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Stillman MD, Mallow M, Ankam N, Ojeda J, Stephens M, Heckert K, Gustafson K. The Dearth of Disability Medical Education and a Partial Solution. TEACHING AND LEARNING IN MEDICINE 2024; 36:83-88. [PMID: 36082770 DOI: 10.1080/10401334.2022.2119239] [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: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Issue: While over one-quarter of adult Americans have a disability, there is a paucity of disability-specific curricula in American medical schools and residency programs. Potential consequences of this educational dearth include persistent inaccessibility of health care facilities and delivery of inequitable health care to individuals with disabilities. Evidence: Several working groups have proposed disability-specific competencies for health professions education and means by which to integrate them into existing curricula. A limited number of medical schools and residency programs have formally introduced disability-specific materials into their curricula. To our knowledge, however, there are no generalist (internal medicine or family medicine) residency programs that offer specialized training in the clinical care of people with disabilities. Implications: Offering generalist physicians the opportunity to acquire the clinical and cognitive skills required to provide thorough and equitable health care to people with disabilities is critically important. There are too few physiatrists to see to their care needs. In this manuscript, we present a novel concentration in an Internal Medicine residency program in the care of individuals with a variety of disabilities. Our hope is that this work will initiate discussions among educational leaders about how to address the lack of graduate medical education-level training in disability care. We also hope it will afford program directors the opportunity to implement similar concentrations and tracks and will eventually produce a generation of generalists who are well-equipped to help care for people with disabilities.
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Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Mallow
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nethra Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Ojeda
- Department of Internal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary Stephens
- Department of Family & Community Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kimberly Heckert
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kirstin Gustafson
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Chiou SY, Clarke E, Lam C, Harvey T, Nightingale TE. Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review. Front Physiol 2022; 13:831372. [PMID: 35392374 PMCID: PMC8982085 DOI: 10.3389/fphys.2022.831372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Individuals with spinal cord injury (SCI) may benefit less from exercise training due to consequences of their injury, leading to lower cardiorespiratory fitness and higher risks of developing cardiovascular diseases. Arm-crank exercise (ACE) is the most common form of volitional aerobic exercise used by people with SCI outside a hospital. However, evidence regarding the specific effects of ACE alone on fitness and health in adults with SCI is currently lacking. Hence, this review aimed to determine the effects of ACE on cardiorespiratory fitness, body composition, cardiovascular disease (CVD) risk factors, motor function, health-related quality of life (QoL), and adverse events in adults with chronic SCI. Inclusion criteria were: inactive adults (≥18 years) with chronic SCI (>12 months post injury); used ACE alone as an intervention; measured at least one of the following outcomes; cardiorespiratory fitness, body composition, cardiovascular disease risk factors, motor function, health-related QoL, and adverse events. Evidence was synthesized and appraised using GRADE. Eighteen studies with a combined total of 235 participants having an injury between C4 to L3 were included. There was a moderate certainty of the body of evidence on ACE improving cardiorespiratory fitness. Exercise prescriptions from the included studies were 30-40 min of light to vigorous-intensity exercise, 3-5 times per week for 2-16 weeks. GRADE confidence ratings were very low for ACE improving body composition, CVD risks factors, motor function, or health-related QoL. No evidence suggests ACE increases the risk of developing shoulder pain or other injuries. Overall, this review recommends adults with chronic SCI should engage in regular ACE to improve cardiorespiratory fitness. More high-quality, larger-scale studies are needed to increase the level of evidence of ACE in improving cardiorespiratory fitness and to determine the effects of ACE on other outcomes. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_reco rd.php?ID=CRD42021221952], identifier [CRD42021221952].
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Affiliation(s)
- Shin Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Clarke
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chi Lam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom Harvey
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Stillman MD, Ankam N, Mallow M, Capron M, Williams S. A survey of internal and family medicine residents: Assessment of disability-specific education and knowledge. Disabil Health J 2020; 14:101011. [PMID: 33041247 DOI: 10.1016/j.dhjo.2020.101011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The literature suggests that primary care physicians are inadequately educated in the care of people with disabilities. No study to date has evaluated whether internal medicine (IM) and family medicine (FM) residents have received disability-specific education or their level of comfort in caring for people with physical disabilities. OBJECTIVES To assess IM and FM residents' receipt of disability-specific education during medical school and residency; to evaluate their self-reported comfort in managing secondary conditions associated with physical disabilities and in coordinating therapies and services for individuals with disabilities; to gauge their interest in receiving disability-specific education. METHODS An on-line survey distributed to residents at a convenience sample of ten academic IM and FM residency programs in the northeastern United States. Participants (n = 176) were asked about their socio-demographic and training-specific characteristics and their self-assessed ability to manage secondary conditions associated with physical disabilities and coordinate care and services for individuals with disabilities. Chi Square tests were used to compare participant characteristics and outcomes. RESULTS Few participants had received disability-specific education during medical school or residency (34.6% and 11.2%, respectively), and nearly all (96.0%) expressed interest in receiving more. Small minorities reported feeling comfortable managing common secondary conditions or in coordinating therapies and services for individuals with disabilities. CONCLUSION Although one-fifth of adult Americans have a disability, few of our participating IM and FM residents had received disability-specific education or felt comfortable managing the care of people living with disabilities. Our results indicate a need to develop and disseminate disability-specific curricula.
