Menopause characteristics and subjective symptoms in women with and without spinal cord injury

OBJECTIVE

To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI).

DESIGN

Prospective cohort (4 data collection periods across 4 years).

SETTING

Community.

PARTICIPANTS

Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms).

RESULTS

The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness.

CONCLUSIONS

Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.

Population-based estimates of outcomes after hospitalization for traumatic brain injury in Colorado11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To determine statewide, population-based outcomes of persons hospitalized with traumatic brain injury (TBI) at 1 year postinjury.

DESIGN

Follow-up survey of a representative cohort.

SETTING

A statewide, population-based registry and follow-up system for persons hospitalized with TBI.

PARTICIPANTS

A total of 1591 adult Coloradoans with moderate and severe injury oversampled, but weighted to be representative of persons hospitalized with TBI (1996-1999) who survived their injuries and completed follow-up telephone interviews at 1 year postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Checklists of symptoms and service utilization, the FIM instrument trade mark, the Craig Handicap Assessment and Reporting Technique Short Form, a single-item quality of life (QOL) measure, and a needs assessment checklist.

RESULTS

Problematic outcomes occurring at 1 year postinjury included one third or more being bothered by fatigue, feeling irritable or grouchy, having headaches, and experiencing trouble sleeping more frequently than preinjury; 37% reported needing the assistance of another person in physical and/or cognitive activities of daily living; substantial participation restrictions were noted in areas of occupation (30%) and social integration (22%); and 29% responded that their QOL was only fair or poor. Negative outcomes were reported more frequently among individuals who were more severely injured, older, or female.

CONCLUSIONS

Substantial percentages of people hospitalized with TBI in a population-based sample reported a variety of problematic outcomes at 1 year postinjury.

Systematic bias in traumatic brain injury outcome studies because of loss to follow-up

OBJECTIVE

To identify potential sources of selection bias created by subjects lost to follow-up in studies of traumatic brain injury (TBI).

DESIGN

Demographic, premorbid, injury-related, and hospital course characteristics were compared for subjects lost and found for 1- and 2-year postinjury follow-ups by using bivariate tests and logistic regression analysis.

SETTING

Three prospective, longitudinal data sets-a single center, a multicenter, and a statewide incidence surveillance system and follow-up registry.

PARTICIPANTS

Adolescents and adults hospitalized with a diagnosis of TBI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Subjects were considered lost when no information was collected from the person with TBI or only limited information could be obtained from a proxy, for any reason, including death, refusal, inability to locate, and inability to interview.

RESULTS

At year 1 follow-up, 58.0% to 58.6% of subjects were found; 39.7% to 42.0% of subjects were found by year 2. Variables most frequently associated with loss to follow-up were cause of injury, blood alcohol level, motor function, hospital payer source, and race and ethnicity.

CONCLUSIONS

TBI follow-up studies may experience selective attrition of subjects who (1) are socioeconomically disadvantaged, (2) have a history of substance abuse, and (3) have violent injury etiologies. These phenomena are mitigated for those with more severe motor deficits. Loss to follow-up may be a problem inherent to this population; however, the high rate and its selective nature are problematic for outcome studies.