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STUDY DESIGN: Prospective follow-up study. OBJECTIVES: To identify indicators leading to compliance with yearly controls (YCs) and to describe the clinical and functional outcomes 2 years after traumatic spinal cord injury (SCI). SETTING: The national SCI rehabilitation centre in Botswana. METHODS: Included in the study were all people who were admitted with a traumatic SCI during a 2-year period and survived to be discharged (n=38). Data were collected at the YCs and included demographic characteristics and clinical and functional outcomes. Comparisons were made between those who did or did not attend YCs and between those who did or did not develop pressure ulcers (PUs). RESULTS: The follow-up rate was 71% (27/38) with higher attendance among those with complete injuries and those with secondary complications, especially pain. Age, gender, distance to the centre and education did not affect the follow-up rate. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Despite high rates of PUs (48%) and urinary tract infections (UTIs; 41%), no death had occurred during the follow-up period. Furthermore, one-third had resumed work. CONCLUSION: Despite high rates of UTIs and PUs developed in the home environment, this study showed a high survival rate 2 years after traumatic SCI, which might be explained by the establishment of a specialised SCI unit and the high follow-up rate. In addition, the continuing contact with the SCI staff might have facilitated the relatively high return-to-work rate. Long-term follow-up seems possible even in resource-constrained settings with clearly stated objectives, transport, dedicated staff and well-educated patients and families.
Assuntos
Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/terapia , Adolescente , Adulto , Botsuana/epidemiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/etiologia , Úlcera por Pressão/terapia , Estudos Prospectivos , Retorno ao Trabalho , Autocuidado , Sexualidade , Fatores Socioeconômicos , Traumatismos da Medula Espinal/complicações , Resultado do Tratamento , Bexiga Urinaria Neurogênica/epidemiologia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/reabilitação , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/terapia , Adulto JovemRESUMO
STUDY DESIGN: Prospective follow-up study. OBJECTIVES: To increase the knowledge regarding clinical and functional outcomes after traumatic spinal cord injuries (TSCI) in a resource-constrained setting. A special focus was placed on secondary complications such as pressure ulcers. SETTING: The national referral hospital in Gaborone, Botswana. METHODS: The study included all patients admitted with an acute TSCI during a 2-year period (n=39). Data collection was conducted at the time of discharge, and clinical characteristics, length of stay and pressure ulcers were analysed using descriptive and inferential statistics. RESULTS: Completeness of injury and presence of pressure ulcers were the factors found to significantly prolong hospitalization, which was 5 months (median). One patient died before discharge and one was discharged to rehabilitation in South Africa; all other patients were living with close or distant family members after discharge. Patients were supplied with electrical or manual active wheelchairs. Self-catheterization or suprapubic catheters were the main methods for bladder management, and ano-rectal stimulation to manage the bowel. Pressure ulcers, urinary tract infections and pain were the most frequent complications during in-patient care. CONCLUSIONS: Rehabilitation of patients with TSCI in Botswana has been going through big changes, and new rehabilitation objectives, such as techniques used for the management of bladder and bowel dysfunctions and the provision of technical aids, have been implemented, which likely can contribute to an overall improvement in the outcomes. However, basic care at the general wards is still lagging behind, causing high rates of pressure ulcers that significantly extend hospitalization periods.
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Admissão do Paciente/tendências , Alta do Paciente/tendências , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/epidemiologia , Adolescente , Adulto , Botsuana/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta/tendências , Traumatismos da Medula Espinal/terapia , Resultado do Tratamento , Adulto JovemRESUMO
This corrects the article DOI: 10.1038/ajg.2017.27.
