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Krause JS, Dismuke-Greer CE, DiPiro ND, Clark JMR, Laursen-Roesler J. Relationships of Self-reported Opioid Use and Misuse and Pain Severity With Probable Major Depression Among Participants With Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:1506-1512. [PMID: 38527688 DOI: 10.1016/j.apmr.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/24/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To examine the relations of pain intensity, opioid use, and opioid misuse with depressive symptom severity and probable major depression (PMD) among participants with spinal cord injuries (SCI), controlling for demographic, injury, and socioeconomic characteristics. STUDY DESIGN Cohort study. SETTING Medical University in the Southeastern United States (US). PARTICIPANTS Participants (N=918) were identified from 1 of 2 sources including a specialty hospital and a state-based surveillance system in the Southeastern US. Participants were a minimum of 18 years old at enrollment and had SCI with non-complete recovery. Participants were on average 57.5 years old at the time of the study and an average of 24.4 years post SCI onset. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed a self-report assessment that included frequency of prescription opioid use and misuse, based on the National Survey on Drug Use and Health (NSDUH), and the PHQ - 9 to measure depressive symptom severity and PMD. RESULTS Opioid use, opioid misuse, and pain intensity were related to elevated depressive symptom severity and higher odds of PMD. Non-Hispanic Blacks had fewer depressive symptoms and lower odds of PMD, as did those with higher incomes. Veterans had lower risk of PMD, whereas ambulatory participants had a higher risk of PMD. Age at SCI onset had a mixed pattern of significance, whereas years of education and years since injury were not significant. CONCLUSIONS The relation between pain intensity with depressive symptom severity and PMD was profound, consistent with the biopsychosocial model of pain. The greater risk of PMD and higher depressive symptom severity among those using opioids and misusing opioids raises further concern about long-term prescription opioid use. Alternative treatments are needed.
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Affiliation(s)
- James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC.
| | - Clara E Dismuke-Greer
- Health Economics Resource Center, Palo Alto Veterans Affairs Health Care, Menlo Park, CA
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Jillian M R Clark
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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Krause JS, DiPiro ND, Dismuke-Greer CE, Laursen-Roesler J. Relationships of self-reported opioid and benzodiazepine use with health-related quality of life among adults with spinal cord injury. Disabil Health J 2024:101668. [PMID: 38987087 DOI: 10.1016/j.dhjo.2024.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/23/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND There is limited understanding of the relationships between prescription opioid and benzodiazepine use and indices of health-related quality of life (HRQOL) among those with spinal cord injuries (SCI). OBJECTIVE To identify the relationships between self-reported prescription opioid and benzodiazepine use and two indicators of HRQOL, number of days in poor physical health and poor mental health in the past 30 days among adults with SCI. METHODS A cross-sectional cohort study of 918 adults with chronic (>1 year), traumatic SCI living in the Southeastern United States was conducted. Participants completed a self-report assessment (SRA). RESULTS In the preliminary model, both opioid and benzodiazepine use were associated with a greater number of days in poor physical health and poor mental health in the past month. After controlling for health conditions (pain intensity, spasticity, anxiety and perceived sleep insufficiency), opioid use was associated with 2.04 (CI = 0.69; 3.39) additional poor physical health days in the past 30 days, and benzodiazepine use was associated with 2.18 (CI = 0.70; 3.64) additional days of poor mental health. Age was associated with greater number of poor physical health days and fewer poor mental health days. Lower income was associated with poor mental health days. Most of the health conditions were significantly related to the number of past month poor physical and mental health days. CONCLUSIONS Opioid and benzodiazepine use are associated with poor physical and mental HRQOL, even after controlling for health conditions. Treatment strategies should consider potential unanticipated negative consequences of pharmacological interventions.
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Affiliation(s)
- James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Aldrich JC, Scheinfeld AR, Lee SE, Dusenbery KJ, Mahach KM, Van de Veire BC, Fonken LK, Gaudet AD. Effects of dim light at night in C57BL/6 J mice on recovery after spinal cord injury. Exp Neurol 2024; 375:114725. [PMID: 38365132 PMCID: PMC10981559 DOI: 10.1016/j.expneurol.2024.114725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
Spinal cord injury (SCI) can cause long-lasting locomotor deficits, pain, and mood disorders. Anatomical and functional outcomes are exacerbated by inflammation after SCI, which causes secondary damage. One promising target after SCI is manipulating the circadian system, which optimizes biology and behavior for time of day - including neuroimmune responses and mood-related behaviors. Circadian disruption after SCI is likely worsened by a disruptive hospital environment, which typically includes dim light-at-night (dLAN). Here, we hypothesized that mice subjected to SCI, then placed in dLAN, would exhibit worsened locomotor deficits, pain-like behavior, and anxiety-depressive-like symptoms compared to mice maintained in light days with dark nights (LD). C57BL/6 J mice received sham surgery or moderate T9 contusion SCI, then were placed permanently in LD or dLAN. dLAN after SCI did not worsen locomotor deficits; rather, SCI-dLAN mice showed slight improvement in open-field locomotion at the final timepoint. Although dLAN did not alter SCI-induced heat hyperalgesia, SCI-dLAN mice exhibited an increase in mechanical allodynia at 13 days post-SCI compared to SCI-LD mice. SCI-LD and SCI-dLAN mice had similar outcomes using sucrose preference (depressive-like) and open-field (anxiety-like) tests. At 21 dpo, SCI-dLAN mice had reduced preference for a novel juvenile compared to SCI-LD, implying that dLAN combined with SCI may worsen this mood-related behavior. Finally, lesion size was similar between SCI-LD and SCI-dLAN mice. Therefore, newly placing C57BL/6 J mice in dLAN after SCI had modest effects on locomotor, pain-like, and mood-related behaviors. Future studies should consider whether clinically-relevant circadian disruptors, alone or in combination, could be ameliorated to enhance outcomes after SCI.
