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Clark JMR, Ozturk ED, Chanfreau-Coffinier C, Merritt VC. Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury. Qual Life Res 2024; 33:229-239. [PMID: 37856045 DOI: 10.1007/s11136-023-03518-7] [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] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To examine clinical outcomes and employment status in Veterans with and without a dual diagnosis of traumatic brain injury (TBI) and spinal cord injury (SCI). METHODS This cross-sectional study examined a national sample of Veterans enrolled in the VA Million Veteran Program who completed the Comprehensive TBI Evaluation (CTBIE) as part of the Veterans Health Administration's TBI Screening and Evaluation Program. Veterans (N = 12,985) were classified into the following TBI/SCI groups using CTBIE data: those with a dual diagnosis of TBI and SCI (TBI+/SCI+); those with a history of TBI but no SCI (TBI+/SCI-); and those with no history of TBI or SCI (TBI-/SCI-; i.e., the control group). CTBIE-derived outcomes included neurobehavioral symptoms, comorbid psychiatric symptoms, pain and pain interference, and employment status. RESULTS Chi-square analyses showed significant associations between TBI/SCI group and all clinical outcomes evaluated (all p's < .001; V = 0.07-0.11). In general, the TBI+/SCI+ and TBI +/SCI- groups endorsed comparable levels of neurobehavioral symptoms, psychiatric symptoms, and pain, but significantly greater rates of symptoms and pain relative to the TBI-/SCI- group. Effect sizes for all pairwise comparisons were small (φ = 0.01-0.11). Finally, there was no significant association between TBI/SCI group and employment status (p = .170; V = 0.02), with all three groups showing relatively comparable rates of unemployment. CONCLUSIONS Regardless of SCI status, Veterans with TBI history endorsed poorer clinical outcomes than Veterans without TBI and SCI. However, rates of unemployment were similarly high across all three groups. Findings suggest that any Veteran completing the CTBIE may be at risk for poor clinical and employment outcomes.
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Affiliation(s)
- Jillian M R Clark
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Erin D Ozturk
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- San Diego Joint Doctoral Program, San Diego State University/University of California, San Diego, CA, USA
| | | | - Victoria C Merritt
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA.
- VA San Diego Healthcare System (151B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
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Sippel JL, Daly JE, Poggensee L, Ristau KD, Eberhart AC, Tam K, Evans CT, Lancaster B, Wickremasinghe IM, Burns SP, Goldstein B, Smith BM. Modernization of a Large Spinal Cord Injuries and Disorders Registry: The Veterans Administration Experience. Arch Rehabil Res Clin Transl 2022; 4:100237. [PMID: 36545529 PMCID: PMC9761267 DOI: 10.1016/j.arrct.2022.100237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since the 1990s, Veterans Health Administration (VHA) has maintained a registry of Veterans with Spinal Cord Injuries and Disorders (SCI/Ds) to guide clinical care, policy, and research. Historically, methods for collecting and recording data for the VHA SCI/D Registry (VSR) have required significant time, cost, and staffing to maintain, were susceptible to missing data, and caused delays in aggregation and reporting. Each subsequent data collection method was aimed at improving these issues over the last several decades. This paper describes the development and validation of a case-finding and data-capture algorithm that uses primary clinical data, including diagnoses and utilization across 9 million VHA electronic medical records, to create a comprehensive registry of living and deceased Veterans seen for SCI/D services since 2012. A multi-step process was used to develop and validate a computer algorithm to create a comprehensive registry of Veterans with SCI/D whose records are maintained in the enterprise wide VHA Corporate Data Warehouse. Chart reviews and validity checks were used to validate the accuracy of cases that were identified using the new algorithm. An initial cohort of 28,202 living and deceased Veterans with SCI/D who were enrolled in VHA care from 10/1/2012 through 9/30/2017 was validated. Tables, reports, and charts using VSR data were developed to provide operational tools to study, predict, and improve targeted management and care for Veterans with SCI/Ds. The modernized VSR includes data on diagnoses, qualifying fiscal year, recent utilization, demographics, injury, and impairment for 38,022 Veterans as of 11/2/2022. This establishes the VSR as one of the largest ongoing longitudinal SCI/D datasets in North America and provides operational reports for VHA population health management and evidence-based rehabilitation. The VSR also comprises one of the only registries for individuals with non-traumatic SCI/Ds and holds potential to advance research and treatment for multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and other motor neuron disorders with spinal cord involvement. Selected trends in VSR data indicate possible differences in the future lifelong care needs of Veterans with SCI/Ds. Future collaborative research using the VSR offers opportunities to contribute to knowledge and improve health care for people living with SCI/Ds.
