaction effects, post-hoc comparisons showed that at week 52, White individuals had higher mature neutrophils, hematocrit, hemoglobin, mean corpuscular hemoglobin, albumin, and triglycerides, and Black individuals had higher amylase. Eosinophils, monocytes, red blood cells, aspartate aminotransferase, bilirubin, cholesterol, partial thromboplastin time, urine specific gravity, urine pH, CO2, and inorganic phosphorus did not differ between races. CONCLUSIONS: Our results revealed racial differences in serological markers and underscores the importance of considering race as a determinant of physiological responses. Future studies are warranted to explore the causes and implications of these racial disparities to facilitate tailored clinical management and social policy changes that can improve health equity.

Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study.

Background: People of Aboriginal (Indigenous) ancestry are more likely to experience traumatic spinal cord injury (TSCI) than other Canadians; however, outcome studies are limited. This study aims to compare Aboriginal and non-Aboriginal populations with acute TSCI with respect to preinjury baseline characteristics, injury severity, treatment, outcomes and length of stay. Methods: This was a retrospective analysis of participants with a TSCI who were enrolled in the prospective Rick Hansen Spinal Cord Injury Registry (RHSCIR), Saskatoon site (Royal University Hospital), between Feb. 13, 2010, and Dec. 17, 2016. Demographic, injury and management data were assessed to identify any differences between the populations. Results: Of the 159 patients admitted to Royal University Hospital with an acute TSCI during the study period, 62 provided consent and were included in the study. Of these, 21 self-identified as Aboriginal (33.9%) and 41 as non-Aboriginal (66.1%) on treatment intake forms. Compared with non-Aboriginal participants, Aboriginal participants were younger, had fewer medical comorbidities, had a similar severity of neurologic injury and had similar clinical outcomes. However, the time to discharge to the community was significantly longer for Aboriginal participants (median 104.0 v. 34.0 d, p = 0.016). Although 35% of non-Aboriginal participants were discharged home from the acute care site, no Aboriginal participants were transferred home directly. Conclusion: This study suggests a need for better allocation of resources for transition to the community for Aboriginal people with a TSCI in Saskatchewan. We plan to assess outcomes from TSCI for Aboriginal people across Canada.

Contexte: Au Canada, les personnes d'origine autochtone sont plus susceptibles que les autres de vivre un traumatisme médullaire. Malgré cela, il y a peu d'études sur les conséquences de cet événement. Notre étude visait à comparer les cas de traumatisme médullaire aigu dans les populations autochtones et non autochtones sur plusieurs plans : les caractéristiques initiales des patients, la gravité du traumatisme, la nature du traitement, les issues cliniques et la durée de séjour. Méthodes: Nous avons fait une analyse rétrospective des dossiers de personnes ajoutées au Rick Hansen Spinal Cord Injury Registry (RHSCIR) [Registre des traumatismes médullaires Rick Hansen] entre le 13 février 2010 et le 17 décembre 2016 pour l'établissement de Saskatoon (l'Hôpital universitaire Royal). Nous avons comparé les renseignements de base des patients ainsi que les données sur le traumatisme et la prise en charge afin de cerner toute différence entre les populations. Résultats: Sur les 159 traumatisés médullaires admis à l'Hôpital universitaire Royal pendant la période à l'étude, 62 ont consenti à l'utilisation de leurs données. Parmi eux, 21 s'étaient identifiés comme Autochtones (33,9 %) sur le formulaire d'hospitalisation, et 41 comme non-Autochtones (66,1 %). Par rapport aux non-Autochtones, les Autochtones étaient plus jeunes, avaient moins de comorbidités, présentaient une atteinte neurologique de gravité comparable et connaissaient à peu près le même tableau clinique. Toutefois, le délai avant leur retour en communauté était significativement plus long (médiane : 104,0 jours contre 34,0 jours; p = 0,016). Aucun participant autochtone n'a été renvoyé directement à la maison, alors que 35 % des participants non autochtones sont retournés chez eux en quittant les soins de première ligne. Conclusion: Cette étude montre qu'il faut améliorer la répartition des ressources de retour dans la communauté pour les traumatisés médullaires autochtones de la Saskatchewan. Enfin, nous comptons examiner les répercussions cliniques du traumatisme médullaire chez les Autochtones de partout au Canada.