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Affiliation(s)
- John C Aldrich
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Ashley R Scheinfeld
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Sydney E Lee
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kalina J Dusenbery
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kathryn M Mahach
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Brigid C Van de Veire
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Laura K Fonken
- Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin
| | - Andrew D Gaudet
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin.
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Ugiliweneza B, Wang D, Rood B, Boakye M, Castillo C, Hetman M. Increased Incidence of Depression and Chronic Pain in Traumatic Spinal Cord Injury Patients With Pre-Injury Alcohol Use Disorder: Longitudinal Analysis of Insurance Claim Database. Neurotrauma Rep 2024; 5:28-36. [PMID: 38249325 PMCID: PMC10797174 DOI: 10.1089/neur.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Alcohol use disorder (AUD) increases risk of traumatic spinal cord injury (SCI) and is associated with depression, anxiety, and chronic pain. Given that these neuropsychiatric morbidities are frequently observed in SCI patients, the effects of pre-injury AUD on risk of depression, anxiety, or chronic pain were analyzed using an insurance claim database. Of 10,591 traumatic SCI patients, 507 had AUD-associated claims in a 12-month period before injury. Those AUD-positive SCI patients showed distinct demographic characteristics, including greater representation of men, younger age, more comorbidities, lower coverage by commercial insurance, and more cervical-level injuries. The AUD group also showed elevated pre-injury comorbidity of depression, anxiety, and chronic pain. However, multi-regression analysis revealed an increased odds ratio (OR) of de novo diagnosis of post-SCI depression in AUD patients 6 months (1.671; 95% confidence interval [CI]: 1.124, 2.483) and 1 year post-injury (1.511; 95% CI: 1.071, 2.131). The OR of de novo post-SCI anxiety was unaffected by pre-injury AUD. Finally, 1 year after SCI, pre-injury AUD increased the OR of de novo diagnosis of post-injury chronic pain (1.545; 95% CI: 1.223, 1.951). Thus, pre-injury AUD may be a risk factor for development of depression and chronic pain after traumatic SCI.
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Affiliation(s)
- Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Dengzhi Wang
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Benjamin Rood
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
- Graduate Program in Biochemistry and Molecular Genetics, University of Louisville, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Camilo Castillo
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Michal Hetman
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, USA
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky, USA
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Aldrich JC, Scheinfeld AR, Lee SE, Dusenbery KJ, Mahach KM, Van de Veire BC, Fonken LK, Gaudet AD. Effects of dim light at night in C57BL/6J mice on recovery after spinal cord injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.15.557980. [PMID: 37745393 PMCID: PMC10516041 DOI: 10.1101/2023.09.15.557980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Spinal cord injury (SCI) can cause long-lasting locomotor deficits, pain, and mood disorders. Anatomical and functional outcomes are exacerbated by inflammation after SCI, which causes secondary damage. One promising target after SCI is manipulating the circadian system, which optimizes biology and behavior for time of day - including neuroimmune responses and mood-related behaviors. Circadian disruption after SCI is likely worsened by a disruptive hospital environment, which typically includes dim light-at-night (dLAN). Here, we hypothesized that mice subjected to SCI, then placed in dLAN, would exhibit worsened locomotor deficits, pain-like behavior, and anxiety-depressive-like symptoms compared to mice maintained in light days with dark nights (LD). C57BL/6J mice received sham surgery or moderate T9 contusion SCI, then were placed permanently in LD or dLAN. dLAN after SCI did not worsen locomotor deficits; rather, SCI-dLAN mice showed slight improvement in open-field locomotion at the final timepoint. Although dLAN did not alter SCI-induced heat hyperalgesia, SCI-dLAN mice exhibited an increase in mechanical allodynia at 13 days post-SCI compared to SCI-LD mice. SCI-LD and SCI-dLAN mice had similar outcomes using sucrose preference (depressive-like) and open-field (anxiety-like) tests. At 21 dpo, SCI-dLAN mice had reduced preference for a novel juvenile compared to SCI-LD, implying that dLAN combined with SCI may worsen this mood-related behavior. Finally, lesion size was similar between SCI-LD and SCI-dLAN mice. Therefore, newly placing C57BL/6J mice in dLAN after SCI had modest effects on locomotor, pain-like, and mood-related behaviors. Future studies should consider whether clinically-relevant circadian disruptors, alone or in combination, could be ameliorated to enhance outcomes after SCI.
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Affiliation(s)
- John C Aldrich
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Ashley R Scheinfeld
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Sydney E Lee
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kalina J Dusenbery
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kathryn M Mahach
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Brigid C Van de Veire
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Laura K Fonken
- Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin
| | - Andrew D Gaudet
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
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Clark JMR, Cao Y, Krause JS. Pain interference and depressive symptom severity across 10 years in individuals with long-term spinal cord injury. J Spinal Cord Med 2023:1-8. [PMID: 37982813 DOI: 10.1080/10790268.2023.2263940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE To examine change in pain interference and depression over a 10-year time period in individuals with long-term traumatic spinal cord injury (SCI) and to identify the extent to which changes in pain interference over time predicts change in depressive symptoms. DESIGN Longitudinal analyses of self-report assessment data. SETTING Specialty and university hospitals in the Southeastern and Midwestern United States. PARTICIPANTS Adults with a history of traumatic SCI (n = 504) who responded to the three most recent data collection periods of the SCI Longitudinal Aging Study (2008 [Time 1], 2013 [Time 2], and 2018 [Time 3]). The participants averaged 59 years of age and 32 years since injury onset at Time 3. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient Health Questionnaire (PHQ-9) assessed depressive symptom severity. The 7-item Pain Interference scale from the Brief Pain Inventory assessed pain interference. RESULTS Over the three study timepoints, the sample averaged moderate levels of pain interference and mild depressive symptom severity. Unconditional linear growth models, reflecting changes in central tendency, indicated that pain interference significantly decreased and depressive symptom severity significantly increased over time. Multiple independent variables random coefficient modeling based on correlations suggested that change in pain interference was positively associated with change in depressive symptom severity over the 10-year study follow-up. CONCLUSION Average depressive symptom severity worsened over time. Change in pain interference was positively associated with change in depressive symptom severity. These results point to the complexity of aging related changes in depressive symptoms and pain interference. They further support the need for continued assessment of mood and pain experiences, particularly among individuals reaching aging milestones with SCI.