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Key Words
- ALS, amyotrophic lateral sclerosis
- ARC, Allocation Resource Center
- ASIA, American Spinal Injury Association Impairment Scale
- Amyotrophic lateral sclerosis
- BI, Business Intelligence
- Big data
- CDW, Corporate Data Warehouse
- CPRS, computerized patient record system
- EMR, electronic medical record
- Electronic health records
- GUI, graphical user interface
- MIO, Management of Information & Outcomes
- MS, multiple sclerosis
- Medical informatics
- Motor neuron disease
- Multiple sclerosis
- Population health
- Population health management
- RHSCIR, Rick Hansen Spinal Cord Injury Registry
- Registries
- Rehabilitation
- SCD, spinal cord dysfunction
- SCI/D, Spinal Cord Injuries and Disorders
- SCIDO, Spinal Cord Injury and Disorders Outcomes
- SCIMS, Spinal Cord Injury Model Systems
- SME, subject matter expert
- Spinal cord injuries
- United States
- VHA, Veterans Health Administration
- VSR, VHA SCI/D Registry
- VSSC, VHA Service Support Center
- Veterans
- VistA, Veteran Health Information Systems and Technology Architecture
- WOC, Without Compensation
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Affiliation(s)
- Jennifer L. Sippel
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC,Corresponding author Jennifer L. Sippel, PhD, Spinal Cord Injuries and Disorders (SCI/D) National Program Office (11SCID), Veterans Health Administration (VHA), 810 Vermont Ave NW, Washington, DC 20420.
| | - Jennifer E. Daly
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC
| | - Linda Poggensee
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Junior Hospital, Hines, IL
| | - Kim D. Ristau
- VHA Support Service Center (VSSC), Office of Analytics and Performance, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Adam C. Eberhart
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC
| | - Katharine Tam
- Spinal Cord Injury Service, John J. Cochran Veterans Hospital, Saint Louis, MO 63106
| | - Charlesnika T. Evans
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Junior Hospital, Hines, IL,Center for Health Services and Outcomes Research and Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Betsy Lancaster
- VHA Support Service Center (VSSC), Office of Analytics and Performance, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - I. Manosha Wickremasinghe
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC
| | - Stephen P. Burns
- Spinal Cord Injury Service, VA Puget Sound Health Care System, Seattle, WA,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Barry Goldstein
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Bridget M. Smith
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Junior Hospital, Hines, IL,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
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Abstract
Objective: Identify the association of personality and purpose in life with competing risks of multiple causes of death after spinal cord injury (SCI), using data from the SCI Longitudinal Health Study. Design: Prospective cohort study with data collected in 1997-1998 and 2007-2009. Mortality status determined as of December 31, 2016. Setting: Specialty hospital in the Southeastern United States. Participants: 3070 adults with chronic (>1-year), traumatic SCI. Interventions: N/A. Outcome Measures: We examined 6 psychological factors (Purpose in Life and 5 scales of the Zuckerman-Kuhlman Personality Questionnaire) and risk of mortality due to 6 specific causes of death, building on published analyses of behavioral and health/clinical risk and protective factors. Results: There were 803 deaths. Four of the 6 psychological factors were predictive of all-cause mortality. All except 1 personality scale were related to cause-specific mortality. Psychological factors were most predictive of unintentional injury deaths. Purpose in life was protective of death due to pneumonia; whereas, Activity was protective of death due to diseases of heart and blood vessels and to unintentional injury. Sociability, Impulsive-Sensation Seeking, and Neuroticism-Anxiety were risk factors for death due to unintentional injury. Neuroticism-Anxiety was related to death due to septicemia. There were no significant psychological predictors of cancer. Conclusions: Rehabilitation professionals have a central role in promoting purpose in life as a means of increasing longevity. By assessing personality factors predictive of specific causes of mortality, those at risk may be targeted for cause-specific prevention strategies.
