PubMed Health⌕ Search

Biomedical subjects

Michael J DeVivo

Publications and source records attributed to Michael J DeVivo.

12 recordsLinked to original sources
PubMed2006

Worklife after traumatic spinal cord injury.

OBJECTIVE: To develop predictive models to estimate worklife expectancy after spinal cord injury (SCI). DESIGN: Inception cohort study. SETTING: Model SCI Care Systems throughout the United States. PARTICIPANTS: 20,143 persons enrolled in the National Spinal Cord Injury Statistical Center database since 1973. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Postinjury employment rates and worklife expectancy. RESULTS: Using logistic regression, we found a greater likelihood of being employed in any given year to be significantly associated with younger age, white race, higher education level, being married, having a nonviolent cause of injury, paraplegia, ASIA D injury, longer time postinjury, being employed at injury and during the previous postinjury year, higher general population employment rate, lower level of Social Security Disability Insurance benefits, and calendar years after the passage of the Americans with Disabilities Act. CONCLUSIONS: The likelihood of postinjury employment varies substantially among persons with SCI. Given favorable patient characteristics, worklife should be considerably higher than previous estimates.

Adult↗
PubMed2004

Microbiology of the urethra and perineum and its relationship to bacteriuria in community-residing men with spinal cord injury.

OBJECTIVE: Reasons why some persons with spinal cord injury (SCI) experience recurrent urinary tract infections more than others are poorly understood. We performed a prospective study of bacterial flora of the urethra and perineum in men with and without bacteriuria to understand more completely the relationship between bacterial colonization and invasion of the urinary tract. METHODS: Urine, urethra, and perineum cultures were obtained from 70 men. Microbial flora of these sites was compared for men with and without bacteriuria. RESULTS: Urine colony count was 0 in 16 (22.9%) men. Perinea in 2 men (12.5%) and urethras in 6 men (37.5%) were colonized with various gram-negative bacilli, enterococci, and/or Staphylococcus aureus. Among 54 (77.1%) men with bacteriuria, uropathogens were shown in the perineum in 31 (57.4%) and in the urethra in 46 (85.2%). In 40 (74.1%) of men with bacteriuria, at least one bacterial species present in the urine was also found in the urethra and/or perineum. Differences in the occurrence of uropathogens in men with and without bacteriuria were statistically significant, and organisms were present in higher numbers in men with bacteriuria. CONCLUSION: Men with SCI who have bacteriuria are significantly more likely to be colonized in the distal urethra and perineum with uropathogens that are often present in the urine in comparison with men without bacteriuria.

Adult↗
PubMed2004

Effect of cranberry extract on bacteriuria and pyuria in persons with neurogenic bladder secondary to spinal cord injury.

OBJECTIVE: To determine whether antibacterial effects of cranberry extract will reduce or eliminate bacteriuria and pyuria in persons with spinal cord injury (SCI). DESIGN: Randomized, double-blind, placebo-controlled study. PARTICIPANTS: Participants were people with SCI residing in the community who were 1 year or longer postinjury with neurogenic bladder managed by intermittent catheterization or external collection device and a baseline urine culture demonstrating at least 10(5) colonies per milliliter of bacteria. METHODS: Each participant ingested 2 g of concentrated cranberry juice or placebo in capsule form daily for 6 months. Baseline urinalysis and cultures were performed at the time of the initial clinic visit and monthly for 6 months. Microbiologic data were evaluated using analysis of variance with repeated measures. RESULTS: Twenty-six persons received cranberry extract and 22 persons received placebo. There were no differences or trends detected between participants and controls with respect to number of urine specimens with bacterial counts of at least 10(4) colonies per milliliter, types and numbers of different bacterial species, numbers of urinary leukocytes, urinary pH, or episodes of symptomatic urinary tract infection. CONCLUSION: Cranberry extract taken in capsule form did not reduce bacteriuria and pyuria in persons with SCI and cannot be recommended as a means to treat these conditions.

Adult↗
PubMed2004

Epidemiology of spinal cord injury in children and adolescents.

