Physical Capacity and Complications During and After Inpatient Rehabilitation for Spinal Cord Injury

A spinal cord injury (SCI) is an interruption of the neural pathways in the spinal canal and is characterized by muscle weakness, loss of sensation and autonomic dysfunction below the level of the lesion. The extent of these neurological deficits is determined by both the level and completeness of the lesion. A complete lesion results in loss of motor function and sensation in the lowest sacral segment whereas, following an incomplete lesion function in this segment is maintained.1 The SCI can either have a traumatic or a non-traumatic cause. In traumatic cases, injury is typically the result of a traffic or sporting accident, but an increasing number of injuries result from a low impact fall, for example, in those with osteoporosis.2,3 A non-traumatic SCI may be caused by metastasis, infection and spinal haemorrhage or infarction.3,4 An estimated 183 new traumatic SCI occur in The Netherlands per year, of whom 154 survive hospitalization, which corresponds to an incidence of over 10 per 1,000,000 per year.2 The incidence of non-traumatic SCI is easily underestimated because many are not registered as SCI, but this incidence largely exceeds the incidence of traumatic injuries.2,4‑6 As compared to the able-bodied population, the life expectancy of those with SCI is reduced. For example, a 20-year-old man with a traumatic paraplegia has an estimated life expectancy of 46 years, whereas an able-bodied man the same age, will have another 58 years to live.3,7 However, because the treatment of complications has improved over the past decades, the life expectancy following SCI has increased.2 Although the life expectancy may have improved, many patients report a low level of functioning and well-being.8‑10 Functioning following SCI may be threatened because most patients have complications, have a low physical capacity, and depend on others for daily activities.6,9,11,12 Therefore, it is important to investigate opportunities to optimize functioning following SCI

Borstvoeding in de eerste zes maanden:een focusgroep studie naar redenen en motieven van vrouwen om gedeeltelijk of geheel te stoppen met het geven van borstvoeding in de eerste 6 maanden

Deze focusgroep studie geeft inzicht in de redenen en motieven van vrouwen om vroegtijdig te stoppen met het geven van borstvoeding of om vroegtijdig kunstvoeding te gaan geven. De resultaten van dit onderzoek zijn gebaseerd op een kwalitatief onderzoek met 10 focusgroepen met in totaal 69 vrouwen die op het moment van het onderzoek borstvoeding gaven aan hun kind maar die vroegtijdig kunstvoeding gingen geven naast de borstvoeding (voordat de baby 6 maanden oud was), en vrouwen die borstvoeding hebben gegeven maar die op het moment van het onderzoek, voordat de baby 6 maanden oud was, daarmee waren gestopt. Het doel van het onderzoek is niet geweest om kwantitatieve gegevens op te leveren; daartoe is kwantitatief vervolgonderzoek nodig

Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation

Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143). Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations. © 2007 Foundation of Rehabilitation Information

"In a situation of rescuing life"

Background: Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. Methods: To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework. Results: In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms—like headache, fever, and tiredness—were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes. Conclusion: The meanings given to diabetes symptoms and the care-seeking practices described in the study are shaped by the prevailing cultural schemas for infectious diseases and their treatments. Efforts to educate people about the symptoms of diabetes and to encourage them to seek out appropriate care should build on the prevailing cultural meaning system and schemas for diseases, health and illness

Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature.

To review the evidence of thromboembolism incidence and prophylaxis in the sub-acute phase of spinal cord injury (SCI) 3-6 months post injury. All observational and experimental studies with any length of follow-up and no limitations on language or publication status published up to March 2015 were included. Two review authors independently selected trials for inclusion and extracted data. Outcomes studied were incidence of pulmonary embolism (PE) and deep vein thrombosis (DVT) in the sub-acute phase of SCI. The secondary outcome was type of thromboprophylaxis. Our search identified 4305 references and seven articles that met the inclusion criteria. Five papers reported PE events and three papers reported DVT events in the sub-acute phase of SCI. Studies were heterogeneous in populations, design and outcome reporting, therefore a meta-analysis was not performed. The included studies report a PE incidence of 0.5%-6.0% and DVT incidence of 2.0%-8.0% in the sub-acute phase of SCI. Thromboprophylaxis was poorly reported. Spinal patients continue to have a significant risk of PE and DVT after the acute period of their injury. Clinicians are advised to have a low threshold for suspecting venous thromboembolism in the sub-acute phase of SCI and to continue prophylactic anticoagulation therapy for a longer period of time