RESUMO
STUDY DESIGN: The present descriptive clinical and laboratory study is cross-sectional in design. OBJECTIVES: The primary aim is to describe and compare resting energy expenditure (REE) and energy expenditure (EE) during different standardized sedentary, non-exercise and exercise activities in people with motor-complete paraplegia (Th7 to Th12.). A secondary aim was to compare men and women. METHODS: Thirty-eight adults (10 women) with SCI, T7-T12 AIS A-B, were recruited. All the data were collected through indirect calorimetry. REE was measured in supine for 30 min after 8 h of overnight fasting. Activity energy expenditure (AEE) for activities was measured for seven minutes during sedentary, non-exercise physical activity (NEPA) and exercise activities. RESULTS: AEE increased four to eight times when engaging in NEPA compared to that in sedentary activities. Men had significantly higher resting oxygen uptake compared to women, 0.19 vs 0.15 l min-1 (P=0.005), REE per 24 h, 1286 vs 1030 kcal (P=0.003) and EE during weight-bearing activities. However, these became nonsignificant after adjustment for body weight and speed of movement, with a mean resting oxygen uptake of 2.47 ml O2 per kg min-1 for the whole group (women 2.43 and men 2.57 ml O2 kg-1 min-1, P=0.49). CONCLUSIONS: NEPA increases AEE up to eight times compared to sedentary activities. Gender differences in oxygen uptake during both rest and weight-bearing activities were diminished after adjustment for body weight. The mean resting oxygen uptake for the whole group was 2.47 ml O2 kg-1 min-1. These results highlight the importance, especially of NEPA, for increasing total daily EE in the target population.
Assuntos
Metabolismo Energético , Paraplegia/fisiopatologia , Adulto , Calorimetria Indireta , Estudos Transversais , Metabolismo Energético/fisiologia , Feminino , Humanos , Masculino , Atividade Motora/fisiologia , Consumo de Oxigênio/fisiologia , Paraplegia/etiologia , Descanso/fisiologia , Caracteres SexuaisRESUMO
OBJECTIVE: Translation of the Spinal Cord Injury Falls Concern Scale (SCI-FCS); validation and investigation of psychometric properties. DESIGN: Translation, adaptation and validation study. SUBJECTS/PATIENTS: Eighty-seven wheelchair users with chronic SCI attending follow-up at Rehab Station Stockholm/Spinalis, Sweden. METHODS: The SCI-FCS was translated to Swedish and culturally adapted according to guidelines. Construct validity was examined with the Mann-Whitney U-test, and psychometric properties with factor and Rasch analysis. RESULTS: Participants generally reported low levels of concerns about falling. Participants with higher SCI-FCS scores also reported fear of falling, had been injured for a shorter time, reported symptoms of depression, anxiety and fatigue, and were unable to get up from the ground independently. Falls with or without injury the previous year, age, level of injury, sex and sitting balance did not differentiate the level of SCI-FCS score. The median SCI-FCS score was 21 (range 16-64). Cronbachs alpha (0.95), factor and Rasch analysis showed similar results of the Swedish as of the original version. CONCLUSION: The Swedish SCI-FCS showed high internal consistency and similar measurement properties and structure as the original version. It showed discriminant ability for fear of falling, time since injury, symptoms of depression or anxiety, fatigue and ability to get up from the ground but not for age, gender or falls. Persons with shorter time since injury, psychological concerns, fatigue and decreased mobility were more concerned about falling. In a clinical setting, the SCI-FCS might help identifying issues to address to reduce the concerns about falling.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Avaliação da Deficiência , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/reabilitação , Índices de Gravidade do Trauma , Cadeiras de Rodas/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Psicometria/métodos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Sensibilidade e Especificidade , Suécia/epidemiologia , Tradução , Adulto JovemRESUMO
STUDY DESIGN: Descriptive study with a cross-sectional design. OBJECTIVES: To describe the epidemiology of traumatic spinal cord injuries (TSCIs) in Botswana, with a specific focus on road traffic crashes (RTC). SETTING: Main public referral hospital, Gaborone, Botswana. METHOD: Two samples were included. Sample one described the epidemiology and included patients admitted during a 2-year period with acute TSCI. Sample two included only patients with TSCI due to RTC. RESULTS: Annual incidence was 13 per million population. Epidemiology of TSCI: 49 patients were included, 71% male, age ranging from 4 to 81 years, 80% ⩽ 45 years. Tetraplegia was more common than paraplegia (59/41%), and 39% had C1-C4 level of injury. The main cause of TSCI was RTC (68%), followed by assault (16%) and falls (10%). Mortality was 20%, where all, but one, had tetraplegia (18%). Median time from injury to spinal surgery was 12 days, with longer time for women, 16 days compared with 8 for men. Burst tire was the primary cause of RTC resulting in a TSCI, followed by hitting animals on the road. The majority had been passengers and 72% were involved in single crashes. CONCLUSION: The most common cause for TSCI was RTC, followed by assault. In-hospital mortality was high and the waiting period from the time of accident to spinal surgery was long, especially for women. The aetiology and high mortality of TSCI in Botswana indicate that improvements in roadway safety and medical care may decrease the TSCI incidence and mortality.