OBJECTIVE: To describe the unique aspects of the epidemiology of pediatric-onset spinal cord injury (SCI). METHODS: The characteristics of persons with SCI enrolled in either the Shriners Hospitals for Children SCI database or the National SCI Statistical Center database from 1973 through 2002 were evaluated based on age at time of injury (0-5 years, 6-12 years, 13-15 years, 16-21 years, and 22 years and older). RESULTS: Males comprised a consistently decreasing proportion of new cases of SCI, ranging from 83% among persons between 16 and 21 years of age to only 51% among those aged 0 to 5 years. Among children and adolescents (under the age of 22), the proportion of SCI due to motor vehicle crashes was higher than in adults (22+ years). Sports, violence, and medical or surgical complications also accounted for a significantly greater proportion of SCI in teenagers (13-21 years) than in adults. Violence has become the leading cause of SCI among African American and Hispanic teenage males (13-21 years), whereas vehicular crashes are more common among African American and Hispanic men of older ages (22 years of age and above). Approximately one third of new cases of SCI in the youngest two age groups (0-5 years, 6-12 years) had cervical injuries compared with almost one half in the older age groups (age 13 and above). SCI was much more likely to be neurologically complete in younger persons (69% age 0-5 years vs 51% age > or = 16 years). CONCLUSION: The pediatric-onset SCI population is heterogeneous and exhibits distinct epidemiologic characteristics both within the different pediatric age groups and with the adult-onset SCI population.

Adolescent↗
PubMed2003

Age and spinal cord injury: an emphasis on outcomes among the elderly.

OBJECTIVES: Determine the unique effects of age across a variety of outcome domains following spinal cord injury (SCI). DESIGN: Cross-sectional; 6132 individuals with traumatic onset SCI in the National Spinal Cord Injury Statistical Center (NSCISC) database. OUTCOME MEASURES: Functional Independence Measure (FIM), Satisfaction With Life Scale (SWLS), the Craig Handicap Assessment and Reporting Technique (CHART), and the Short Form-12 (SF-12). RESULTS: Older age was most consistently associated with decreased self-reported outcomes across most domains assessed. More specifically, a significant linear decline with age was found for functional independence (FIM), overall life satisfaction (SWLS), perceived physical health (SF-12 physical health), and overall handicap (CHART-total score), particularly in the areas of physical independence, mobility, occupational functioning, and social integration (CHART subscales). However, regression analyses, controlling for numerous demographic and medical characteristics, indicated that the amount of unique variance that could be specifically attributed to age was relatively small. Age was unrelated to self-reported mental health (SF-12 mental health subscale) and economic functioning (CHART-economic self-sufficiency subscale). Pain interference in day-to-day activities (ie, a single item from SF-12) significantly increased with age. CONCLUSION: There is a small but consistent decline with age in several outcome domains following SCI. Follow-up longitudinal studies should help tease a part possible cohort effects from the effects of age.

Activities of Daily Living↗
PubMed2002

Recurrent kidney stone: a 25-year follow-up study in persons with spinal cord injury.

OBJECTIVES: To document the recurrence rate of kidney stones in patients with spinal cord injury and to assess the potential contributing factors and long-term renal function outcome. METHODS: A consecutive sample of 77 patients with initial kidney stones followed up on a yearly basis between 1973 and 1999 was used to estimate stone recurrence, stratified by demographic and clinical characteristics. Longitudinal data analyses were performed to assess the change in renal function over time among various post-treatment outcomes. RESULTS: During an average of 7 years (range 1 to 21) of follow-up after the initial stone episode, 19 patients with recurrence, 15 with residual stones, and 43 who were stone free were documented. It was estimated that approximately 34% of the patients with an initial stone would develop a second stone episode within 5 years. This figure did not significantly change during the past 25 years (P = 0.18). Stone recurrence was two or more times greater for men than for women, for whites than for blacks, and for tetraplegics than for paraplegics, but the differences were not statistically significant (P >0.05). Renal function did not significantly decline over time for any of the post-treatment outcomes of the initial stones. CONCLUSIONS: Despite marked improvement in urologic rehabilitation, little progress has been made during the past 25 years in reducing stone recurrence in persons with spinal cord injury. Future studies are required to determine the critical components of the causal pathway to stone formation, which may lead to the establishment of effective prophylactic interventions.

Adolescent↗
PubMed2002

Interference due to pain following spinal cord injury: important predictors and impact on quality of life.