Racial and Ethnic Differences in Obesity in People With Spinal Cord Injury: The Effects of Disadvantaged Neighborhood.

OBJECTIVE: To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI). DESIGN: A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract. SETTING: A total of 17 SCI Model Systems centers. PARTICIPANTS: Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Body mass index (BMI) (kg/m2). RESULTS: The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods. CONCLUSIONS: Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods.

Race and socioeconomic disparity in treatment and outcome of traumatic cervical spinal cord injury with fracture: Nationwide Inpatient Sample database, 1998-2009.

STUDY DESIGN: A retrospective national administrative database study. OBJECTIVE: Advances in treatment of traumatic cervical spinal cord injury with fracture (TCSCIF) have led to significant improvements in clinical outcomes; however, progress in healthcare is seldom ubiquitous across demographic groups. Therefore, we explored if disparities in treatment and outcome after TCSCIF exist across race and socioeconomic status. SETTING: USA. METHODS: We queried the Nationwide Inpatient Sample database from 1998 to 2009 for TCSCIF hospitalizations. Multivariate analysis was used to identify the correlation between socioeconomic status and race to injury, treatment type, and outcome. RESULTS: There were 21,985 admissions for TCSCIF, 66.9% of whom had a favorable discharge disposition. In-hospital mortality rate was 12.5%. A total of 43.7% underwent surgery. Overall, surgery was associated with lower in-hospital mortality (OR 0.30, 95% CI 0.27-0.34, p < 0.01) and better discharge disposition (OR 0.68, 95% CI 0.62-0.74, p < 0.01) versus nonsurgical or no intervention. African-American (AA) race and low socioeconomic status (LSES) were significant predictors of lower odds to undergo surgery and unfavorable discharge disposition, respectively; potentially explained by a higher odds of increased New Injury Severity Score classification at presentation. Surgical and favorable discharge rates for LSES and non-Caucasian races, however, have been steadily improving over the study period. CONCLUSIONS: Despite trending improved outcomes after TCSCIF, LSES, or AA race were more likely to have worse outcomes compared to their counterparts. In addition, LSES, AA, and Hispanic groups were less likely to undergo surgical treatment, suggesting disparities in management and outcome effect.

Racial Differences in Weight Gain: A 5-Year Longitudinal Study of Persons With Spinal Cord Injury.

OBJECTIVE: To assess racial differences in body mass index (BMI) change over 5 years among people with spinal cord injury (SCI). DESIGN: Multicenter longitudinal study. SETTING: Spinal Cord Injury Model Systems centers. PARTICIPANTS: Individuals (N=437; 313 non-Hispanic white, 81 non-Hispanic black, and 43 Hispanic; 335 men; mean age, 41.3±13.5y) who incurred an SCI from 1974 to 2010 and completed 2 follow-up assessments within 5 years between October 1, 2006 and September 18, 2015 (mean duration of injury, 9.1±9.6y at the start of the 5-year follow-up). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMI (in kilograms per meters squared). RESULTS: The mean BMI of 437 participants increased from 26.4±6.3 to 27.0±6.4kg/m2 over 5 years (P=.002). The greatest increase was noted for Hispanics (2.0±5.7kg/m2; P=.02), followed by non-Hispanic whites (0.6±3.9kg/m2; P=.01) and non-Hispanic blacks (0.01±3.7kg/m2; P>.99). The differences in BMI increase across racial groups were significant (P=.03) in those with paraplegia (American Spinal Injury Association Impairment Scale A, B or C), those who were underweight or of normal weight at baseline, and those within 10 years of their injury. Such racial differences remained significant after taking into account demographic and injury characteristics. CONCLUSIONS: Our study findings provide a foundation for future research to explore risk and protective factors that contribute to racial differences in weight gain after SCI, which help alert health care professionals to a high-risk group for obesity prevention and management.

Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972-2014.

OBJECTIVE: To document trends in the demographic and injury profile of new spinal cord injury (SCI) over time. DESIGN: Cross-sectional analysis of longitudinal data by injury years (1972-1979, 1980-1989, 1990-1999, 2000-2009, 2010-2014). SETTING: Twenty-eight Spinal Cord Injury Model Systems centers throughout the United States. PARTICIPANTS: Persons with traumatic SCI (N=30,881) enrolled in the National Spinal Cord Injury Database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Age, sex, race, education level, employment, marital status, etiology, and severity of injury. RESULTS: Age at injury has increased from 28.7 years in the 1970s to 42.2 years during 2010 to 2014. This aging phenomenon was noted for both sexes, all races, and all etiologies except acts of violence. The percentage of racial minorities expanded continuously over the last 5 decades. Virtually among all age groups, the average education levels and percentage of single/never married status have increased, which is similar to the trends noted in the general population. Although vehicular crashes continue to be the leading cause of SCI overall, the percentage has declined from 47.0% in the 1970s to 38.1% during 2010 to 2014. Injuries caused by falls have increased over time, particularly among those aged ≥46 years. Progressive increases in the percentages of high cervical and motor incomplete injuries were noted for various age, sex, race, and etiology groups. CONCLUSIONS: Study findings call for geriatrics expertise and intercultural competency of the clinical team in the acute and rehabilitation care for SCI. This study also highlights the need for a multidimensional risk assessment and multifactorial intervention, especially to reduce falls and SCI in older adults.

To What Extent Do Neighborhood Differences Mediate Racial Disparities in Participation After Spinal Cord Injury?

OBJECTIVE: To examine the role of residential neighborhood characteristics in accounting for race disparities in participation among a large sample of community-living adults with chronic spinal cord injury (SCI). DESIGN: Secondary analysis of cross-sectional survey data from the national Spinal Cord Injury Model Systems (SCIMS) database linked with national survey and spatial data. SETTING: SCIMS database participants enrolled at 10 collaborating centers active in follow-up between 2000 and 2014. PARTICIPANTS: The sample consisted of persons with SCI (N=6892) in 5441 Census tracts from 50 states and the District of Columbia. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: The Craig Handicap Assessment and Reporting Technique was used to measure full participation across 4 domains: physical independence, mobility, occupation, and social integration. RESULTS: Racial minority groups had lower odds of reporting full participation relative to whites across all domains, suggesting that blacks and Hispanics are at risk for poorer community reintegration after SCI. Neighborhood characteristics, notably differences in socioeconomic advantage, reduced race group differences in the odds of full occupational and social integration, suggesting that the race disparities in community reintegration after SCI are partially attributable to variation in the economic characteristics of the places where people live. CONCLUSIONS: This investigation suggests that addressing disadvantage at the neighborhood level may modify gaps in community participation after medical rehabilitation and provides further support for the role of the environment in the experience of disability.

Ethnicity and rehabilitation outcomes: the Needs Assessment Checklist.