Assuntos
Traumatismos da Medula Espinal/epidemiologia , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Botsuana/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Paraplegia/epidemiologia , Paraplegia/fisiopatologia , Quadriplegia/epidemiologia , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Tempo para o Tratamento , Adulto JovemRESUMO
SETTING: Retrospective analysis and retrospective follow-up. INTRODUCTION: Spinal cord injury (SCI) patients have today a nearly normal lifespan. Avoidance of medical complications is key to this end. The aim of the study was to analyse health in individuals surviving 25 years or more after traumatic SCI in Stockholm and Florence, and compare medical complications. METHODS: Data from the databases of the Spinal Unit of Florence and from the Spinalis, Stockholm were analysed. Patients included were C2-L 2, American Spinal Cord Association (ASIA) Impairment Scale (AIS) A-C, and ≥25 years post traumatic SCI. Patients underwent a thorough neurological and general examination, and were interviewed about medical events during those years. Analysed data include: gender, age at injury, current age, neurological level, AIS, cause of injury, presence of neuropathic pain (NP), and spasticity and medical complications. RESULTS: A total of 66 Italian patients and 74 Swedish patients were included. The only statistical difference between the groups was cause of injury due to falls was higher in the Florence group (P<0.01). Male/female ratio was 4:1. Traffic accidents were the most common cause of injury. In all, 60% were paraplegics. Pressure ulcers (PU) occurred in nearly 60% and 32% experienced NP. Respiratory complications (RC) occurred in 25% among tetraplegics. Neurological deterioration occurred in 14%. CONCLUSION: PU, bony fractures, spasticity and NP are important problems after SCI. RC are of clinical importance in the tetraplegics. Complications occur during all periods after injury. Many patients are otherwise healthy 25 years or more after SCI.
Assuntos
Traumatismos da Medula Espinal/complicações , Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Etnicidade , Feminino , Seguimentos , Humanos , Itália , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/terapia , Suécia , Adulto JovemRESUMO
STUDY DESIGN: Double-blind, placebo-controlled, flexible-dose study. OBJECTIVE: To evaluate the efficacy, safety and tolerability of oral sildenafil in women with female sexual arousal disorder as a result of SCI (paraplegia/tetraplegia). SETTING: The study was conducted at clinical practice sites in North America (n =23), 11 European countries (n =23), Australia (n =4) and South Africa (n =2). METHODS: 129 women were randomized and treated with sildenafil or matching placebo. A 4-week baseline period was followed by 12 weeks of treatment, which could be increased from 50 to 100 mg or decreased to 25 mg once during the treatment period, depending on efficacy and tolerability. By use of an event log, sexual activity was monitored between screening and the end of treatment. The Sexual Function Questionnaire, the Sexual Quality of Life Questionnaire-Female, a global efficacy question and Sexual Distress Question were also assessed. RESULTS: Sildenafil-treated women and placebo-treated women had an increase in their percentage of sexual activities throughout the course of the study, with no statistically significant difference between groups in the percentage of successful sexual activities at end of treatment versus baseline. There were also no statistically significant differences between sildenafil- and placebo-treated women on the aforementioned measures. The most common adverse events included headache and vasodilatation. CONCLUSION: The results of this study are similar to other reports regarding a lack of clinically meaningful benefit of sildenafil in other populations of women. SPONSORSHIP: This study was sponsored by Pfizer Inc.