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Affiliation(s)
- Jillian M R Clark
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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Shoup JA, Welter J, Binswanger IA, Hess F, Dullenkopf A, Coker J, Berliner J. Spinal cord injury and prescribed opioids for pain: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1138-1152. [PMID: 37280072 DOI: 10.1093/pm/pnad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Spinal cord injury (SCI) is a life-altering neurological condition affecting physical and psycho-social functioning and associated high rates of pain. Thus, individuals with SCI may be more likely to be exposed to prescription opioids. A scoping review was conducted to synthesize published research findings on post-acute SCI and prescription opioid use for pain, identify literature gaps, and propose recommendations for future research. METHODS We searched 6 electronic bibliographic databases (PubMed [MEDLINE], Ovid [MEDLINE], EMBASE, Cochrane Library, CINAHL, PsychNET) for articles published from 2014 through 2021. Terms for "spinal cord injury" and "prescription opioid use" were used. Included articles were in English and peer reviewed. Data were extracted using an electronic database by 2 independent reviewers. Opioid use risk factors for chronic SCI were identified and a gap analysis was performed. RESULTS Of the 16 articles included in the scoping review, a majority were conducted in the United States (n = 9). Most articles lacked information on income (87.5%), ethnicity (87.5%), and race (75%). Prescription opioid use ranged from 35% to 64% in articles reporting this information (n = 7 articles, n = 3675 participants). Identified risk factors for opioid use included middle age, lower income, osteoarthritis diagnosis, prior opioid use, and lower-level spinal injury. Limited reporting of diversity in study populations, absence of risk of polypharmacy, and limited high quality methodology were identified gaps. CONCLUSIONS Future research should report data on prescription opioid use in SCI populations, with additional demographics such as race, ethnicity, and income, given their importance to risk outcomes.
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Affiliation(s)
- Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO 80014, United States
- School of Public Affairs, University of Colorado Denver, Denver, CO 80204, United States
| | - JoEllen Welter
- Department of Orthopedic Surgery and Traumatology, Spital Thurgau, 8501 Frauenfeld, Switzerland
- Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau, 8501 Frauenfeld, Switzerland
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO 80014, United States
- Colorado Permanente Medical Group, Denver, CO 80218, United States
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, United States
| | - Florian Hess
- Department of Orthopedic Surgery and Traumatology, Spital Thurgau, 8501 Frauenfeld, Switzerland
| | - Alexander Dullenkopf
- Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau, 8501 Frauenfeld, Switzerland
| | - Jennifer Coker
- Craig Hospital Research Department, Craig Hospital, Englewood, CO 80113, United States
| | - Jeffrey Berliner
- Craig Hospital Research Department, Craig Hospital, Englewood, CO 80113, United States
- CNS Medical Group, Craig Hospital, Englewood, CO 80113, United States
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Meade MA, Yin Z, Lin P, Kamdar N, Rodriguez G, McKee M, Peterson MD. Type 2 Diabetes Increases the Risk of Serious and Life-Threatening Conditions Among Adults With Traumatic Spinal Cord Injury. Mayo Clin Proc Innov Qual Outcomes 2023; 7:452-461. [PMID: 37818139 PMCID: PMC10562090 DOI: 10.1016/j.mayocpiqo.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Objective To compare the incidence of and adjusted hazards for serious and life-threatening morbidities among adults with traumatic spinal cord injury (TSCI) with and without type 2 diabetes (T2D). Participants and Methods A retrospective longitudinal cohort study was conducted from September 1, 2022 to February 2, 2023, among privately insured beneficiaries if they had an International Classification of Diseases, 9th Revision or 10th Revision, Clinical Modification diagnostic code for TSCI (n=9081). Incidence estimates of serious and life-threatening morbidities, and more common secondary and long-term health conditions, were compared at 5 years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for serious and life-threatening morbidities. Results Adults living with TSCI and T2D had a higher incidence of all of the morbidities assessed as compared with nondiabetic adults with TSCI. Fully adjusted survival models reported that adults with TSCI and T2D had a greater hazard for most of the serious and life-threatening conditions assessed, including sepsis (hazard ratio [HR]: 1.65), myocardial infarction (HR: 1.63), osteomyelitis (HR: 1.9), and stroke or transient ischemic attack (HR: 1.59). Rates for comorbid and secondary conditions were higher for individuals with TSCI and T2D, such as pressure sores, urinary tract infections, and depression, even after controlling for sociodemographic and comorbid conditions. Conclusion Adults living with TSCI and T2D have a significantly higher incidence of and risk of developing serious and life-threatening morbidities as compared with nondiabetic adults with TSCI.