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Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, Sidney Kimmel Medical College, 1100 Walnut Street, Suite 601, Philadelphia, PA, 19107, USA; Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Nethra Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Michael Mallow
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Maclain Capron
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
| | - Steve Williams
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 25 South 9th Street, Philadelphia, PA, 19107, USA.
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Blanco Belver A, Aach M, Schmiegel W, Schildhauer TA, Meindl R, Brechmann T. Similar Adenoma Detection Rates in Colonoscopic Procedures of Patients with Spinal Cord Injury Compared to Controls. Dig Dis Sci 2020; 65:1197-1205. [PMID: 31468268 DOI: 10.1007/s10620-019-05814-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer is a major cause of death in patients with spinal cord injury (SCI). Preventive strategies, such as colonoscopy, deal with higher burdens that may lead to lower quality. AIMS The primary objective was to evaluate the adenoma detection rate. Secondary objectives were to investigate other quality indicators regarding bowel preparation, sedation, and endoscopy. METHODS Consecutive SCI patients who had undergone colonoscopy from 2003 to 2014 were assigned to a control group matched for age, gender, and year of procedure and reviewed retrospectively. RESULTS Bowel preparation lasted longer (3.6 ± 1.5 vs. 1.2 ± 0.6 days, p = 0.001), achieved unsatisfactory cleansing results more often (23.7 vs. 3.6%) and caused more adverse events in 236 SCI compared to 414 control patients. Colonoscopy needed a longer time (36.9 vs. 25.0 min) and remained incomplete more often (24.6 vs. 4.6%), resulting in more re-colonoscopies (14.8 vs. 4.3%). Endoscopy- and sedation-related adverse events were equal. However, neither overall nor size-dependent polyp (30.9 vs. 34.8%), adenoma (21.2 vs. 21.0%), advanced adenoma (6.8 vs. 7.2%), or cancer (1.7 vs. 2.0%) detection rates differed. CONCLUSION Despite intensified protocols, bowel preparation shows inferior results in SCI patients; colonoscopy needs more effort to succeed but achieves a comparable quality.
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Affiliation(s)
- Ana Blanco Belver
- Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Mirko Aach
- Department of General and Trauma Surgery, Spinal Cord Injury Unit, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Wolff Schmiegel
- Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, Spinal Cord Injury Unit, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Renate Meindl
- Department of General and Trauma Surgery, Spinal Cord Injury Unit, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Thorsten Brechmann
- Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
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Colizzo J, Keshishian J, Kumar A, Vidyarthi G, Amodeo D. Colonic stasis and chronic constipation: Demystifying proposed risk factors for colon polyp formation in a spinal cord injury veteran population. J Spinal Cord Med 2018; 41:292-297. [PMID: 29072121 PMCID: PMC6055954 DOI: 10.1080/10790268.2017.1388602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND AND AIMS Patients with spinal cord injury (SCI) suffer significant morbidity from neurogenic bowel. Chronic constipation has long-been a proposed risk factor for polyp development. We performed a retrospective cohort study in veterans with SCI to assess polyp presence in the setting of colonic stasis. METHODS All consecutive patients at the James A. Haley Veterans Affairs Hospital with SCI and neurogenic bowel who completed screening colonoscopy between January 1, 2004 to June 30, 2013 were included. Colonoscopies were excluded if they were aborted, not completed to the cecum, of less than adequate preparation, or if polypectomy was precluded. Patient data included level, duration, and completeness of SCI. Polyp data included number, location, and histology. RESULTS 325 patients ultimately met inclusion criteria. Most were male (96%). The average age at screening colonoscopy was 62.8 years. The majority of patients had injury to the cervical spine (41.5%). Colon polyps were detected in 130 patients (40%). Adenomatous change was seen in 95 (73%) of these patients. The adenoma detection rate (ADR) across all patients was 29.2%. Polyp presence and ADR demonstrated no statistically significant correlation with level, degree, or duration of SCI. Only patient age at time of screening colonoscopy had a significant correlation with polyp and adenoma presence (P<0.05). CONCLUSIONS SCI had no statistically significant correlation with polyp or adenoma presence. The ADR in our veteran SCI population with chronic constipation is comparable with that reported in the general population.