Assuntos
Paraplegia/complicações , Inibidores da Fosfodiesterase 5/administração & dosagem , Piperazinas/administração & dosagem , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Disfunções Sexuais Psicogênicas/etiologia , Traumatismos da Medula Espinal/complicações , Sulfonas/administração & dosagem , Adulto , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Inibidores da Fosfodiesterase 5/efeitos adversos , Piperazinas/efeitos adversos , Efeito Placebo , Purinas/administração & dosagem , Purinas/efeitos adversos , Quadriplegia/complicações , Quadriplegia/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Citrato de Sildenafila , Traumatismos da Medula Espinal/fisiopatologia , Sulfonas/efeitos adversos , Adulto JovemRESUMO
Cystic lesions of the spinal cord (syringomyelia) may occur after spinal cord injury. Posttraumatic syringomyelia may result in a myelopathy causing symptoms of sensory and motor loss, as well as worsening spasticity, pain, hyperhidrosis, and autonomic dysreflexia. Shunting of the cyst cavity along with untethering of the scarred spinal cord is widely accepted as the treatment of choice. However, the long-term stabilization of the progressive myelopathy caused by a posttraumatic cyst is suboptimal because of arachnoidal rescarring, shunt tube blockage, and cyst reexpansion. A new neurosurgical strategy to overcome the complication of cyst reexpansion was designed. Experimental studies have shown the successful use of embryonic spinal cord grafts, including human grafts, to obliterate induced spinal cord cavities in rats. The authors report the first use of solid human embryonic spinal cord grafts to successfully obliterate 6 cm of a large cyst cavity in a patient becoming myelopathic from a posttraumatic cyst. The grafts are well visualized by MRI to the 7-month postoperative follow-up and cyst obliteration is seen in the region where the grafts were placed.
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Transplante de Tecido Fetal , Medula Espinal/transplante , Siringomielia/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Regeneração Nervosa , Medula Espinal/patologia , Traumatismos da Medula Espinal/complicações , Procedimentos Cirúrgicos Operatórios/métodos , Siringomielia/diagnóstico , Siringomielia/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the incidence of delivery in women after a traumatic spinal cord injury and to describe pregnancy outcome in this group of patients. METHODS: Between 1980-1991, 29 women with a traumatic spinal cord injury experienced 49 pregnancies and gave birth to 52 children in Sweden. A retrospective chart review of the antepartum, intrapartum, and perinatal records of these patients was performed. In addition, all patients participated in a telephone interview held by one of the authors. Of the 29 women, 12 had lesions above T5 and 17 had lesions at T5 or below. RESULTS: Antenatal complications occurred frequently in this group. Nine of 12 patients with lesions above T5 had symptoms of autonomic hyperreflexia during pregnancy and/or delivery. Only in a minority of the women was the problem recognized by the medical professionals. Nine of the infants (19%) were born preterm and two were small for gestational age. The perinatal mortality rate was two of 52 (3.8%) and occurred in two cases of abruptio placentae. Few of the patients were allowed to deliver vaginally. The cesarean delivery rate for women with lesions above T5 was 47% and for women with lesions below that level, 26%. CONCLUSION: The overall prognosis for these women was favorable. However, women with higher spinal cord lesions would probably benefit from referral to centers with a particular interest and expertise in the management of their problems.
