An empty heart Cragg, Jacquelyn J
Canadian Medical Association journal (CMAJ),
05/2024, Letnik:
196, Številka:
20
Journal Article
Recenzirano
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Cragg shares her experience of losing their father to a home invasion and their subsequent grief and decision to use their skills as an epidemiologist to study fatal stab wounds. Her father was ...brutally killed when she was eight years old. The intruder stabbed him so violently that he broke the knife on a bone in her father's leg. His killer was convicted of second-degree murder and spent 25 years in prison. Last year, the killer had died. While she never expected to grieve the loss of the man who killed her father, she mourned the missed opportunity for him to make amends and find redemption. To find meaning in his death, she turned to my love for numbers and decided to research the epidemiology of fatal stab wounds. She examines trends, geographical distributions, and factors affecting outcomes. Although this research cannot bring her father back, it may help others who have lost loved ones in a similar way.
To evaluate the association between cardiovascular disease (CVD) and spinal cord injury (SCI) in a large representative sample.
Data were compiled from more than 60,000 individuals from the 2010 ...cycle of the cross-sectional Canadian Community Health Survey (CCHS). Multivariable logistic regression analysis was conducted to examine this relationship, adjusting for confounders and using probability weighting to account for the CCHS sampling method.
After adjusting for age and sex, SCI was associated with a significant increased odds of heart disease (adjusted odds ratio OR = 2.72, 95% confidence interval CI 1.94-3.82) and stroke (adjusted OR = 3.72, 95% CI 2.22-6.23).
These remarkably heightened odds highlight the exigent need for targeted interventions and prevention strategies addressing modifiable risk factors for CVD in individuals with SCI.
Spinal cord injury is a severely disabling neurological condition leading to impaired mobility, pain, and autonomic dysfunction. Most often, a single traumatic event, such as a traffic or ...recreational accident, leads to primary spinal cord damage through compression and laceration, followed by secondary damage consisting of inflammation and ischaemia, and culminating in substantial tissue loss. Patients need appropriate timely surgical and critical care, followed by neurorehabilitation to facilitate neuronal reorganisation and functional compensation. Although some neurological function might be regained, most patients with initially complete lesions have severe, irreversible neurological impairment. Cell-based and stem-cell-based therapies are recognised as promising candidates to promote functional recovery. However, no trials of these therapies in patients have yet provided reproducible evidence for clinical efficacy, challenged by small effect sizes, low immune suppression, and low sensitivity study designs. Nevertheless, in the past decade, clinical trials have shown the feasibility and long-term safety of cell transplantation into the injured spinal cord. This crucial milestone has paved the way to consider refinements and combined therapies, such as the use of biomaterials to augment the effects of cell transplantation. In the future, emerging cell types, scaffolding, and cell engineering might improve cell survival, integration, and therapeutic efficiency.
Findings from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) have provided valuable insight into the descriptive epidemiology of diseases and injuries for many countries over ...time.1 GBD 2019 approximates incidence, prevalence, and years of life lived with disability (YLDs) for more than 350 unique diseases and injuries for 204 countries and territories from 1990 to 2019.2 Among these diseases and injuries is spinal cord injury, a debilitating neurological condition that can result in lifelong disability and costly medical care, which has become a global health priority owing to the preventability of some injuries. For the GBD 2019 spinal cord injury findings to reliably “facilitate health-care planning, especially in terms of guiding evidence-based prevention and resource allocation”,5 readers must understand the data from which the estimates were derived, including all data items outlined in the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).7 GATHER consists of a checklist of 18 items that are essential for best practice reporting in studies that use many information sources to compute health estimates for more than one population.7 Although the GBD Spinal Cord Injuries Collaborators acknowledge that data were unavailable for 111 (54%) of 204 countries studied, data availability is not explicitly reported by country for each year. Valid self-report proxies of spinal cord injury, its severity, and its completeness are also needed; for example, self-reported spinal cord injury in population-based surveys can be confused with lower back injuries.8 With respect to increasing the volume of spinal cord injury data that are collected, greater awareness of health registries and administrative claims data sources (consisting of insurance claims and electronic health data), and their value, is needed among researchers.
Physical activity is a powerful modifiable risk factor for disease and mortality. Physical activity levels in people with spinal cord injury (SCI) have not been quantified relative to uninjured ...individuals in a large population-based sample. We aimed to quantify and compare physical activity in people with and without SCI, and to examine the associations between physical activity, lifestyle, and socioeconomic factors. The 2010 Canadian Community Health Survey (n > 57,000) was used, which includes three measures that assess physical activity levels (i.e., leisure time activity frequency, leisure time activity intensity, and transportation time activity intensity). Bivariable and multivariable logistic regressions were performed and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were estimated. The odds of physical activity in people with SCI were 0.43 (95% CI 0.3-0.61), 0.53 (95% CI 0.36-0.75), and 0.42 (95% CI 0.28-0.61), across the three measures of physical activity, respectively. These differences persisted after adjustment for lifestyle, comorbidities, and socioeconomic factors. Physical activity is reduced in the SCI population compared with the general population. This knowledge is important to direct future research and guide the allocation of health care resources.
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