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Affiliation(s)
- Jason Colizzo
- University of South Florida, Morsani College of Medicine, Department of Internal Medicine, Tampa, Florida, USA
| | - Jonathan Keshishian
- University of South Florida, Morsani College of Medicine, Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Tampa, Florida, USA
| | - Ambuj Kumar
- University of South Florida, Morsani College of Medicine, Department of Internal Medicine, Division of Evidence Based Medicine, Tampa, Florida, USA
| | - Gitanjali Vidyarthi
- University of South Florida, Morsani College of Medicine, Department of Internal Medicine, Division of Digestive Diseases and Nutrition, James A. Haley Veterans Affairs Hospital, Tampa, Florida, USA
| | - Donald Amodeo
- University of South Florida, Morsani College of Medicine, Department of Internal Medicine, Division of Digestive Diseases and Nutrition, James A. Haley Veterans Affairs Hospital, Tampa, Florida, USA
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Song SH, Svircev JN, Teng BJ, Dominitz JA, Burns SP. A safe and effective multi-day colonoscopy bowel preparation for individuals with spinal cord injuries. J Spinal Cord Med 2018; 41:149-156. [PMID: 28366050 PMCID: PMC5901450 DOI: 10.1080/10790268.2016.1258968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
CONTEXT/OBJECTIVE Colonoscopy with polypectomy is associated with a reduced risk of colorectal cancer (CRC), but poor bowel cleansing limits the diagnostic yield of the procedure. Patients with spinal cord injury (SCI) frequently have suboptimal bowel cleansing with standard pre-colonoscopy bowel preparation regimens. We aimed to assess the safety, tolerability, and efficacy of a multi-day inpatient bowel preparation regimen in a population of patients with SCI. DESIGN Retrospective case series. SETTING VA Puget Sound SCI Center. PARTICIPANTS All patients with SCI (n = 53) who underwent inpatient colonoscopy at the VA Puget Sound from July 12, 2013 to February 12, 2015. OUTCOME MEASURES Patient characteristics, tolerance of full bowel preparation, pre- and post-bowel preparation electrolyte values, adverse events, and adequacy of bowel cleansing were abstracted. RESULTS Sixty-eight percent of patients had a cervical level of injury and the majority were either American Spinal Injury Association Impairment Scale A (41%) or D (43%). The full bowel preparation was tolerated by 91% of inpatients. In those with pre- and post-bowel preparation laboratory testing, there were small, but statistically significant decreases in serum calcium and phosphate. No patient had symptoms associated with electrolyte abnormalities or required treatment. Five out of 53 inpatients experienced autonomic dysreflexia (AD) during bowel preparation. Eighty-nine percent of patients had adequate bowel cleansing at colonoscopy. CONCLUSIONS We demonstrate a safe and effective inpatient bowel preparation regimen in a SCI population. The regimen was associated with mild, asymptomatic hypophosphatemia and hypocalcemia. AD was an uncommon event, predominantly occurring in patients who experienced frequent AD episodes at baseline.
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Affiliation(s)
- Shawn H. Song
- Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA,Correspondence to: Shawn H. Song, 1660 South Columbian Way, Seattle, WA 98108, USA.
| | - Jelena N. Svircev
- Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Brandon J. Teng
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Jason A. Dominitz
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA,Division of Gastroenterology, Hospital and Specialty Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Stephen P. Burns
- Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Friedman C, Owen AL. Sexual health in the community: Services for people with intellectual and developmental disabilities. Disabil Health J 2017; 10:387-393. [DOI: 10.1016/j.dhjo.2017.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/21/2017] [Accepted: 02/26/2017] [Indexed: 10/19/2022]
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Stillman MD, Bertocci G, Smalley C, Williams S, Frost KL. Healthcare utilization and associated barriers experienced by wheelchair users: A pilot study. Disabil Health J 2017; 10:502-508. [PMID: 28245968 DOI: 10.1016/j.dhjo.2017.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/06/2016] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than twenty-five years after passage of the ADA, little remains known about the experiences of wheelchair users when attempting to access health care and how accessibility may influence health care utilization. OBJECTIVE/HYPOTHESIS To describe health care utilization among wheelchair users and characterize barriers encountered when attempting to obtain access to health care. METHODS An internet-based survey of wheelchair users was conducted. Measures included demographics, condition, socioeconomic status, health care utilization and receipt of preventive services within the past year, physical barriers encountered at outpatient facilities, and satisfaction with care. RESULTS Four hundred thirty-two wheelchair users responded to the survey. Nearly all respondents (97.2%) had a primary care appointment within the past year and most reported 3-5 visits to both primary and specialty care providers. Most encountered physical barriers when accessing care (73.8% primary, 68.5% specialty). Participants received most preventive interventions at rates similar to national averages with the exception of Pap tests. Most participants remained clothed for their primary care evaluation (76.1%), and were examined seated in their wheelchair (69.7%). More than half of participants (54.1%) felt they received incomplete care, and 57% believed their physician had no more than a moderate understanding of their disability-specific medical concerns. CONCLUSIONS Wheelchair users face persistent barriers to care, may receive less than thorough physical evaluations, receive fewer screenings for cervical cancer, and largely believe they receive incomplete care.