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Affiliation(s)
- Michelle A. Meade
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Zhe Yin
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
| | - Neil Kamdar
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan Health, University of Michigan, Ann Arbor
| | - Gianna Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
| | - Michael McKee
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan Health, University of Michigan, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan Health, University of Michigan, Ann Arbor
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Abrams SK, Rabinovitch BS, Zafar R, Aziz AS, Cherup NP, McMillan DW, Nielson JL, Lewis EC. Persons With Spinal Cord Injury Report Peripherally Dominant Serotonin-Like Syndrome After Use of Serotonergic Psychedelics. Neurotrauma Rep 2023; 4:543-550. [PMID: 37636336 PMCID: PMC10457609 DOI: 10.1089/neur.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Psychedelic-assisted therapy (PAT) may treat various mental health conditions. Despite its promising therapeutic signal across mental health outcomes, less attention is paid on its potential to provide therapeutic benefits across complex medical situations within rehabilitation medicine. Persons with spinal cord injury (SCI) have a high prevalence of treatment-resistant mental health comorbidities that compound the extent of their physical disability. Reports from online discussion forums suggest that those living with SCI are using psychedelics, though the motivation for their use is unknown. These anecdotal reports describe a consistent phenomenon of neuromuscular and autonomic hypersensitivity to classical serotonergic psychedelics, such as psilocybin and lysergic acid diethylamide (LSD). Persons describe intense muscle spasms, sweating, and tremors, with an eventual return to baseline and no reports of worsening of their baseline neurological deficits. The discomfort experienced interferes with the subjective beneficial effects self-reported. This phenomenon has not been described previously in the academic literature. We aim to provide a descriptive review and explanatory theoretical framework hypothesizing this phenomenon as a peripherally dominant serotonin syndrome-like clinical picture-that should be considered as such when persons with SCI are exposed to classical psychedelics. Raising awareness of this syndrome may help our mechanistic understanding of serotonergic psychedelics and stimulate development of treatment protocols permitting persons with SCI to safely tolerate their adverse effects. As PAT transitions from research trials into accepted clinical and decriminalized use, efforts must be made from a harm reduction perspective to understand these adverse events, while also serving as an informed consent process aid if such therapeutic approaches are to be considered for use in persons living with SCI.
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Affiliation(s)
| | - Brenden Samuel Rabinovitch
- Numinus Toronto, Toronto, Ontario, Canada
- Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, Ontario, Canada
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rayyan Zafar
- Centre for Psychedelic Research and Neuropsychopharmacology, Imperial College, London, United Kingdom
| | - Aly Shah Aziz
- Pediatric Neurology Clinic, Oakville, Ontario, Canada
| | - Nicholas Paul Cherup
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - David W. McMillan
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Jessica L. Nielson
- Department of Psychiatry and Behavioral Sciences; Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Evan Cole Lewis
- Numinus Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Han A, Wilroy JD, Jenkins J, Yuen HK. Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study. Disabil Rehabil 2023; 45:644-654. [PMID: 35156500 DOI: 10.1080/09638288.2022.2038283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE This study examined effects of coach-guided videoconferencing acceptance and commitment therapy (ACT) accompanied by psychoeducation on distressed individuals with spinal cord injury (SCI) and explored participants' experiences in the intervention. MATERIALS AND METHODS Ten people with SCI participated in 8 individual videoconferencing sessions delivered by trained coaches. Data using self-reported questionnaires and individual interviews was collected at pretest and posttest and analyzing using Wilcoxon signed-rank tests and interpretative phenomenological analysis (ClinicalTrials.gov ID: NCT04670406). RESULTS Statistically significant improvements were found in depression, anxiety, stress, grief, engagement in meaningful activities, and self-compassion with medium to large effect sizes. There was no significant change in quality of life, resilience, and ACT processes. Participants gained a new way of thinking by: being aware of thoughts and emotions; exploring perceptions of others; and focusing on the present. Also, the intervention equipped participants to deal with challenges by: improving coping with SCI-related conditions; practicing self-compassion, acceptance, and meditation; and acquiring skills of value-based decision making and committed action. CONCLUSIONS Findings contribute to the limited evidence as the first study that measured effects of videoconferencing ACT on people with SCI. Future randomized controlled trials are needed to measure efficacy of internet-delivered ACT for people with SCI.IMPLICATIONS FOR REHABILITATIONGuided videoconferencing ACT may reduce depressive symptoms, anxiety, stress, and grief and increase engagement in meaningful activities and self-compassion in people with SCI.Professionals may consider ACT as a supportive or adjunct service for people with SCI who experience psychological distress.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jereme D Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy Jenkins
- Telehealth Private Practice: jeremyjenkins.icouch.me, Edmond, OK, USA
| | - Hon K Yuen
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Pedersen ML, Handberg C, Dreyer P. Mental health reported in adult invasive home mechanical ventilation through a tracheostomy: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100110. [PMID: 38745622 PMCID: PMC11080294 DOI: 10.1016/j.ijnsa.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Although people receiving invasive home mechanical ventilation through a tracheostomy are facing both physical and mental health challenges, healthcare services often focus mainly on physical symptoms. To ensure well-functioning treatment and care for people receiving tracheostomy ventilation in a home setting, their mental health needs to be promoted and seen as an integral part of their health in general. Objective This scoping review aimed to provide a summary of the current knowledge on the mental health of people receiving invasive home mechanical ventilation through a tracheostomy. Design A scoping review of published and gray literature based on the framework developed by Arksey and O'Malley and refined by the JBI was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist was used for reporting the findings. Methods A literature search was conducted by two researchers independently in the PubMed, CINAHL and PsycINFO databases. Additional searches for gray literature were conducted in Google, Google Scholar, websites of selected organisations, and the reference lists of included studies. The software system Covidence was used in the study selection process. For critical appraisal, the Mixed Methods Appraisal Tool was used. Results Thirteen studies were included in this review, of which six used qualitative, six quantitative, and one mixed methods. The majority of studies were authored in Europe (n = 10), followed by the Americas (n = 2) and the Western Pacific (n = 1). Mental health was investigated both directly and indirectly (61.5% vs. 38.5%). Categorizing the reported mental health outcomes, we found that emotional well-being was reported widely across the studies (n = 13), while psychological well-being (n = 5) and social well-being (n = 4) were less widely reported. Conclusions The mental health of people receiving home tracheostomy ventilation has received some scholarly attention. A heterogeneity of mental health outcomes was reported in the literature with emotional well-being being an important mental health area both in relation to the sub-components positive affect and quality of life appraisal. Mental health outcomes in relation to psychological well-being and social well-being were fragmented and only sparsely investigated.