STUDY DESIGN: Retrospective cohort study with matched samples. OBJECTIVES: To investigate whether significant differences in rehabilitation outcomes exist between different ethnic groups, using the Needs Assessment Checklist (NAC). SETTINGS: Tertiary care, spinal cord injury rehabilitation unit (National Spinal Injuries Centre), Stoke Mandeville Hospital, UK. METHODS: Rehabilitation outcomes and demographic information were obtained from the NAC. Data on 461 individuals were included in the study. Analysis of variance was employed to investigate differences in rehabilitation outcomes between various ethnic groups, across both the whole cohort and matched samples. RESULTS: Significant differences were evident across the different rehabilitation domains when ethnicity was examined, in particular within the domains of physical healthcare and psychological well-being. Within the unmatched data set, significant differences were found to exist in 3 of the 10 rehabilitation domains, and with the matched data set within 4 of the 10 domains. The results indicated that the cohort as a whole made significant improvements from the first to the second NAC within all rehabilitation domains. CONCLUSION: Results indicate that ethnicity may have an impact on rehabilitation outcomes for individuals with spinal cord injury. Further investigation is needed to explore the nature of this relationship, and the future role of targeted interventions focusing on improving rehabilitation outcomes within the domains of physical and psychological care, in particular for individuals from different ethnic backgrounds.

Longitudinal analysis of hospitalization after spinal cord injury: variation based on race and ethnicity.

OBJECTIVE: To examine the longitudinal effects of race/ethnicity on hospitalization among adults with spinal cord injury (SCI) in the 10-year period after initial injury. DESIGN: Retrospective analysis of postinjury hospitalizations among non-Hispanic white, non-Hispanic African American, and Hispanic adults with SCI. SETTING: Community. Data were extracted from the 2011 National Spinal Cord Injury Model Systems database. PARTICIPANTS: Patients with traumatic SCI (N= 5146; white, 3175; African American, 1396; Hispanic, 575) who received rehabilitation at one of the relevant SCI Model Systems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Hospitalization, including rate of hospitalization, number of hospitalizations, and number of days hospitalized during the 12 months before the first-, fifth-, and tenth-year follow-up interviews for the SCI Model Systems. RESULTS: Significant differences were found in rates of hospitalization at 1 and 5 years postinjury, with participants from Hispanic backgrounds reporting lower rates than either whites or African Americans. At 10 years postinjury, no differences were noted in the rate of hospitalization between racial/ethnic groups; however, compared with whites (P=.011) and Hispanics (P=.051), African Americans with SCI had 13 and 16 more days of hospitalization, respectively. Compared with the first year postinjury, the rate of hospitalization declined over time among whites, African Americans, and Hispanics; however, for African Americans, the number of days hospitalized increased by 12 days (P=.036) at 10 years versus 5 years postinjury. CONCLUSIONS: Racial/ethnic variation appears to exist in postinjury hospitalization for individuals with SCI, with Hispanics showing the lowest rates of hospitalization at 1 and 5 years postinjury and African Americans having a significantly higher number of days hospitalized at 10 years postinjury. Potential explanations for these variations are discussed, and recommendations are made for potential changes to policy and clinical care.

Racial and ethnic disparities in functioning at discharge and follow-up among patients with motor complete spinal cord injury.

OBJECTIVE: To examine racial and ethnic differences in self-care and mobility outcomes for persons with a motor complete, traumatic spinal cord injury (SCI) at discharge and 1-year follow-up. DESIGN: Retrospective cohort study. SETTING: Sixteen rehabilitation centers contributing to the Spinal Cord Injury Model Systems (SCIMS) database. PARTICIPANTS: Adults with traumatic, motor complete SCI (N=1766; American Spinal Injury Association Impairment Scale grade A or B) enrolled in the SCIMS between 2000 and 2011. Selected cases had complete self-reported data on race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic) and motor FIM scores assessed at inpatient rehabilitation admission, discharge, and 1-year follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes were measured by FIM self-care and mobility scores on a 1 to 7 FIM scale, at discharge and 1-year follow-up. RESULTS: Multiple regression models stratified by neurologic category and adjusted for sociodemographic and injury characteristics assessed racial and ethnic group differences in FIM self-care and mobility change scores at discharge and 1-year follow-up. At discharge, non-Hispanic black participants with tetraplegia and paraplegia had significantly poorer gains in FIM self-care and mobility scores relative to non-Hispanic white and Hispanic participants. At 1-year follow-up, similar FIM self-care and mobility change scores were found across racial and ethnic groups within each neurologic category. CONCLUSIONS: Non-Hispanic white and Hispanic participants had comparatively more improvement in self-care and mobility during inpatient rehabilitation compared with non-Hispanic black participants. At 1-year follow-up, no differences in self-care and mobility outcomes were observed across racial and ethnic groups. Additional research is needed to identify potential modifiable factors that may contribute to racially and ethnically different patterns of functional outcomes observed during inpatient rehabilitation.