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Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Gina Bertocci
- Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA.
| | - Craig Smalley
- Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA.
| | - Steve Williams
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Karen L Frost
- Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA.
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Xu X, Mann JR, Hardin JW, Gustafson E, McDermott SW, Deroche CB. Adherence to US Preventive Services Task Force recommendations for breast and cervical cancer screening for women who have a spinal cord injury. J Spinal Cord Med 2017; 40:76-84. [PMID: 27077580 PMCID: PMC5376149 DOI: 10.1080/10790268.2016.1153293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
CONTEXT Women with spinal cord injury (SCI) may face barriers that result in disparities in receipt of recommended mammography and Papanicolaou testing. SETTING South Carolina. PARTICIPANTS South Carolina women with SCI were identified using International Classification of Diseases codes in 2000-2010 Medicaid and Medicare billing data. OUTCOME MEASURES Receipt of mammography and Pap testing was determined using procedure billing codes. Partial proportional odds models were estimated to examine the association between SCI and adherence with screening recommendations from the United States Preventive Services Task Force. Each individual's screening experience was classified as full adherence, partial adherence, or no screening. RESULTS The cohort for mammography consisted of 3,173 women with SCI and 6,433 comparison women without SCI. The cohort for Pap testing consisted 5,025 women with SCI and 9,538 comparison women. Women with SCI were less likely to have full adherence with mammography recommendations (aOR = 0.69, 95% CI 0.64, 0.76) and Pap test recommendations (aOR = 0.53, 95% CI 0.49, 0.57). They were more likely to have no mammography screening (aOR = 1.44, 95% CI 1.33, 1.57) and no Pap testing (aOR = 1.89, 95% CI 1.77, 2.03) than women without SCI. CONCLUSION Using longitudinal data with multiple outcome levels, women with SCI were less likely to be fully adherent with receipt of recommended breast and cervical cancer screenings and more likely to have no screenings during the eligible years when compared to women without SCI.
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Affiliation(s)
- Xinling Xu
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Joshua R. Mann
- Department of Preventive Medicine. University of Mississippi Medical Center, Jackson, MS, USA
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Erin Gustafson
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Suzanne W. McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA,Correspondence to: Suzanne W. McDermott, Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Chelsea B. Deroche
- Biostatistics and Research Design Unit, University of Missouri Columbia School of Medicine, Columbia, MO, USA
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Kao CH, Sun LM, Chen YS, Lin CL, Liang JA, Kao CH, Weng MW. Risk of Nongenitourinary Cancers in Patients With Spinal Cord Injury: A Population-based Cohort Study. Medicine (Baltimore) 2016; 95:e2462. [PMID: 26765443 PMCID: PMC4718269 DOI: 10.1097/md.0000000000002462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little information is available regarding the risk of nongenitourinary (GU) cancers in patients with spinal cord injury (SCI). The authors conducted a nationwide population-based study to investigate whether a higher risk of non-GU cancer is seen among patients with SCI.Data retrieved from the National Health Insurance Research Database of Taiwan were used in this study. A total of 41,900 patients diagnosed with SCI between 2000 and 2011 were identified from the National Health Insurance Research Database and comprised the SCI cohort. Each of these patients was randomly frequency matched with 4 people from the general population (without SCI) according to age, sex, comorbidities, and index year. Cox proportional hazards regression analysis was used to calculate adjusted hazard ratios and 95% confidence intervals and determine how SCI affected non-GU cancer risk.No significant difference in overall non-GU cancer risk was observed between the SCI and control groups. The patients with SCI exhibited a significantly higher risk of developing esophageal, liver, and hematologic malignancies compared with those without SCI. By contrast, the SCI cohort had a significantly lower risk of colorectal cancer compared with the non-SCI cohort (adjusted hazard ratio = 0.80, 95% confidence interval = 0.69-0.93). Additional stratified analyses by sex, age, and follow-up duration revealed various correlations between SCI and non-GU cancer risk.The patients with SCI exhibited higher risk of esophageal, liver, and hematologic malignancies but a lower risk of colorectal cancer compared with those without SCI. The diverse patterns of cancer risk among the patients with SCI may be related to the complications of chronic SCI.