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Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- National Rehabilitation Centre for Neuromuscular Diseases, Kongsvang Allé 23, 8000 Aarhus C, Denmark
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5020 Bergen, Norway
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12
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Tickle JA, Sen J, Adams C, Furness DN, Price R, Kandula V, Tzerakis N, Chari DM. A benchtop brain injury model using resected donor tissue from patients with Chiari malformation. Neural Regen Res 2022; 18:1057-1061. [PMID: 36254993 PMCID: PMC9827764 DOI: 10.4103/1673-5374.355761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The use of live animal models for testing new therapies for brain and spinal cord repair is a controversial area. Live animal models have associated ethical issues and scientific concerns regarding the predictability of human responses. Alternative models that replicate the 3D architecture of the central nervous system have prompted the development of organotypic neural injury models. However, the lack of reliable means to access normal human neural tissue has driven reliance on pathological or post-mortem tissue which limits their biological utility. We have established a protocol to use donor cerebellar tonsillar tissue surgically resected from patients with Chiari malformation (cerebellar herniation towards the foramen magnum, with ectopic rather than diseased tissue) to develop an in vitro organotypic model of traumatic brain injury. Viable tissue was maintained for approximately 2 weeks with all the major neural cell types detected. Traumatic injuries could be introduced into the slices with some cardinal features of post-injury pathology evident. Biomaterial placement was also feasible within the in vitro lesions. Accordingly, this 'proof-of-concept' study demonstrates that the model offers potential as an alternative to the use of animal tissue for preclinical testing in neural tissue engineering. To our knowledge, this is the first demonstration that donor tissue from patients with Chiari malformation can be used to develop a benchtop model of traumatic brain injury. However, significant challenges in relation to the clinical availability of tissue were encountered, and we discuss logistical issues that must be considered for model scale-up.
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Affiliation(s)
- Jacqueline A. Tickle
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Jon Sen
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | | | | | - Rupert Price
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Viswapathi Kandula
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Nikolaos Tzerakis
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Divya M. Chari
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK,Correspondence to: Divya M. Chari, .
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Castro-de-Araujo LFS, Cortes F, de Siqueira Filha NT, Rodrigues EDS, Machado DB, de Araujo JAP, Lewis G, Denaxas S, Barreto ML. Patterns of multimorbidity and some psychiatric disorders: A systematic review of the literature. Front Psychol 2022; 13:940978. [PMID: 36186392 PMCID: PMC9524392 DOI: 10.3389/fpsyg.2022.940978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The presence of two or more chronic diseases results in worse clinical outcomes than expected by a simple combination of diseases. This synergistic effect is expected to be higher when combined with some conditions, depending on the number and severity of diseases. Multimorbidity is a relatively new term, with the first fundamental definitions appearing in 2015. Studies usually define it as the presence of at least two chronic medical illnesses. However, little is known regarding the relationship between mental disorders and other non-psychiatric chronic diseases. This review aims at investigating the association between some mental disorders and non-psychiatric diseases, and their pattern of association. Methods We performed a systematic approach to selecting papers that studied relationships between chronic conditions that included one mental disorder from 2015 to 2021. These were processed using Covidence, including quality assessment. Results This resulted in the inclusion of 26 papers in this study. It was found that there are strong associations between depression, psychosis, and multimorbidity, but recent studies that evaluated patterns of association of diseases (usually using clustering methods) had heterogeneous results. Quality assessment of the papers generally revealed low quality among the included studies. Conclusions There is evidence of an association between depressive disorders, anxiety disorders, and psychosis with multimorbidity. Studies that tried to examine the patterns of association between diseases did not find stable results. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021216101, identifier: CRD42021216101.
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Affiliation(s)
- Luis Fernando Silva Castro-de-Araujo
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Bahia, Brazil
- Department of Psychiatry, Austin Health, The University of Melbourne, Parkville, VIC, Australia
| | - Fanny Cortes
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Bahia, Brazil
| | - Noêmia Teixeira de Siqueira Filha
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Bahia, Brazil
- Department of Health Sciences, University of York, York, United Kingdom
| | - Elisângela da Silva Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Bahia, Brazil
- Federal University of Ceará, Ceará, Brazil
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Bahia, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Jacyra Azevedo Paiva de Araujo
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Bahia, Brazil
- *Correspondence: Jacyra Azevedo Paiva de Araujo
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Mauricio L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Bahia, Brazil
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14
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Sandalic D, Arora M, Pozzato I, Simpson G, Middleton J, Craig A. A Narrative Review of Research on Adjustment to Spinal Cord Injury and Mental Health: Gaps, Future Directions, and Practice Recommendations. Psychol Res Behav Manag 2022; 15:1997-2010. [PMID: 35957761 PMCID: PMC9363004 DOI: 10.2147/prbm.s259712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
Abstract
Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into “positive” or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with “outcomes” to better inform management of mental health after SCI.
