Cohort Profile of the International Spinal Cord Injury Community Survey Implemented in 22 Countries

Objectives: To detail the methodological features of the first International Spinal Cord Injury (InSCI) Community Survey by describing recruitment and data collection procedures, and to report on the recruitment results and basic characteristics of participants by country and income setting. Design: Cross-sectional survey. Setting: Community setting in 22 countries representing all 6 World Health Organization regions. Participants: Individuals (N = 12,591) with traumatic or non-traumatic spinal cord injury (SCI) aged over 18 years. Interventions: Not applicable. Main Outcome Measures: Recruitment and data collection procedures, recruitment results, and basic sociodemographic and lesion characteristics of participants. Results: Eight countries used predefined sampling frames and 14 countries applied convenience sampling for recruitment. Most countries recruited participants through specialized rehabilitation facilities, patient organizations, or acute and general hospitals. Modes of approaching potential participants depended on the sampling strategy and multiple response modes were offered to maximize participation. Contact rates ranged from 33% to 98%, cooperation rates ranged from 29% to 90%, and response rates ranged from 23% to 54%. The majority of participants were men (73%), the median age was 52 years (interquartile range, 40-63y), 60% had a partner, 8% reported that they were born in another country than where they were currently residing, and the median length of education was 12 years (interquartile range, 9-15y). Paraplegia was the main diagnosis (63%), traumatic etiologies were the major cause of injury (81%), and the median time since injury (TSI) was 9 years (interquartile range, 4-19y). Compared with participants from lower income settings, participants from higher income settings were over-represented and, in general, were older, more often diagnosed with tetraplegia, had a longer TSI, higher education, and were more often born in a country different than their current residence country. Conclusions: The successful implementation of the InSCI survey enables the comparison of the situation of individuals with SCI around the world and constitutes a crucial starting point for an international learning experience. (C) 2020 by the American Congress of Rehabilitation Medicin

Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey

Spinal cord injury; Aging; EuropeLesión de la médula espinal; Envejecimiento; EuropaLesió de la medul·la espinal; Envelliment; EuropaBackground As the European population with Spinal Cord Injury (SCI) is expected to become older, a better understanding of ageing with SCI using functioning, the health indicator used to model healthy ageing trajectories, is needed. We aimed to describe patterns of functioning in SCI by chronological age, age at injury and time since injury across eleven European countries using a common functioning metric, and to identify country-specific environmental determinants of functioning. Methods Data from 6’635 participants of the International Spinal Cord Injury Community Survey was used. The hierarchical version of Generalized Partial Credit Model, casted in a Bayesian framework, was used to create a common functioning metric and overall scores. For each country, linear regression was used to investigate associations between functioning, chronological age, age at SCI or time since injury for persons with para- and tetraplegia. Multiple linear regression and the proportional marginal variance decomposition technique were used to identify environmental determinants. Results In countries with representative samples older chronological age was consistently associated with a decline in functioning for paraplegia but not for tetraplegia. Age at injury and functioning level were associated, but patterns differed across countries. An association between time since injury and functioning was not observed in most countries, neither for paraplegia nor for tetraplegia. Problems with the accessibility of homes of friends and relatives, access to public places and long-distance transportation were consistently key determinants of functioning. Conclusions Functioning is a key health indicator and the fundament of ageing research. Enhancing methods traditionally used to develop metrics with Bayesian approach, we were able to create a common metric of functioning with cardinal properties and to estimate overall scores comparable across countries. Focusing on functioning, our study complements epidemiological evidence on SCI-specific mortality and morbidity in Europe and identify initial targets for evidence-informed policy-making

De las catacumbas a los últimos confines: violencia, sentido y representación en los periplos del martirio

En este trabajo propongo un análisis transversal de las figuras del mártir y del martirio. Recurriendo a la noción de mediación, en la primera parte analizo el rol protagónico de las representaciones del martirio en las prácticas de la memoria durante la segunda mitad del siglo XVI. Analizo algunas de las condiciones que contribuyeron a la emergencia de una "cultura del martirio" y el rol de las mediaciones en tal surgimiento. En la segunda parte, estudio la forma en que el (re)descubrimiento de las catacumbas romanas, abrió un campo de producción de sentido en torno a la figura del martirio. En la tercera parte, centrándome en la Compañía de Jesús, analizo algunas mediaciones a través de las cuáles las figuras del martirio transgredieron las fronteras de iglesias y conventos para proyectarse a los últimos confines en un mundo en plena expansión.Neste artigo proponho uma análise transversal das figuras do mártir e do martírio. Usando a noção de mediação, na primeira parte eu tento analisar o papel de liderança de representações de martírio em práticas de memória durante a segunda metade do século XVI. Eu analiso algumas das condições que contribuíram para o surgimento de uma "cultura do martírio" e o papel da mediação nesta emergência. Na segunda parte, eu estudo como a (re) descoberta das catacumbas romanas abriu um campo de produção de significados em torno da figura do martírio. Na terceira parte, com foco na Companhia de Jesus, analiso algumas mediações pelas quais as representações do martírio transgrediram as fronteiras de igrejas e conventos para se projetar nas fronteiras de um mundo em plena expansão mundial.This paper proposes a cross-sectional analysis of martyr and martyrdom. Through the notion of mediation, in the first part I analyze the leading role of representations of martyrdom in memory practices during the second half of the sixteenth century. I analyze some of the conditions that contributed to the emergence of a "martyrdom's culture" and the role of mediation in such emergence. The second part studies how the (re)discovery of the Roman catacombs encouraged the production of meanings around the figure of martyrdom. In the third part, focusing on the Society of Jesus, I analyze a few instances of mediation through which the figures of martyrdom transgressed the boundaries of churches and convents to project themselves to the last frontiers of a world in full expansion.Fil: Salamanca Villamizar, Carlos Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

IMPACT OF SPASTICITY ON FUNCTIONING IN SPINAL CORD INJURY: AN APPLICATION OF GRAPHICAL MODELLING

Objective: To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Design: Secondary analysis of cross-sectional survey data using graphical modelling. Subjects: Individuals (n= 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Methods: Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation - Participation. Results: Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion. Conclusion: This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.Funding Agencies|Swiss Spinal Cord Injury Cohort Study (SwiSCI) - Swiss Paraplegic Foundation</p