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Affiliation(s)
- James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA,Correspondence to: James S. Krause, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, MSC 962, Charleston, SC29425, USA; Ph: 843-792-1337.
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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VanDerwerker CJ, Gregory CM, Simpson KN. Using Inferred Mobility Status to Estimate the Time to Major Depressive Disorder Diagnosis Post-Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:658-666. [PMID: 31891714 PMCID: PMC7441847 DOI: 10.1016/j.apmr.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/25/2019] [Accepted: 11/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors associated with MDD diagnosis; (3) time at which MDD is diagnosed post-spinal cord injury (SCI); and (4) interaction of inferred mobility status (IMS) in a commercially insured population over 3 years. DESIGN Retrospective longitudinal cohort design. SETTING A commercial insurance claims database from January 1, 2010 to December 31, 2013. PARTICIPANTS Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history of MDD ≤30 days pre-SCI (N=1409). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A stratified survival analysis using IMS, based upon durable medical equipment (DME) claims, was also completed. RESULTS Post-SCI, 294 out of 1409 (20.87%) were diagnosed with new-onset MDD. Significant (P<.05) risk factors included: employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, and 2 of 5 IMS comparisons. Median time to MDD was 86 days. Survival analysis demonstrated a significant difference between 6 of 10 IMS comparisons. Regarding new-onset or recurring MDD, 432 out of 1409 (30.66%) were diagnosed post-SCI. Significant risk factors included: female, employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, MDD>30 days pre-SCI, catheter claims, and 2 of 5 IMS comparisons. Median time to MDD was 74 days. Survival analysis demonstrated a significant difference between 4 of 10 IMS comparisons. CONCLUSIONS Prevalence of MDD post-SCI is greater than the general population. Stratification by IMS illustrated that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI.
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Affiliation(s)
- Catherine J VanDerwerker
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina.
| | - Chris M Gregory
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Kit N Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
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6
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HIV, schizophrenia, and all-cause mortality: A population-based cohort study of individuals accessing universal medical care from 1998 to 2012 in British Columbia, Canada. Schizophr Res 2019; 209:198-205. [PMID: 31255392 DOI: 10.1016/j.schres.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 02/01/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022]
Abstract
Schizophrenia is a severe mental illness with important implications for morbidity and mortality. This population-based cohort study examined the impact of schizophrenia diagnoses on all-cause mortality among a sample of people living with HIV (PLHIV) and a 10% random sample of individuals living without HIV (HIV-) in British Columbia (BC), through a data linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC's data holdings. Schizophrenia diagnoses were identified via International Classification of Diseases version 9 and version 10 codes. Age- and sex-adjusted all-cause mortality rates from January 1st, 1998 to December 31st, 2012 were calculated. Multivariable logistic models assessed (1) HIV status and mortality among individuals diagnosed with schizophrenia, (2) schizophrenia diagnosis and mortality among PLHIV, and (3) correlates of mortality among PLHIV concurrently diagnosed with schizophrenia (HIV+/SZO+). From 1998 to 2012, 6.3% of those with HIV had a schizophrenia diagnosis, compared to 1.1% of those without HIV. While significant declines in mortality rates were observed throughout the study period, mortality rates were highest among HIV+/SZO+. After adjustment for substance use disorder and age at baseline, HIV+/SZO+ had a 2.64 times greater odds of mortality (95% confidence interval [CI] = 2.14-3.25) compared to HIV-/SZO+. For PLHIV, a schizophrenia diagnosis was not associated with mortality after controlling for potential confounders (adjusted odds ratio [aOR] = 0.90, 95%CI = 0.74-1.09). Among HIV+/SZO+, age, history of injection drug use, ever having an AIDS-defining illness, and never being on anti-psychotic medication or accessing psychiatric services were associated with mortality. Efforts should be made to identify and link to care individuals disproportionately affected by schizophrenia and excess mortality, including those living with HIV.