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Affiliation(s)
- Chia-Hong Kao
- From the Lab of Biomaterials, School of Chinese Medicine, China Medical University, Taichung (C-HK, Y-SC), Department of Chinese Medicine, Taipei Medical University Hospital, Taipei (C-HK), Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung (L-MS), Department of Bioinformatics and Medical Engineering, Asia University, Wufeng District, Taichung, Taiwan (Y-SC), Management Office for Health Data, China Medical University Hospital (C-LL), College of Medicine, China Medical University (C-LL), Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University (J-AL, C-HK), Department of Radiation Oncology, China Medical University Hospital (J-AL), Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung (C-HK); and Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan (M-WW)
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11
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Morris BP, Kucchal T, Burgess AN. Colonoscopy after spinal cord injury: a case-control study. Spinal Cord 2014; 53:32-5. [PMID: 25366532 DOI: 10.1038/sc.2014.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/28/2014] [Accepted: 07/30/2014] [Indexed: 01/14/2023]
Abstract
DESIGN An age- and gender-matched case-control study. OBJECTIVE To compare colonoscopy after spinal cord injury (SCI) with the general population in terms of indications, bowel preparation, technical success and disease detection. SETTING Victoria, Australia. METHODS Consecutive SCI colonoscopies between January 1998 and February 2013 were compared with a randomly selected age- and gender-matched control group. Injury level, indication for procedure and demographics were collected. Outcome measures included quality of bowel preparation, completion rates, procedural duration and benign and malignant disease detection. RESULTS A total of 440 colonoscopies were assessed, comprising 148 SCI patients and 292 age- and gender-matched controls. Both the groups were of similar age (54.7 years vs 54.5 years, P=0.906) and comprised predominantly males (87.1% vs 86.3%, P=0.919). SCI colonoscopies were more often performed to investigate abnormalities (85.1% vs 58.2%, P<0.001) than for screening or surveillance (18.2% vs 40.8%, P<0.001). Unsatisfactory bowel preparation was recorded more often in the SCI group (36.0% vs 13.0%, P<0.001) and completion rates were lower (75.7% vs 93.1%, P<0.001). Overall disease detection was lower in the SCI group (45.3% vs 59.6%, P<0.006). The polyp detection rate was lower for SCI (11.4% vs 25.3%, P=0.001). The rate of diagnosis of malignancy was equivalent (2.7% vs 3.0%, P=0.904). CONCLUSION SCI patients have the same risk of malignancy as the general population and are less likely to undergo screening colonoscopy. Colonoscopy is then limited by poor bowel preparation and lower completion rates with a subsequent lower polyp detection rate.
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Affiliation(s)
- B P Morris
- Department of Colorectal Surgery, Austin Hospital, Melbourne, VIC, Australia
| | - T Kucchal
- Department of Colorectal Surgery, Austin Hospital, Melbourne, VIC, Australia
| | - A N Burgess
- Department of Colorectal Surgery, Austin Hospital, Melbourne, VIC, Australia
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Stillman M, Williams S. A more perfect union: reports from an interdisciplinary primary care clinic for patients with spinal cord injury. J Spinal Cord Med 2014; 37:368-9. [PMID: 24621038 PMCID: PMC4116718 DOI: 10.1179/2045772313y.0000000189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The literature suggests that patients with spinal cord injury may have limited physical access to health care, receive fewer preventive services than able-bodied patients, and rely on physiatrists to provide primary care services. In this essay, the authors - an internist and a physiatrist - reflect on a year-long experience of cooperatively caring for patients with spinal cord injury in an interdisciplinary setting.
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Affiliation(s)
- Michael Stillman
- Department of Internal Medicine and Neurosurgery, University of Louisville School of Medicine, Louisville, KY, USA,Correspondence to: Michael Stillman, Department of Internal Medicine and Neurosurgery, University of Louisville School of Medicine, 550 S. Jackson Street, ACB Third Floor, Louisville, KY 40202, USA.
| | - Steve Williams
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY, USA
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Stillman MD, Frost KL, Smalley C, Bertocci G, Williams S. Health care utilization and barriers experienced by individuals with spinal cord injury. Arch Phys Med Rehabil 2014; 95:1114-26. [PMID: 24565745 DOI: 10.1016/j.apmr.2014.02.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To identify from whom individuals with spinal cord injury (SCI) seek health care, the percentage who receive preventative care screenings, and the frequency and types of barriers they encounter when accessing primary and specialty care services; and to examine how sociodemographic factors affect access to care and receipt of preventative screenings. DESIGN Cross-sectional, observational study using an Internet-based survey. SETTING Internet based. PARTICIPANTS Adults (N=108) with SCI who use a wheelchair as their primary means of mobility in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Health care utilization during the past year, barriers encountered when accessing health care facilities, and receipt of routine care and preventative screenings. RESULTS All but 1 participant had visited a primary care provider within the past 12 months, and 85% had had ≥ 1 visit to specialty care providers. Accessibility barriers were encountered during both primary care (91.1%) and specialty care (80.2%) visits; most barriers were clustered in the examination room. The most prevalent barriers were inaccessible examination tables (primary care=76.9%; specialty care=51.4%) and lack of transfer aids (primary care=69.4%; specialty care=60.8%). Most participants had not been weighed during their visit (89%) and had remained seated in their wheelchair during their examinations (85.2%). Over one third of individuals aged ≥ 50 years had not received a screening colonoscopy, 60% of women aged ≥ 50 years had not had a mammogram within the past year, 39.58% of women had not received a Papanicolaou smear within the previous 3 years, and only 45.37% of respondents had ever received bone density testing. CONCLUSIONS Individuals with SCI face remediable obstacles to care and receive fewer preventative care screenings than their nondisabled counterparts. We recommend that clinics conduct Americans with Disabilities Act self-assessments, ensure that their clinical staff are properly trained in assisting individuals with mobility disabilities, and take a proactive approach in discussing preventative care screenings with their patients who have SCI.