Race-ethnicity and poverty after spinal cord injury.

STUDY DESIGN: Secondary analysis of existing data. OBJECTIVE: Our objective was to examine the relationship between race-ethnicity and poverty status after spinal cord injury (SCI). SETTING: A large specialty hospital in the southeastern United States. METHODS: Participants were 2043 adults with traumatic SCI in the US. Poverty status was measured using criteria from the US Census Bureau. RESULTS: Whereas only 14% of non-Hispanic White participants were below the poverty level, 41.3% of non-Hispanic Blacks were in poverty. Logistic regression with three different models identified several significant predictors of poverty, including marital status, years of education, level of education, age and employment status. Non-Hispanic Blacks had 2.75 greater odds of living in poverty after controlling for other factors, including education and employment. CONCLUSION: We may need to consider quality of education and employment to better understand the elevated risk of poverty among non-Hispanic Blacks in the US.

Online support for individuals with spinal cord injuries: an ethnographic investigation.

BACKGROUND: Although social support is an important protective factor for individuals with spinal cord injuries (SCIs), individuals often encounter significant barriers to obtaining support after experiencing a SCI. It has been suggested that the Internet may serve to help individuals with disabilities overcome common barriers in obtaining support, yet research examining the efficacy of Internet-based support for individuals with SCI has been mixed. OBJECTIVE: To develop a more nuanced understanding of how individuals with SCI can or might use the Internet for support. DESIGN: Using an ethnographic approach, we conducted semi-structured interviews with nine individuals with SCI to explore perceived needs and barriers to information-seeking and online support. SETTING: Participants were recruited from Veterans Administration medical center outpatient and inpatient units providing specialty care to individuals with SCIs and from a community SCI Center of Excellence. RESULTS: Individuals with SCI gain emotional, problem-focused, and reciprocal support from online sources. CONCLUSIONS: Online resources can provide important opportunities for social support for individuals with SCI.

Life satisfaction and life values in people with spinal cord injury living in three Asian countries: a multicultural study.

OBJECTIVE: To compare the differences in life satisfaction and life values among people with spinal cord injury (SCI) living in three economically similar Asian countries: India, Vietnam, and Sri Lanka. DESIGN: Cross-sectional and comparative investigation using the unified questionnaire. SETTING: Indian Spinal Injuries Centre in New Delhi (India), Spinal Cord Rehabilitation Department of the Bach Mai Hospital in Hanoi (Vietnam), and Foundation for the Rehabilitation of the Disabled in Colombo (Sri Lanka). PARTICIPANTS: Two hundred and thirty-seven people with SCI using a wheelchair; 79 from India, 92 from Vietnam, and 66 from Sri Lanka. OUTCOME MEASURES: Life Satisfaction Questionnaire, Chinese Value Survey. RESULTS: People with SCI in Vietnam had significantly higher general life satisfaction than participants in India and Sri Lanka. Significant differences were identified in several demographic and life situation variables among the three Asian countries. With regard to "Traditional", "Universal", and "Personal" life values significant differences among three participating countries were identified in all domains. No significant relationships were identified between life satisfaction and life values for people with SCI in India, Vietnam, or Sri Lanka. CONCLUSION: It could be presumed that particular demographic and life situation variables are more powerful factors of life satisfaction following SCI than the dominant culture of a country expressed by life values.