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McDonald SD, Mickens MN, Goldberg-Looney LD, Mutchler BJ, Ellwood MS, Castillo TA. Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries. J Spinal Cord Med 2018; 41:691-702. [PMID: 28287932 PMCID: PMC6217469 DOI: 10.1080/10790268.2017.1293868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. DESIGN Cross-sectional. SETTING A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. PARTICIPANTS/METHODS Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. RESULTS Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. CONCLUSIONS Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.
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Affiliation(s)
- Scott D. McDonald
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melody N. Mickens
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Brian J. Mutchler
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael S. Ellwood
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Teodoro A. Castillo
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Kang MG, Kim CH, Park E, Huh JW, Yang WJ, Nam TW, Min YS, Jung TD. Effect of Family Caregiving on Depression in the First 3 Months After Spinal Cord Injury. Ann Rehabil Med 2018; 42:130-136. [PMID: 29560333 PMCID: PMC5852216 DOI: 10.5535/arm.2018.42.1.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the effect of family caregiving on depression in the first 3 months after spinal cord injury (SCI). Methods A retrospective study was carried out on 76 patients diagnosed with an SCI from January 2013 to December 2016 at the Department of Physical Medicine and Rehabilitation of Kyungpook National University Hospital, Korea. Clinical characteristics including age, gender, level of injury, completeness of the injury, time since injury, caregiver information, etiology, and functional data were collected through a retrospective review of medical records. Depression was assessed using the Beck Depression Inventory (BDI). Patients with 14 or more points were classified as depressed and those with scores of 13 or less as non-depressed group. Results Of the 76 patients, 33 were in the depressed group with an average BDI of 21.27±6.17 and 43 patients included in the non-depressed group with an average BDI of 4.56±4.20. The BDI score of patients cared by unlicensed assistive personnel (UAP) was significantly higher than that of patients cared by their families (p=0.020). Univariate regression analysis showed that motor complete injury (p=0.027), UAP caregiving (p=0.022), and Ambulatory Motor Index (p=0.019) were associated with depression after SCI. Multivariate binary logistic regression analysis showed that motor completeness (p=0.002) and UAP caregiving (p=0.002) were independent risk factors. Conclusion Compared with UAP, family caregivers lowered the prevalence of depression in the first 3 months after SCI.
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Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eunhee Park
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jae-Won Huh
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Won-Jong Yang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Tae-Woo Nam
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
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Huỳnh C, Rochette L, Pelletier É, Lesage A. Définir les troubles liés aux substances psychoactives à partir de données
administratives. SANTE MENTALE AU QUEBEC 2018. [DOI: 10.7202/1058609ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Krause JS, Cao Y, DeVivo MJ, DiPiro ND. Risk and Protective Factors for Cause-Specific Mortality After Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:1669-78. [PMID: 27449321 DOI: 10.1016/j.apmr.2016.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the association of multiple sets of risk and protective factors (biographic and injury, socioeconomic, health) with cause-specific mortality after spinal cord injury (SCI). DESIGN Retrospective analysis of a prospectively created cohort. SETTING Spinal Cord Injury Model Systems facilities. PARTICIPANTS Adults (N=8157) with traumatic SCI who were enrolled in a model systems facility after 1973 and received follow-up evaluation that included all study covariates (between November 1, 1995 and October 31, 2006). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES All-cause mortality was determined using the Social Security Death Index as of January 1, 2014. Causes of death were obtained from the National Death Index and classified as infective and parasitic diseases, neoplasms, respiratory system diseases, heart and blood vessel diseases, external causes, and other causes. Competing risk analysis, with time-dependent covariates, was performed with hazard ratios (HRs) for each cause of death. RESULTS The HRs for injury severity indicators were highest for deaths due to respiratory system diseases (highest HR for injury level C1-4, 4.84) and infective and parasitic diseases (highest HR for American Spinal Injury Association Impairment Scale grade A, 5.70). In contrast, injury level and American Spinal Injury Association Impairment Scale grade were relatively unrelated to death due to neoplasms and external causes. Of the socioeconomic indicators, education and income were significantly predictive of a number of causes of death. Pressure ulcers were the only 1 of 4 secondary health condition indicators consistently related to cause of death. CONCLUSIONS Injury severity was related to mortality due to infective disease and respiratory complications, suggesting that those with the most severe SCI should be targeted for prevention of these causes. Socioeconomic and health factors were more broadly related to a number of causes of death. Intervention strategies that enhance socioeconomic status and health may also result in reduced mortality due to multiple causes.