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Affiliation(s)
- Danielle Sandalic
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mohit Arora
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ilaria Pozzato
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Grahame Simpson
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - James Middleton
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ashley Craig
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Correspondence: Ashley Craig, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia, Email
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15
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Peterson MD, Berri M, Meade MA, Lin P, Kamdar N, Mahmoudi E. Disparities in Morbidity After Spinal Cord Injury Across Insurance Types in the United States. Mayo Clin Proc Innov Qual Outcomes 2022; 6:279-290. [PMID: 36532826 PMCID: PMC9754933 DOI: 10.1016/j.mayocpiqo.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To compare the prevalence and incidence of, and adjusted hazards for comorbidities among adults with traumatic spinal cord injuries (TSCIs) across insurance types (private vs governmental insurance) in the United States. PATIENTS AND METHODS Privately insured (N=9081) and Medicare (N=7645) beneficiaries with a diagnosis of TSCI were included. Prevalence and incidence estimates of common psychological, cardiometabolic, and musculoskeletal morbidities were compared at baseline and at 4-years after index diagnosis, respectively. Survival models were used to quantify hazard ratios (HRs) for outcomes, controlling for insurance type, sociodemographic characteristics, and other comorbidities. Sensitivity analyses were conducted to determine the effects of insurance and race/ethnicity. RESULTS Adults with TSCIs on Medicare had a higher prevalence of any psychological (54.7% vs 35.4%), cardiometabolic (74.7% vs 70.1%), and musculoskeletal (72.8% vs 66.3%) morbidity than privately insured adults with TSCIs. Similarly, the 4-year incidences of most psychological (eg, depression: 37.6% [Medicare] vs 24.2% [private]), cardiometabolic (eg, type 2 diabetes: 22.5% [Medicare] vs 12.9% [private], and musculoskeletal (eg, osteoarthritis: 42.1% [Medicare] vs 34.6% [private]) morbidities were considerably higher among adults with TSCIs on Medicare. Adjusted survival models found that adults with TSCIs on Medicare had a greater hazard for developing psychological (HR, 1.40; 95% CI, 1.31-1.50) and cardiometabolic (HR, 1.21; 95% CI, 1.10-1.33) morbidities compared with privately insured adults with TSCI. There was evidence of both insurance and racial disparities. CONCLUSION Adults with TSCIs on Medicare had significantly higher prevalence and risk for developing common physical and mental health comorbidities, compared with privately insured adults with TSCIs.
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Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Maryam Berri
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Michelle A. Meade
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | - Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor
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16
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Dekalo A, Myers JB, Kennelly M, Welk B. General and bladder-related quality of life: A focus on women living with spinal cord injury. Neurourol Urodyn 2022; 41:980-990. [PMID: 35347755 DOI: 10.1002/nau.24912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/19/2022] [Accepted: 02/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare bladder symptoms, and urinary and overall quality of life (QOL) among women and men after Spinal cord injury (SCI), and to describe specific aspects of QOL among women with SCI. METHODS We used data from a prospective, multi-center, and cross-sectional study that was carried out from May 2019 to September 2020. Clinical and demographic details were obtained and participants completed two patient reported outcomes: the neurogenic bladder symptoms score-short form (NBSS-SF, which measures bladder symptoms and QOL) and the SF-12 (which measures overall physical and mental health QOL). RESULTS Our cohort included 135 women and 210 men with SCI. Among the women, the median age was 50, and 40% had a cervical SCI. For general QOL, women with SCI had physical functioning scores similar to men, but lower mental health scores on the SF-12 (46.85 vs. 49.76, p = 0.01). Women had significantly worse overall NBSS (10.76 vs. 9.08, p < 0.001) and NBSS continence domain scores (4.71 vs. 3.66, p < 0.001) compared to men. There were significant differences between overall QOL measures, and bladder symptoms based on bladder management techniques among the women. NBSS-SF symptom scores were better among women who used overactive bladder medications compared to women who did not (8.43 vs. 11.9, p = 0.02) and NBSS-SF QOL domain scores were significantly better among women who underwent surgery and those that used overactive bladder medications. CONCLUSIONS Women have more bladder symptoms (specifically incontinence) compared to men. Symptom burden and overall QOL vary among women who use different bladder management techniques and treatments.
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Affiliation(s)
- Ann Dekalo
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy B Myers
- Department of Surgery, Division of Urology University of Utah, Salt Lake City, Utah, USA
| | - Michael Kennelly
- Department of Urology, Obstetrics and Gynecology, Carolinas Medical Center, Atrium Health, North Carolina, USA
| | - Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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17
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Sanguinetti RD, Soriano JE, Squair JW, Cragg JJ, Larkin-Kaiser KA, McGirr A, Phillips AA. National survey of mental health and suicidal thoughts in people with spinal cord injury. Spinal Cord 2022; 60:444-450. [PMID: 35347266 DOI: 10.1038/s41393-022-00783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional epidemiological study. OBJECTIVES Previous studies have quantified longitudinal psychological morbidity in individuals with spinal cord injury (SCI) relative to uninjured individuals. However, there is limited information regarding how lifestyle and socioeconomic factors are associated with mental health conditions in individuals with SCI. This study aims to quantify and compare mental health and suicidal thoughts in people with and without SCI, and examine the associations between mental health, suicidal thoughts, sex, age, lifestyle, and socioeconomic factors. SETTING Canada. METHODS The 2010 Canadian Community Health Survey (n > 40,000) was used, which includes several measures assessing mental health and suicidal thoughts. Bivariate and multivariate logistic regressions were performed and odds ratios with corresponding 95% confidence intervals were estimated. Sensitivity analyses were performed to evaluate the effect of covariates on reported effect sizes. RESULTS People with SCI had higher odds of having mood (3.6) and anxiety disorders (2.5), suicidal thoughts (2.3), self-perceived stress (1.9), and depression (4.4); in addition to lower odds of having good self-perceived mental health (0.24) and satisfaction with life (0.25). These differences persisted after adjusting for age, sex, lifestyle, and socioeconomic factors. Lower household income, fruit and vegetable consumption, and physical activity levels, and increased smoking use were associated with poorer mental health in individuals with SCI. CONCLUSIONS Mental health is poorer in those with SCI when compared with the general population. Those with SCI exhibit a unique profile of lifestyle and socioeconomic factors that are associated with poorer mental health and increased suicidal thoughts.