Stability of vocational interests after recent spinal cord injury: comparisons related to sex and race.

OBJECTIVE: To identify the stability of vocational interests first assessed during inpatient rehabilitation for spinal cord injury and again an average of 834.9 days postinjury to determine the extent to which stability of interest varies as a function of race and sex. DESIGN: Longitudinal. SETTING: Data were collected at a specialty hospital. PARTICIPANTS: At enrollment, participants were a minimum of 16 years of age, were currently hospitalized for inpatient rehabilitation, were less than 6 months postinjury, had residual impairment after traumatic spinal cord injury, and were either white or black, and non-Hispanic. Participants (N=304) were assessed an average ± SD of 50±26.6 days after injury and again an average ± SD of 834.9±192.7 days postinjury (averaged 785.1 d between assessments). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Strong Interest Inventory, a 317-item vocational interests measure. RESULTS: A repeated-measures general linear model was used with 4 groups based on a combination of race and sex. Significant cohort by time interactions were observed on 4 general occupational themes (investigative, artistic, enterprising, and conventional). In nearly all cases, black women showed decreases in average interest scores compared with the other groups. There was a clear pattern of change in the direction of greater homogeneity of interests over time as measured by the range of theme scores between cohorts based on sex and race. Although changes in mean interest profiles varied as a function of sex and race, less consistent differences were observed when stability coefficients were the measure of change. CONCLUSIONS: The direction and degree of change in mean scores for vocational interests was related to sex and race. With the exception of black women, vocational interests increased from baseline to follow-up.

Traumatic and non-traumatic spinal cord impairment in New Zealand: incidence and characteristics of people admitted to spinal units.

This paper estimates the incidence (all ages) of spinal cord neurological impairment (SCI; traumatic and non-traumatic) in New Zealand and describes pre-SCI characteristics and early post-SCI outcomes for participants (16-64 years) in this longitudinal study. Demographic and clinical data on all people admitted to New Zealand's two spinal units (mid-2007 to mid-2009) were included for the estimate of incidence. Participants in this longitudinal study were asked at first interview about pre-SCI socio-demographic, health and behavioural characteristics, and about post-SCI symptoms, general health status (EQ-5D) and disability (WHODAS 12-item). Age-adjusted incidence rates (95% CI) for European, Maori, Pacific and 'Other' ethnicities were 29 (24-34), 46 (30-64), 70 (40-100) and 16 (9-22) per million, respectively. Interviews with 118 (73%) participants (16-64 years), occurred 6.5 months post-SCI. Most reported bother with symptoms, and problems with health status and disability. Compared with Europeans, the incidence of SCI is high among Maori and particularly high among Pacific people. Six months after SCI, proximate to discharge from the spinal units, considerable symptomatic, general health and disability burden was borne by people with SCI.

Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study.

INTRODUCTION: The epidemiology of spinal cord injury without radiographic abnormality (SCIWORA) is less frequently reported in adults as compared with children. The annual incidence of SCIWORA was approximately 5.74% per million in Tianjin from 2004 to 2008. Importantly, the epidemiological characteristics of adult SCIWORA may be different from that in children. The aim of this study was to evaluate the radiological-clinical data of patients with adult SCIWORA, and to relatively analyze the epidemiological features. MATERIALS AND METHODS: Inpatients with cervical SCIWORA who were 16 and above in Tianjin were admitted in municipal hospitals in Tianjin from 2004 to 2008; all the patients received MRI scanning in sagittal and axial views. Epidemiological characteristics, such as injury origin, injury level or severity, neurological scale and MRI feature were acquired. RESULTS: In total, 203 patients were enrolled. The average age among the adult groups was 55.9 years (men 55.8 years, women 53.6 years). SCIWORA occurred more commonly in adults in the 46-60 age group, and falls were the leading cause of injury (52.2%), followed by vehicular injury (28.6%). The most predominantly affected level was C4/5 (48.7%), followed by C5/6 (30.5%) and C3/4 (12.8%), respectively. The occurrence of central cord syndrome (50.2%) with posterior longitudinal ligament tear (43.8%) was relatively higher than other injury patterns. CONCLUSION: It is clear that adult cervical SCIWORA is different from that in the pediatric group. Our study highlights the epidemiological properties of adult SCIWORA in Tianjin, China. Differing from other reports, particularly epidemiology study, we represent the first report regarding adult SCIWORA from China. As the geriatric population increases, it is very important to set up an individualized evaluation system based on a nationally scaled epidemiological database. The results from our study will be useful in assisting in the creation of such a database.