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Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, School of Medicine, University of Louisville, Louisville, KY.
| | - Karen L Frost
- Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY
| | - Craig Smalley
- Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY
| | - Gina Bertocci
- Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY
| | - Steve Williams
- Neurosurgery, School of Medicine, University of Louisville, Louisville, KY
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Hayman AV, Guihan M, Fisher MJ, Murphy D, Anaya BC, Parachuri R, Rogers TJ, Bentrem DJ. Colonoscopy is high yield in spinal cord injury. J Spinal Cord Med 2013; 36:436-42. [PMID: 23941791 PMCID: PMC3739893 DOI: 10.1179/2045772313y.0000000091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES/BACKGROUND Colorectal cancer (CRC) can be prevented by routine colonoscopy. CRC screening in special populations, e.g. spinal cord injury and disorders, presents unique barriers and, potentially, a higher risk of complications. We were concerned about potentially higher risks of complications and sought to determine the safety of colonoscopy. METHODS Retrospective observational design using medical record review for 311 patients who underwent 368 colonoscopies from two large VA SCI centers from 1997-2008. Patient demographics and peri-procedural characteristics, including indication, bowel prep quality, and pathological findings are presented. Descriptive statistics are presented. RESULTS The population was predominantly male and Caucasian, and 199 (64%) had high-level injuries (T6 or above). Median age at colonoscopy was 61 years (interquartile range 53-69). Just <1/2 of the colonoscopies were diagnostic, usually for evidence of rectal bleeding. Although a majority of colonoscopies were reported as poorly prepped, the proportion that were adequately prepped increased over time (from 3.7 to 61.3%, P = <0.0001). Of the 146 polyps removed, 101 (69%) were adenomas or carcinomas. Ten subjects had 11 complications, none of which required surgical intervention. CONCLUSIONS Although providing quality colonoscopic care in this population is labor intensive, the data suggests that it appears safe and therapeutically beneficial. The results indicate that the risk of screening is outweighed by the likelihood of finding polyps. Recognition of the benefit of colonoscopy in this population may have improved bowel prep and reporting over time. Spinal cord injury providers should continue to offer screening or diagnostic colonoscopy to their patients when indicated, while being aware of the special challenges that they face.
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Affiliation(s)
- Amanda V. Hayman
- Jesse Brown VA, Chicago, IL, USA; and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marylou Guihan
- SCI QUERI, Center for the Management of Complex Chronic Care, Department of Surgery, Edward Hines Jr. VA, Hines, IL, USA; and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Correspondence to: Marylou Guihan, Spinal Cord Injury QUERI Research Coordinating Center, Center for Management of Complex Chronic Care (CMC), Department of Surgery, Edward Hines Jr. VA Hospital, 5000 South 5th Avenue (151H), Hines, IL 60141–3030, USA.
| | | | - Deirdre Murphy
- SCI QUERI, Center for the Management of Complex Chronic Care, Department of Surgery, Edward Hines Jr. VA, Hines, IL, USA; and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Thea J. Rogers
- SCI QUERI, Center for the Management of Complex Chronic Care, Department of Surgery, Edward Hines Jr. VA, Hines, IL, USA; and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Bean-Mayberry B, Yano EM, Washington DL, Goldzweig C, Batuman F, Huang C, Miake-Lye I, Shekelle PG. Systematic Review of Women Veterans’ Health: Update on Successes and Gaps. Womens Health Issues 2011; 21:S84-97. [DOI: 10.1016/j.whi.2011.04.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 11/30/2022]
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Graham CL, Mann JR. Accessibility of primary care physician practice sites in South Carolina for people with disabilities. Disabil Health J 2011; 1:209-14. [PMID: 21122731 DOI: 10.1016/j.dhjo.2008.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 06/16/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Quality and level of health care provided for people with disabilities at primary care physician's offices can be drastically impacted by the level of accessibility of the practice. The study goal was to assess the accessibility of primary care physician practices sites in South Carolina for people with mobility or sensory disabilities. METHODS Primary care offices were contacted through two different networks, and 68 agreed to a modified accessibility assessment. Prior to each visit, practice characteristics were gathered. The rehabilitation engineer assessed the sites for 93 specific accessibility items using a tape measure, inclinometer, and weight scale. The survey items were taken from the American with Disabilities Act Accessibility Guidelines (ADAAG). RESULTS The level of accessibility varied substantially; the average practice was deemed adequate on 70% of the items assessed. The strongest predictor of overall accessibility was the year of construction or most recent renovation. Hospital-owned buildings were significantly more accessible (P = 0.04) when controlling for year built. Key aspects of accessibility that were often lacking included car- and van-accessible parking, lever door handles, clear floor space and grab bars in the restroom, TTY telephone or a hearing aid-compatible telephone, wheelchair accessible scale, and an adjustable-height examination table. CONCLUSION The accessibility of primary care practice sites in South Carolina is suboptimal. Research is needed to identify effective approaches for encouraging primary care practices to make their practices fully accessible.