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Affiliation(s)
| | - Jan Elaine Soriano
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jordan W Squair
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,MD/PhD Training Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Kelly A Larkin-Kaiser
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology Cardiac Sciences & Clinical Neurosciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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18
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Betthauser LM, Hoffberg AS, Stearns-Yoder KA, Harmon M, Coons D, Brenner LA. A systematic review of suicidal ideation and behaviors among adults with spinal cord injury. J Spinal Cord Med 2022:1-12. [PMID: 35192444 DOI: 10.1080/10790268.2022.2029282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT Suicide is a public health crisis within the United States. Individuals with spinal cord injury (SCI) are vulnerable to negative outcomes such as suicide. OBJECTIVE This systematic review describes frequency of suicidal ideation (SI) and behaviors (suicide attempt [SA] and deaths) among samples of adults living with SCI. Associated risk and protective factors of SI and suicidal behaviors were also explored. METHODS On July 7, 2021, OVID Medline, EMBASE, OVID PsycINFO, Web of Science Core Collection, CINAHL, Cochrane Library, and Google Scholar databases were searched for SI, SA, and deaths by suicide among adults with a history of SCI. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Results were synthesized descriptively considering the likely impact of RoB. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting method was used. RESULTS Sixty-nine articles were included. Frequency of SI and SAs within study samples ranged from 4% to 67%, and 0% to approximately 66%, respectively. While assessment methods for SI and SA widely varied, suicide deaths data sources were more consistent. Studies assessing SI and SA generally had high RoB and the overall strength of evidence was low. Stronger observational study designs assessing death by suicide had low RoB and the overall strength of evidence was high. Very few studies examined protective factors. DISCUSSION Findings support previous work. Quality of evidence, and therefore confidence in the frequency of these outcomes, was impacted by the use of assessment measures without sufficient psychometric properties. The field will benefit from use of psychometrically sound measures to assess for SI, SA and suicide deaths. Furthermore, additional work is needed to elucidate risk and protective factors and to clearly characterize samples to increase generalizability of findings to the larger SCI community, including standardized reporting of SCI characteristics (e.g. use of American Spinal Injury Association classification system). Ultimately, improved suicide assessment and risk management is expected to prevent suicide among those living with SCI. REGISTRATION CRD42020164686.
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Affiliation(s)
- Lisa M Betthauser
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - Adam S Hoffberg
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kelly A Stearns-Yoder
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - Matthew Harmon
- Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - David Coons
- Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA.,Spinal Cord Injury/Disorder Clinic, RMR VAMC, Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA.,Departments of Psychiatry, & Neurology, University of Colorado, Aurora, Colorado, USA
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19
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Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain. Spinal Cord 2022; 60:163-169. [PMID: 35058578 PMCID: PMC8828667 DOI: 10.1038/s41393-021-00731-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/28/2022]
Abstract
Study Design: Longitudinal cohort study of privately-insured beneficiaries with and without traumatic spinal cord injury (SCI). Objectives: Compare the incidence of and adjusted hazards for psychological morbidities among adults with and without traumatic SCI, and examine the effect of chronic centralized and neuropathic pain on outcomes. Setting: Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n=9,081). Adults without SCI were also included (n=1,474,232). Methods: Incidence of common psychological morbidities were compared at 5-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. Results: Adults with SCI had a higher incidence of any psychological morbidity (59.1% vs. 30.9%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any psychological morbidity (HR: 1.67; 95%CI: 1.61, 1.74), and all but one psychological disorder (impulse control disorders), and ranged from HR: 1.31 (1.24, 1.39) for insomnia to HR: 2.10 (1.77, 2.49) for post-traumatic stress disorder. Centralized and neuropathic pain was associated with all psychological disorders, and ranged from HR: 1.31 (1.23, 1.39) for dementia to HR: 3.83 (3.10, 3.68) for anxiety. Conclusions: Adults with SCI have a higher incidence of and risk for common psychological morbidities, as compared to adults without SCI. Efforts are needed to facilitate the development of early interventions to reduce risk of chronic centralized and neuropathic pain and psychological morbidity onset/progression in this higher risk population.
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Cardiovascular and metabolic morbidity following spinal cord injury. Spine J 2021; 21:1520-1527. [PMID: 34023517 PMCID: PMC9645293 DOI: 10.1016/j.spinee.2021.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Individuals living with a spinal cord injury (SCI) are at heightened risk for a number of chronic health conditions such as secondary comorbidities that may develop or be influenced by the injury, the presence of impairment, and/or the process of aging. PURPOSE The objective of this study was to compare the incidence of and adjusted hazards for cardiovascular and metabolic (cardiometabolic) morbidities among adults following SCI compared to adults without SCIs. STUDY DESIGN/SETTING Longitudinal cohort from a nationwide insurance claims database. PATIENT SAMPLE Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n=9,081). Adults without SCI were also included (n=1,474,232). OUTCOME MEASURES AND METHODS Incidence estimates of common cardiometabolic morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident cardiometabolic morbidities. RESULTS Adults living with traumatic SCIs had a higher 5-year incidence of any cardiometabolic morbidities (56.2% vs. 36.4%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any cardiometabolic morbidity (Hazard Ratio [HR]: 1.67; 95%CI: 1.58, 1.76) and all cardiometabolic disorders; this ranged from HR: 1.45 (1.32, 1.59) for non-alcoholic fatty liver disease to HR: 3.55 (3.36, 3.76) for heart failure. CONCLUSIONS Adults with SCIs have a significantly higher incidence of and risk for common cardiometabolic morbidities, as compared to adults without SCIs. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of cardiometabolic disease onset/progression in this vulnerable population.