Assuntos
Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Gravidez , Reflexo Anormal , Estudos Retrospectivos , Suécia/epidemiologiaRESUMO
The purpose of the present quasi-experimental post-test-design study was to compare 32 wheelchair users' (mostly para/tetraplegics) experience of wearing specially adapted clothes and non-adapted clothes for sailing, quad rugby or wheel-walking. Four existing assessment instruments were used: the Klein-Bell Activities of Daily Living Scale; a two-part Basic Information Questionnaire eliciting experience of effort, comfort and feeling of physical condition; the Experience Sampling Form for investigating the individuals' attitudes in terms of involvement and affective and activity mood states, and the Occupational Therapy Assessment of Leisure Time interview framework for collecting data about experience of leisure time. The wheelchair users all associated significantly greater comfort with use of the adapted clothes and, particularly the 'sailors', better physical condition. Overall, significantly greater involvement and more positive affect states were associated with the adapted clothes than with conventional garments, and mood state changed for the better. The wheelchair users set a higher priority upon work or leisure activities than upon independence in activities of daily living, and for this reason the Klein-Bell ratings showed great variation between the 'sailors' and the 'quad rugby players' (range 57%-93%), though these groups demonstrated more independence than the 'wheel-walkers'. The results of the study confirm the value of adapting sportswear for handicapped people. Such adaptations should also be of benefit for other activities than those studied.
Assuntos
Vestuário , Pessoas com Deficiência/reabilitação , Esportes , Cadeiras de Rodas , Adaptação Fisiológica , Adulto , Idoso , Feminino , Futebol Americano , Humanos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Meio Social , Inquéritos e Questionários , CaminhadaAssuntos
Disfunção Erétil/tratamento farmacológico , Ereção Peniana , Inibidores de Fosfodiesterase/administração & dosagem , Piperazinas/administração & dosagem , Parceiros Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Método Duplo-Cego , Disfunção Erétil/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Purinas , Citrato de Sildenafila , Traumatismos da Medula Espinal/complicações , SulfonasAssuntos
Disfunção Erétil/tratamento farmacológico , Inibidores de Fosfodiesterase/administração & dosagem , Piperazinas/administração & dosagem , Administração Oral , Adulto , Estudos Cross-Over , Método Duplo-Cego , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Purinas , Citrato de Sildenafila , Traumatismos da Medula Espinal/complicações , SulfonasAssuntos
Traumatismos da Medula Espinal/reabilitação , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/terapia , Masculino , Centros de Reabilitação , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/reabilitação , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Suécia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/reabilitaçãoAssuntos
Ejaculação , Terapia por Estimulação Elétrica , Fertilização in vitro/métodos , Infertilidade Masculina/terapia , Traumatismos da Medula Espinal/complicações , Adulto , Anestesia Intravenosa , Terapia por Estimulação Elétrica/instrumentação , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Gravidez , Sêmen , Manejo de Espécimes , Traumatismos da Medula Espinal/fisiopatologiaRESUMO
STUDY DESIGN: Retrospective register study. OBJECTIVE: To investigate the predictive value of the following parameters for the development of neuropathic pain after non-traumatic spinal cord lesion: that is age at onset of spinal cord disease, gender, completeness of lesion, level of lesion, and aetiology. SETTING: A unit for patients with post-acute traumatic and non-traumatic spinal cord lesions in the greater area of Stockholm, Sweden. METHOD: All patients with non-traumatic spinal cord lesions visiting the unit between 1995 and 2000 were classified according to the following: that is neuropathic pain at or below lesion level according to IASP criteria, age at time of the onset of the spinal cord symptoms, injury level, complete/incomplete injury, and aetiology. Results were analysed with chi(2) - analysis and logistic regression. RESULTS: In total, 38% had neuropathic pain, 15% had pain predominantly at the level of lesion, and 23% predominantly below the level of lesion. Of those with pain, 67% reported that the pain affected daily life. Women reported neuropathic pain below the level of lesion more often (40%) than men (13%). The prevalence was particularly high (64%) for patients with malignant spinal cord diseases. Neither age at onset of the spinal cord symptoms, nor complete/incomplete injury nor injury level had significant influence on the prevalence. CONCLUSION: Neuropathic pain is common among patients with acquired non-traumatic spinal cord lesions regardless of aetiology, often causing severe problems in daily life.