The relationship between prescription medication use and ability to ambulate distances after spinal cord injury.

OBJECTIVE: To investigate the relationship between prescription medication use for pain and spasticity and ambulation distances while controlling for pain severity, injury severity, age, sex, and race in participants with spinal cord injury (SCI). DESIGN: Secondary analysis of survey data. SETTING: Specialty hospital in the Southeast United States. PARTICIPANTS: Adults (N=407) with traumatic SCI identified through inpatient and outpatient hospital databases. INTERVENTION: Not applicable. MAIN OUTCOMES MEASURES: A questionnaire measured prescription medication use, ambulation distance, and other demographic data. A composite score of four 10-point scales from the Brief Pain Inventory was used to measure pain severity. Multinomial logistic regression was used to calculate the odds ratio (OR) of ambulation distance using 1000 ft or more as the reference group. RESULTS: Persons with SCI who were heavy prescription medication users (defined as weekly or daily use for pain or spasticity) were more likely to be limited to distances less than 150 (OR, 2.82; 95% confidence interval [CI], 1.57-5.04) and 150 to 999 ft (OR, 2.52; 95% CI, 1.45-4.39). CONCLUSION: Heavy prescription medication use for pain and spasticity was related inversely to a person's ability to achieve community ambulation distances of 1000 ft or more.

Barriers to sexual activity: counselling spinal cord injured women in Malaysia.

STUDY DESIGN: This study is a cross-sectional, face-to-face interview. OBJECTIVES: To examine the sexual activity in a sample of Malaysian women with traumatic spinal cord injuries (SCIs), identify the physical and psychological barriers to it, and explore their experiences with sexual counseling and rehabilitation. SETTING: This study was conducted at the Spinal Rehabilitation Unit of a teaching hospital. METHODS: All women who attended scheduled check-ups, over 1 year, and who met the inclusion criteria (age above 18 years, spinal injury of traumatic aetiology, living in the community and having completed the rehabilitation) were consecutively included in a face-to-face interview using a self-constructed questionnaire. Sociodemographic and disability-related variables, barriers to sexual activity/satisfaction and experiences of sexual rehabilitation services were obtained. RESULTS: During the study period, 33/36 subjects were recruited. Although 67% indicated interest in sexual activity, only 24% was sexually active. The frequency of sexual activity declined after the injury, from 4.6 times per month to 1.5 times per month. Feeling unattractive, unable to satisfy the partner and less confident about sexual ability were top three psychological barriers to sexual activity, and the top three physical barriers were impaired genital sensation, positioning and vaginal lubrication. In all, 50% received some sexual information during rehabilitation. Rehabilitation professionals were expected to initiate sexual counseling by 62.5% of subjects. CONCLUSION: The effect of SCIs on sexual function is tremendous. Sexual counseling services must be improved and take into account the impact of psychological factors.

Quality of life among the traumatic spinal cord injured patients.