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Affiliation(s)
- Catherine Leigh Graham
- Department of Family and Preventive Medicine, Interagency Office on Disability and Health, University of South Carolina, School of Medicine, Columbia, SC 29203, USA.
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Nosek MA, Robinson-Whelen S, Hughes RB, Petersen NJ, Taylor HB, Byrne MM, Morgan R. Overweight and obesity in women with physical disabilities: associations with demographic and disability characteristics and secondary conditions. Disabil Health J 2011; 1:89-98. [PMID: 21122716 DOI: 10.1016/j.dhjo.2008.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 04/09/2007] [Accepted: 07/13/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND This cross-sectional study was designed to examine weight in association with demographic and disability characteristics and secondary conditions in a sample of community living women with physical disabilities. METHODS 443 predominantly ethnic minority women with physical disabilities were recruited through public and private health clinics and community organizations. They completed questionnaires including measures of body mass index and a health conditions checklist. RESULTS Data showed that nearly three-quarters of the sample were overweight (26.6%) or obese (47.6%) with 14% extremely obese. Obesity was highest among middle aged women (aged 45-54, 52.7%; aged 55-64, 52.5%; compared to aged 18-44, 37.8%; or aged ≥65, 39.1%). Black (84.0%) and Hispanic women (83.8%) were more likely to be overweight or obese compared to non-Hispanic white women (56.7%). Women with joint and connective tissue diseases and women with more extensive functional limitations were more likely to have excess weight. Disability factors were more strongly associated with excess weight than demographic factors other than age. Weight classification was significantly related to whether or not the women had ever had diabetes or blood pressure problems. Diabetes was reported 4 times as often as among women in general (36.3% versus 8.9%), and hypertension nearly twice as often (56.2% versus 30.9%). CONCLUSIONS These findings indicate extremely high rates of overweight and obesity in women with physical disabilities, a growing population greatly in need of effective weight management interventions. Overweight and obesity in combination with disability in women was associated with disproportionately high rates of diabetes and hypertension.
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Affiliation(s)
- Margaret A Nosek
- Center for Research on Women with Disabilities, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
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Rosso AL, Wisdom JP, Horner-Johnson W, McGee MG, Michael YL. Aging with a disability: a systematic review of cardiovascular disease and osteoporosis among women aging with a physical disability. Maturitas 2010; 68:65-72. [PMID: 21075569 DOI: 10.1016/j.maturitas.2010.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 10/13/2010] [Accepted: 10/14/2010] [Indexed: 01/19/2023]
Abstract
Compared to men, women live longer but experience greater morbidity as they age. However, little is known about the rapidly growing population of women aging with disability. Women aging with disabilities may encounter barriers that increase risk of morbidity, including lack of access to medical care or inadequate assistance, equipment, or services. To evaluate risks of morbidity in this group, we conducted a systematic review focused on two important and prevalent conditions: cardiovascular disease (CVD) and osteoporosis. MEDLINE was searched for reports published between January 1, 1990 and August 6, 2010 and additional studies were identified through searches of bibliographies. 9156 abstracts and 93 articles were reviewed to identify empirical studies of women with physical disability who were 45 years or older and that reported CVD or osteoporosis as an outcome and not a cause of the disability. Articles meeting inclusion criteria were then critically appraised to exclude poor quality studies. In seven articles that evaluated CVD outcomes, we found limited evidence to support an increased risk of prevalence of CVD or risk factors for CVD in women aging with physical disabilities compared to non-disabled control populations. The literature is limited by small sample sizes that reduced statistical power to detect true differences. No articles meeting inclusion criteria were identified to evaluate osteoporosis risk in this group. This review is limited by the narrow focus on physical disabilities and two health outcomes. Additional high quality empirical research is necessary to understand the risks to health of women aging with disabilities.
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Affiliation(s)
- Andrea L Rosso
- Drexel University School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, PA 19102, USA.