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Sturm C, Gutenbrunner CM, Egen C, Geng V, Lemhöfer C, Kalke YB, Korallus C, Thietje R, Liebscher T, Abel R, Bökel A. Which factors have an association to the Quality of Life (QoL) of people with acquired Spinal Cord Injury (SCI)? A cross-sectional explorative observational study. Spinal Cord 2021; 59:925-932. [PMID: 34239041 PMCID: PMC8338547 DOI: 10.1038/s41393-021-00663-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional explorative observational study. OBJECTIVES To identify factors which have an association to the self-perceived Quality of Life (QoL) for persons with acquired spinal cord injury (SCI). SETTING Eight specialized SCI-centers in Germany. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI). METHODS Self-disclosure questionnaire, created from the InSCI group, translated and adapted for Germany. The questionnaire collects a very broad range of data and, and due to its design as a self-report, is particularly suitable for the analysis on QoL. Because of the content, which is binding for all participating states, it allows a direct comparability of the results. Included in Germany were 1479 persons with acquired SCI aged 18 years and older. RESULTS Various factors were identified with high associations to QoL, including changeable and unchangeable ones, such as those of particular importance: pain, sleep problems, sexual dysfunction, age, and time since onset of SCI. Some results confirmed reports of previous studies, others were surprising. CONCLUSION this study provides an important basis for the planned analysis of the InSCI participating countries in the 6 WHO regions. Germany was able to contribute the largest study population. The concrete study design of InSCI allows us to directly compare data and helps us to improve ourselves within the framework of a "learning health system". Medical measures can be orientated towards the found results, in order to ensure the best possible care and support by the therapeutic team, individually adapted to the person, place of residence and impairment.
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Affiliation(s)
- Christian Sturm
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany.
| | | | - Christoph Egen
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | | | | | - Yorck B Kalke
- RKU - University and Rehabilitation Clinics Ulm, Ulm, Germany
| | - Christoph Korallus
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | - Roland Thietje
- Center for spinal injuries, Trauma Hospital Hamburg, Hamburg, Germany
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Rainer Abel
- SCI Unit, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Andrea Bökel
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
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22
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Mahmoudi E, Lin P, Peterson MD, Meade MA, Tate DG, Kamdar N. Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and Related Dementia: Large Longitudinal Study. Arch Phys Med Rehabil 2021; 102:1147-1154. [PMID: 33508336 PMCID: PMC10536758 DOI: 10.1016/j.apmr.2020.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/12/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Traumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed. DESIGN Cohort study. SETTING Using 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD. PARTICIPANTS Adults with and without TSCI (N=6083). INTERVENTION Not applicable. MAIN OUTCOMES MEASURES Diagnosis of ADRD. RESULTS Both middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]). CONCLUSIONS Adults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Mark D Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle A Meade
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Cao J, Wu J, Mu J, Feng S, Gao J. The design criteria and therapeutic strategy of functional scaffolds for spinal cord injury repair. Biomater Sci 2021; 9:4591-4606. [PMID: 34018520 DOI: 10.1039/d1bm00361e] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spinal cord injury (SCI) remains a therapeutic challenge in clinic. Current drug and cell therapeutics have obtained significant efficacy but are still in the early stages for complete neural and functional recovery. In the past few decades, functional scaffolds (FSs) have been rapidly developed to bridge the lesion and provide a framework for tissue regeneration in SCI repair. Moreover, a FS can act as an adjuvant for locally delivering drugs in the lesion with a designed drug release profile, and supplying a biomimetic environment for implanted cells. In this review, the design criteria of FSs for SCI treatment are summarized according to their biocompatibility, mechanical properties, morphology, architecture, and biodegradability. Subsequently, FSs designed for SCI repair in the scope of drug delivery, cell implantation and combination therapy are introduced, respectively. And how a FS promotes their therapeutic efficacy is analyzed. Finally, the challenges, perspectives, and potential of FSs for SCI treatment are discussed. Hopefully, this review may inspire the future development of potent FSs to facilitate SCI repair in clinic.
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Affiliation(s)
- Jian Cao
- Institute of Pharmaceutics, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, P.R. China.
| | - Jiahe Wu
- Institute of Pharmaceutics, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, P.R. China.
| | - Jiafu Mu
- Institute of Pharmaceutics, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, P.R. China.
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, P.R. China. and International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, 300052, P.R. China
| | - Jianqing Gao
- Institute of Pharmaceutics, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, P.R. China. and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou, 310058, P.R. China
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Li C, Clark JMR, Krause JS. Twenty-Five-Year Cross-sequential Analysis of Self-reported Problems: Findings From 5 Cohorts From the Spinal Cord Injury Longitudinal Aging Study. Arch Phys Med Rehabil 2020; 102:888-894. [PMID: 33373601 DOI: 10.1016/j.apmr.2020.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate how self-reported problems change over time among people with spinal cord injury (SCI). DESIGN Cross-sequential analysis. SETTING Medical university in the Southeastern United States. PARTICIPANTS Participants included 1997 individuals with traumatic SCI of at least 1-year duration who were identified from participation in the SCI Longitudinal Aging Study from 1993-2018. INTERVENTIONS None. MAIN OUTCOME MEASURES The outcomes analyzed were 6 problem factors defined as health, social isolation, emotional distress, environmental barriers, money, and lack of opportunities. A series of cross-sequential models, using PROC MIXED procedure, were developed to evaluate the initial and change of the 6 problem factors over the 6 times of measurements in 25 years. RESULTS Years post injury was negatively associated with initial status of problems of social isolation, emotional distress, environmental barriers, and lack of opportunities because participants with more years post injury at baseline reported lower scores on each factor. Longitudinally, with increased years post injury, higher scores were observed on the health problem factor. However, problems of social isolation, emotional distress, environmental barriers, money, and lack of opportunities decreased over time with increasing years post injury. CONCLUSIONS Participants had more health problems with increasing years after SCI, but fewer problems of social isolation, emotional distress, environmental barriers, money, and lack of opportunities.
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Affiliation(s)
- Chao Li
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Jillian M R Clark
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
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