Two studies were designed to examine important predictors of pain following spinal cord injury (SCI), and the impact of pain on self-reported quality of life (QOL). Pain was defined as "interference in day-to-day activities secondary to pain". In order to determine risk factors associated with the development of pain interference, Study 1 examined the predictive validity of multiple demographic, medical, and QOL variables at year 1 post-SCI to self-reported pain interference 2 years post-injury. Results showed that middle age (30-59-year-olds), lower self-reported mental health, and pain interference at 1 year post-SCI were the most important unique predictors of pain interference 2 years post-SCI. In Study 2, participants were separated into four groups; (1) those pain-free at years 1 and 2, (2) those pain-free at year 1 and in pain at year 2, (3) those in pain at year 1 and pain-free at year 2, and (4) those in pain at years 1 and 2. Results showed that only those experiencing a change in pain interference status reported a change in QOL. More specifically, those developing pain interference (group 2) from year 1 to year 2 reported decreased life satisfaction, physical health, and mental health, whereas, those with resolving pain interference from year 1 to year 2 reported an increase in these same domains. Unexpectedly, change in pain interference status was unrelated to change in self-reported handicap. Implications and future directions are discussed.

Activities of Daily Living↗
PubMed2002

Predictors of life satisfaction: a spinal cord injury cohort study.

OBJECTIVE: To determine unique demographic, medical, perceived health, and handicap predictors of life satisfaction 2 years after spinal cord injury (SCI), as well as the predictors of change in life satisfaction from year 1 to year 2. DESIGN: Prospective predictive study performed by using longitudinal data from 18 Spinal Cord Injury Model Systems. SETTING: University physical medicine and rehabilitation department. PARTICIPANTS: Adults with traumatic onset SCI (N = 940) evaluated at 1 and 2 years' postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Satisfaction with Life Scale (SWLS) 2 years post-SCI. PREDICTOR VARIABLES: demographic characteristics, impairment and disability classifications, and 1 year post-SCI measures of life satisfaction (SWLS), medical complications, self-perceived health (Medical Outcomes Study 12-Item Short-Form Health Survey), and extent of handicap (Craig Handicap Assessment and Reporting Technique). RESULTS: The factors uniquely associated with an increased risk of lower self-reported life satisfaction at year 2 post-SCI included being male and unemployed, with poor perceived health, decreased mobility, and decreased social integration. After controlling for year 1 estimates of life satisfaction (ie, examining change in life satisfaction), only mobility and perceived health were uniquely related to life satisfaction 2 years post-SCI. CONCLUSION: Mobility and perceived health appear to be the consistent predictors of life satisfaction at year 2 post-SCI, as well as change in satisfaction from year 1 to year 2. Because both factors are amenable to change, they are reasonable targets of intervention programs. Identifying specific mechanisms of perceived health and mobility associated with life satisfaction should be an important area of continued research.

Adult↗
PubMed2002

Overview of the national spinal cord injury statistical center database.

OBJECTIVE: An evaluation of the history, design, and status of the database of the National Spinal Cord Injury Statistical Center (NSCISC) was undertaken to identify its continued relevance. RESEARCH DESIGN: A systematic review was conducted of goals, content, and quality control procedures, as well as its suitability and public availability for conducting future epidemiologic and health services research. RESULTS: The NSCISC database contains information on approximately 29,000 persons injured since 1973 and treated at any regional model spinal cord injury system within 1 year of injury. The NSCISC database is structured longitudinally with data collected at discharge, 1 year after injury, 5 years after injury, and every 5 years thereafter. The database includes information on demographics, injury severity, medical complications, surgical procedures, types and amounts of therapy, length of stay, charges, and both short-term and long-term treatment outcomes. Strengths include large sample size, use of valid and reliable measures, geographic and patient diversity, comprehensiveness, availability of long-term prospective follow-up information, good case identification, and rigorous quality control procedures. Limitations include lack of population basis, inclusion of only model system patients, losses to follow-up, and other missing data. Recent content additions include detailed information on each treatment phase, depression, substance abuse, environmental barriers to community integration, and patient identifying information. A process exists for researchers to gain access to the data. CONCLUSIONS: The database remains a valuable resource. Future plans include linkage to other databases to enhance research capability, a published research compendium, and development of a user's guide to facilitate database usage.

Databases as Topic↗
PubMed2002

Providing SCI education during changing times.

The educational role of the spinal cord injury (SCI) nurse has changed with the ongoing developments in health care. Current statistics show that length of stay during both acute care and rehabilitation has shortened dramatically. This fact, along with new formats for locating and obtaining educational materials, are a few of the challenges that SCI nurses face in providing essential SCI education. The Rehabilitation Research and Training Center on Secondary Conditions of SCI, and the Model SCI Care Center at the University of Alabama at Birmingham, produce a number of accessible and affordable SCI educational materials. These materials are available through various electronic formats, including the Internet, e-mail, and fax. SCI nurses can use these resources to provide individuals the information needed to handle their long-term health care needs following their injuries.

Humans↗