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Yuen HK, Wolf BJ, Bandyopadhyay D, Magruder KM, Selassie AW, Salinas CF. Factors that limit access to dental care for adults with spinal cord injury. SPECIAL CARE IN DENTISTRY 2010; 30:151-6. [PMID: 20618781 DOI: 10.1111/j.1754-4505.2010.00146.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population. There were 192 subjects with SCI who participated in the oral health survey assessing dental care service utilization and they were compared with subjects from the 2004 Behavioral Risk Factors Surveillance System (BRFSS). There was no significant difference in the proportion of subjects with SCI who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, p= .350). However, subjects with SCI were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, p < .001). The three most commonly reported barriers to accessing dental care were cost (40.1%), physical barriers (22.9%), and dental fear (15.1%). Multivariate modeling showed that physical barriers and fear of dental visits were the two significant factors deterring subjects from dental visits in the past year. Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling of their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI.
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Affiliation(s)
- Hon K Yuen
- Occupational Therapy Division, Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA.
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Park SJ, Park WS. Identifying barriers to Papanicolaou smear screening in Korean women: Korean National Health and Nutrition Examination Survey 2005. J Gynecol Oncol 2010; 21:81-6. [PMID: 20613896 DOI: 10.3802/jgo.2010.21.2.81] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/11/2010] [Accepted: 05/04/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study was conducted to provide a nationwide analysis on barriers to cervical cancer screening in Korea. METHODS Data used for this study was obtained in a survey called Korean National Health and Nutrition Examination Survey (KNHANES) 2005, which collected data from 2,590 Korean women aged older than 21 years who had not had a hysterectomy and were eligible for Papanicolaou (Pap) smears. Multivariate analysis was adopted to control each demographic factor and unhealthy behavior variable. Demographic factors included age, education, income, job and region; health-related behavior factors were defined as current smoking, obesity, hormone replacement therapy and disability. RESULTS The study found that cervical cancer screening rate was significantly positively associated with income (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001 to 1.002), with education (OR, 1.324; 95% CI, 1.030 to 1.703), with job (OR, 1.420; 95% CI, 1.030 to 1.957), and with hormone replacement therapy (OR, 3.732; 95% CI, 2.354 to 5.916). Meanwhile, the age (OR, 0.977; 95% CI, 0.968 to 0.985), disability (OR, 0.358; 95% CI, 0.143 to 0.894) and smoking (OR, 0.447; 95% CI, 0.280 to 0.715) were significantly negatively associated with one's chances to take cervical cytology. CONCLUSION In order to increase the rates of Korean women taking Pap test, cervical cancer screening programs will have to pay special attention to the elderly, low-income group, smokers, and the disabled.
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Affiliation(s)
- Su Jeong Park
- Yesarang Obstetrics and Gynecology Clinic, Seoul, Korea
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Abstract
BACKGROUND/OBJECTIVE In spinal cord injury (SCI), loss of central or peripheral neural control causes neurogenic bowel. Patients may not exhibit the typical signs and symptoms of gastrointestinal disease. Few studies have looked at the risk of gastrointestinal disease in this group and the indications for preventive screening. The objective of this study was to study colonoscopic lesions in patients with SCI and determine whether there are any differences in the prevalence of lesions between SCI and control patients. DESIGN Case control study. METHODS Twenty-five patients with SCI were compared with 41 control patients who received colonoscopy at the same time. Mann-Whitney test for continuous variable, and Fisher exact test for frequency variables were used. OUTCOME MEASURES Demographic information, duration of SCI, and colonoscopy findings were gathered. RESULTS Colonic lesions were observed in 52% of patients with SCI and in 41.5% of control patients. Most frequent lesions in SCI group were inflammatory bowel disease (16%) and polyp (16%), followed by proctitis (12%) and hemorrhoid (12%). In the control group, hemorrhoid (17.1%) was most common, followed by polyp (12.2%) and melanosis coli (9.8%). No significant differences were found between the 2 groups. In the SCI group, no significant differences in lesions were found among the patients with cervical, thoracic, and lumbar SCI in the SCI group. Duration of SCI did not affect the pattern of colonoscopic lesions. CONCLUSION Patients with SCI had the same incidence of colonscopic lesions as control patients. Inflammatory bowel disease, which is a risk factor for cancer, was the most common findings in the SCI group, although there was no significant difference from the control group. In patients with SCI, colonoscopy screening is warranted at the same frequency as for the general population.
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Affiliation(s)
- Soo Jeong Han
- Department of Rehabilitation Medicine, Ewha Womans University, School of Medicine, Seoul, Republic of Korea.
| | - Chung Mi Kim
- Department of Internal Medicine, Incheon Chungang General Hospital, Incheon, Republic of Korea
| | - Jeong Eun Lee
- Department of Rehabilitation Medicine, Cham Hospital, Seoul, Republic of Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Joan C. Edward School of Medicine, Marshall University, Huntington, West Virginia
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Nosek MA. Disability as a Lifestyle Factor: The Critical Need for More Information. Am J Lifestyle Med 2008. [DOI: 10.1177/1559827608317275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Margaret A. Nosek
- Center for Research on Women with Disabilities and the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas,
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