Assuntos
Neuralgia/epidemiologia , Sistema de Registros , Medição de Risco/métodos , Doenças da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Doenças da Coluna Vertebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Traumatismos da Medula Espinal/classificação , Suécia/epidemiologiaRESUMO
STUDY DESIGN: A cross-sectional descriptive study of self-reported quality of sleep in individuals with a spinal cord injury (SCI). OBJECTIVES: To assess and describe subjective quality of sleep in patients with SCI, with and without pain. SETTING: Spinalis SCI unit, Stockholm, Sweden. METHODS: A total of 230 patients with an SCI were mailed a questionnaire containing queries about pain intensities, pain unpleasantness, mood, and sleep quality (Basic Nordic Sleep Questionnaire) to assess quality of sleep in patients with SCI with and without pain. RESULTS: Of the 192 questionnaires that were returned (response rate 83.4%), 191 were analysed. Patients were divided into three groups: (1) those who reported no pain (n=50), (2) those who reported intermittent pain (n=42), and (3) those who suffered from continuous pain (n=99). Patients suffering from continuous pain rated pain intensity and unpleasantness significantly higher than those who only suffered from intermittent pain. The group with continuous pain also reported the poorest quality of sleep and the highest ratings of anxiety and depression of the three groups. Anxiety, together with pain intensity and depression, were the main predictors for poor sleep quality. CONCLUSIONS: Poor subjective sleep quality was associated with higher ratings of pain intensity, anxiety, and depression. It is possible that melatonin serves as a modulator of these different aspects.
Assuntos
Dor/fisiopatologia , Sono/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Atividades Cotidianas , Adulto , Idoso , Ansiedade/etiologia , Estudos Transversais , Depressão/etiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/etiologia , Medição da Dor/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/etiologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia , Inquéritos e QuestionáriosRESUMO
The comprehensive care of patients with traumatic spinal cord injuries (SCI) necessitates, among other things, a structured, life-long follow up. The high consumption of medical care in chronic SCI patients, often a result of diseases affecting many different organ systems, soon causes the cumulated medical documentation to be extensive and therefore hard to survey. The possibilities for rational patient management, adequate quality assurance, and clinical research may improve considerably by computerisation of medical records. A computerised medical records system for SCI has recently been developed, using a semistructured medical record format for data input and a medical entity dictionary for facilitated data storage and retrieval. The principles for developing this computer-assisted follow up system are described.
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Sistemas Computadorizados de Registros Médicos , Traumatismos da Medula Espinal/reabilitação , Humanos , Armazenamento e Recuperação da Informação , Pacientes Ambulatoriais , Controle de Qualidade , Traumatismos da Medula Espinal/complicações , Suécia , VocabulárioRESUMO
In previous articles on the Stockholm Spinal Cord Injury Study (SSCIS), we have reported the frequent occurrence of medical problems in a near-total regional SCI population comprising 353 subject. This present study further investigates health-related issues in this SCI population, by a level-of-living survey that has been used annually on 8000-14,000 Swedes since 1974. The health-focused version of this survey was used for data collection in those 326 subjects in the SSCIS who were residents of the Greater Stockholm area. Subjects of the SSCIS living on the island of Gotland were excluded because they represented a sociodemographically different (rural) population. The normative material consisted of 1978 interviews of residents of the Greater Stockholm area, provided by the Swedish Bureau of Statistics. Results show a higher utilisation of health care resources among SCI subjects, shown by higher rates of long-term sick leave and sick pension, and more treatment as inpatients, emergency room attendees, and outpatients. Pain, bladder problems, and psychological symptoms are more commonly reported by SCI subjects. Medications such as antibiotics, analgesics, sedatives, hypnotics and laxatives are used more frequently in the SCI group. In contrast, no statistically significant differences were found as regards reported prevalence of diseases other than SCI, including diabetes, hypertension and cardiac disease. The results thus verify the impression from our previous studies of a clearly increased morbidity among these SCI subjects. The increased morbidity seems to be accounted for by the SCI itself, or conditions directly caused by it.