OBJECTIVES: To study the quality of life among the traumatic spinal cord injured patients and to identify the factors related with the quality of life in the good level of such patients. MATERIAL AND METHOD: The traumatic SCI patients who had been treated in the Department of Rehabilitation Medicine, Siriraj Hospital, Bangkok, Thailand from January 2003 until August 2009 were interviewed for the demographic data. The injury related data were obtained from the medical records. The WHOQOL-BREF-Thai was used to acquire the QOL score, which would be interpreted as poor fair, and good QOL level according to the questionnaire. The Center for Epidemiologic Studies Depression scale and the modified Barthel Index (BI) were used to assess depression, and functional disability respectively. The median split method was used to divide the participants into two groups as good and poor QOL groups. The Chi-square and Independent Sample t-test were performed to determine the difference between these two groups and multivariate logistic regression was used to analyze the factors associated with the good QOL. P-value < 0.05 was accepted as statistical significance. RESULTS: Sixty-seven patients (49 males and 18 females) with a mean age 36.54 +/- 11.46 years old participated the present study. They suffered from traffic accident 67.2%, gunshot 16.4%, fall from a height 11.9%, and others 4.5%. The injury levels were cervical 31.3%, thoracic 50.7%, and lumbosacral 18%. Most of them (60.6%) had incomplete lesion. Eighteen patients (26.1%) reported depression. The mean BI score was 69.71 +/- 29.42. Three (4.5%), forty-nine (73.1%), and fifteen (22.4%) participants reported their QOL score in the range of poor, fair and good levels respectively. Using the median split method, participants with a score over 82 were classified as having good QOL groups and the rest were classified as having poor QOL group. When considering the score in each domain of the WHOQOL questionnaire, the differences between the good and poor QOL groups had statistical significance. The sufficient income (OR 13.67, 95% CI: 3.1-60.22, p = 0.001), having no depression (OR 7.6, 95% CI: 1.17-49.22, p = 0.033), and being employed (OR 6.88, 95% CI: 1.44-32.94, p = 0.016) were significantly related with the good QOL. CONCLUSION: Most of the SCI patients determined their QOL as fair level. Sufficient income, having no depression, and being employed were associated with the good QOL.

Influence of season, ethnicity, and chronicity on vitamin D deficiency in traumatic spinal cord injury.

BACKGROUND: Inadequate levels of vitamin D increase the risk of osteoporosis, a highly prevalent condition in patients with traumatic spinal cord injury (SCI). Reduced sunlight and dark skin further contribute to low vitamin D levels. OBJECTIVES: To compare serum 25-hydroxy vitamin D [vitamin D25(OH)] levels in acute and chronic SCI and to explore seasonal and ethnic differences among patients with acute and chronic SCI. PATIENTS/METHODS: Patients (N=96) aged 19 to 55 years with C3-T10 motor complete SCI participated. Acute SCI was 2 to 6 months after injury, whereas chronic SCI was at least 1 year from injury. Serum vitamin D25(OH), calcium, and parathyroid hormone were drawn dUring summer or winter months. Vitamin D deficiency (<13 ng/mL), insufficiency (<20 ng/mL), and subtherapeutic (<32 ng/mL) levels were compared for all groups. A 3-way analysis of covariance was adopted to determine significant main effects of season, chronicity, and ethnicity. Interactions between season and chronicity, season and ethnicity, and chronicity and ethnicity were evaluated. Evaluation of a 3-way interaction among season, chronicity, and ethnicity was completed. RESULTS: In summer, 65% of patients with acute SCI and 81% of patients with chronic SCI had subtherapeutic vitamin D levels, whereas in winter, 84% with acute SCI and 96% with chronic SCI had vitamin D25(OH) (<32 ng/mL). Lower vitamin D25(OH) levels were observed in African Americans relative to whites. Significant main effects were noted for season (P = 0.017), chronicity (P = 0.003), and ethnicity (P < 0.001). However, interactions between 2 or more factors were not found. CONCLUSIONS: Vitamin D insufficiency and deficiency are found in the majority of patients with chronic SCI and in many with acute SCI. Initial screening for serum vitamin D25(OH) levels should be performed early in rehabilitation. Periodic monitoring in the chronic setting is highly recommended.