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Affiliation(s)
| | - Yue Cao
- Medical University of South Carolina, Charleston, SC
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11
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Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MWG. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology 2015; 44:182-98. [PMID: 25997873 DOI: 10.1159/000382079] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population. METHODS A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI. RESULTS Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics. CONCLUSION This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies.
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Williams R, Murray A. Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil 2014; 96:133-40. [PMID: 25220943 DOI: 10.1016/j.apmr.2014.08.016] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/17/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To use meta-analysis to synthesize point prevalence estimates of depressive disorder diagnoses for persons who have sustained a spinal cord injury (SCI). DATA SOURCES We searched PsycINFO, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Dissertation Abstracts International (DAI) for studies examining depression after SCI through 2013. We also conducted a manual search of the reference sections of included studies. STUDY SELECTION Included studies contained persons with SCI; used a diagnostic measure of depression (ie, an unstructured, semi-structured, or structured clinical interview, and/or a clinician diagnosis); and provided a diagnosis of major or minor depressive episodes for the subjects in the study. Diagnostic criteria were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (including Research Diagnostic Criteria) criteria. DATA EXTRACTION The 2 authors of this study screened the titles and abstracts of 1053 unique studies for inclusion in this meta-analysis. Nineteen studies, containing 35,676 subjects and 21 effect size estimates, were included. DATA SYNTHESIS The mean prevalence estimate of depression diagnosis after SCI was 22.2%, with a lower-bound estimate of 18.7% and an upper bound estimate of 26.3%. Random effects and mixed effects models were used in this work. A small number of study moderators were explored, including sample sex composition, Diagnostic and Statistical Manual of Mental Disorders version used, data collection method (primary vs secondary), sample traumatic etiology composition, sample injury level and completeness composition, and sample diagnostic composition. Data collection method, Diagnostic and Statistical Manual of Mental Disorders version, and diagnostic composition significantly predicted variation in observed effect size estimates, with primary data collection studies having lower estimates compared with secondary data analysis studies, studies using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria having higher estimates compared with studies using Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria, and samples comprising individuals diagnosed only with major depression having lower prevalence estimates. CONCLUSIONS The existing data on depression after SCI indicate that the prevalence of depression after SCI is substantially greater than that in the general medical population. These results underscore the importance of continued research on measuring depression in persons with SCI and on treatments for depression after SCI.
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Affiliation(s)
| | - Adrian Murray
- Department of Counseling, Educational Psychology, and Research, College of Education, Health and Human Sciences, University of Memphis, Memphis, TN
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Ji W, Hu S, Zhou J, Wang G, Wang K, Zhang Y. Tissue engineering is a promising method for the repair of spinal cord injuries (Review). Exp Ther Med 2013; 7:523-528. [PMID: 24520240 PMCID: PMC3919911 DOI: 10.3892/etm.2013.1454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/10/2013] [Indexed: 12/23/2022] Open
Abstract
Spinal cord injury (SCI) may lead to a devastating and permanent loss of neurological function, which may place a great economic burden on the family of the patient and society. Methods for reducing the death of neuronal cells, inhibiting immune and inflammatory reactions, and promoting the growth of axons in order to build up synapses with the target cells are the focus of current research. Target cells are located in the damaged spinal cord which create a connect with the scaffold. As tissue engineering technology is developed for use in a variety of different areas, particularly the biomedical field, a clear understanding of the mechanisms of tissue engineering is important. This review establishes how this technology may be used in basic experiments with regard to SCI and considers its potential future clinical use.
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Affiliation(s)
- Wenchen Ji
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China ; Department of Physiology, College of Medicine, University of Sydney, Sydney 2006, Australia
| | - Shouye Hu
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jiao Zhou
- Department of Surgery, The Third Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Gang Wang
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Kunzheng Wang
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yuelin Zhang
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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