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Cragg J.J.,University of Sfax | Noonan V.K.,Rick Hansen Institute | Krassioukov A.,International Collaboration on Repair Discoveries ICORD | Krassioukov A.,Strong Rehabilitation Center | And 3 more authors.
Neurology | Year: 2013

Objective: To evaluate the association between cardiovascular disease (CVD) and spinal cord injury (SCI) in a large representative sample. Methods: 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. Results: After adjusting for age and sex, SCI was associated with a significant increased odds of heart disease (adjusted odds ratio [OR] 5 2.72, 95%confidence interval [CI] 1.94-3.82) and stroke (adjusted OR 5 3.72, 95% CI 2.22-6.23). Conclusions: These remarkably heightened odds highlight the exigent need for targeted interventions and prevention strategies addressing modifiable risk factors for CVD in individuals with SCI. © 2013 American Academy of Neurology. Source

Cragg J.J.,University of Sfax | Noonan V.K.,Rick Hansen Institute | Krassioukov A.,International Collaboration on Repair Discoveries | Krassioukov A.,Strong Rehabilitation Center | And 4 more authors.
Neurology | Year: 2013

Objective: The objective of this study was to evaluate the association between spinal cord injury (SCI) and type 2 diabetes in a large representative sample and to determine whether an association exists irrespective of known risk factors for type 2 diabetes. Methods: Data were obtained on 60,678 respondents to the Statistics Canada 2010 Cycle of the cross-sectional Canadian Community Health Survey. Multivariable logistic regression, incorporating adjustment for confounders and probability weights to account for the Canadian Community Health Survey sampling method, was conducted to quantify this association. Results: After adjustment for both sex and age, SCI was associated with a significant increased odds of type 2 diabetes (adjusted odds ratio 5 1.66, 95%confidence interval 1.16-2.36). These heightened odds persisted after additional adjustment for smoking status, hypertension status, body mass index, daily physical activity, alcohol intake, and daily consumption of fruits and vegetables (fully adjusted odds ratio 5 2.45, 95% confidence interval 1.34-4.47). Conclusions: There is a strong association between SCI and type 2 diabetes, which is not explained by known risk factors for type 2 diabetes. © 2013 American Academy of Neurology. Source

Noreau L.,Laval University | Noonan V.,Rick Hansen Institute | Noonan V.,University of British Columbia | Cobb J.,Rick Hansen Institute | And 2 more authors.
Topics in Spinal Cord Injury Rehabilitation | Year: 2014

To better understand service-related needs and the current situation of persons with spinal cord injury (SCI) living in the community, a more comprehensive approach for studying their interrelationships (needs vs community living outcomes) is greatly needed. Objective: To describe the development, design, and findings of a Canadian survey portraying the life situation of people with SCI. Method: The SCI Community Survey covers demographics, health, SCI-specific needs, community participation, employment, quality of life, health care utilization, and overall health rating. A total of 1,549 persons with SCI completed the survey (Web or phone) between May 2011 and August 2012. Results: Some major expressed needs for services to support community living are met to a great extent for a substantial proportion of people with SCI. Complications remain highly prevalent for some health issues, including pain, sexual dysfunction, and musculoskeletal disorders. The extent of community participation based on values and preferences varies tremendously among daily activities and social roles. Some dimensions of quality of life are rated positively (eg, family life) while others are greatly disrupted (eg, sex life and physical health). Most of these findings vary significantly between people with traumatic and nontraumatic lesions. Conclusion: This survey is the first in Canada and among the first worldwide to draw a comprehensive picture of major aspects of the lives of people with SCI including service needs. The results will help to determine the links between various aspects of community living and guide service providers and policy makers in focusing on major issues to enhance quality of life after SCI. © 2014 Thomas Land Publishers, Inc. Source

Young M.,St. Pauls Hospital | Fallah N.,Rick Hansen Institute | Forooghian F.,St. Pauls Hospital
Retina | Year: 2015

Purpose: The purpose of the study was to determine if progressive choroidal changes occur in birdshot chorioretinopathy (BSCR). Methods: Retrospective chart review of all patients with BSCR who were seen over a 3-year period. Controls consisted of healthy age-matched and gender-matched patients. Choroidal thickness at baseline and final follow-up visit was measured with the use of optical coherence tomography. Results were analyzed using univariate and multivariable statistical models. Results: A total of 11 patients (22 eyes) with BSCR were identified. The majority of BSCR eyes (86%) had clinically inactive disease. Follow-up ranged from 2 months to 27 months. Mean age was 55 years. Patients with BSCR had significantly thinner choroid compared with controls (P < 0.001). Furthermore, the rate of choroid thinning for patients diagnosed with BSCR (2.68 m per month) was significantly higher than that of controls (0.27 m per month) (P 0.003). There was no statistically significant difference in the rate of choroidal thinning between the two eyes of patients with BSCR (P 0.859), indicating that the choroidal thinning was symmetrical. Conclusion: Despite having clinically inactive uveitis, eyes with BSCR can develop progressive choroidal thinning. The clinical relevance of this choroidal thinning, or degeneration, remains to be fully elucidated. Source

Schouten R.,Christchurch Hospital | Lewkonia P.,University of Calgary | Noonan V.K.,Rick Hansen Institute | Dvorak M.F.,University of British Columbia | Fisher C.G.,University of British Columbia
Journal of Neurosurgery: Spine | Year: 2015

OBJECT: The aim of this study was to define the expected functional and health-related quality of life outcomes following common thoracolumbar injuries on the basis of consensus expert opinion and the best available literature. Patient expectations are primarily determined by the information provided by health care professionals, and these expectations have been shown to influence outcome in various medical and surgical conditions. This paper presents Part 2 of a multiphase study designed to investigate the impact of patient expectations on outcomes following spinal injury. Part 1 demonstrated substantial variability in the information surgeons are communicating to patients. Defining the expected outcomes following thoracolumbar injury would allow further analysis of this relationship and enable surgeons to more accurately and consistently inform patients. METHODS: Expert opinion was assembled by distributing questionnaires comprising 4 cases representative of common thoracolumbar injuries to members of the Spine Trauma Study Group (STSG). The 4 cases included a thoracolumbar junction burst fracture treated nonoperatively or with posterior transpedicular instrumentation, a low lumbar (L-4) burst fracture treated nonoperatively, and a thoracolumbar junction flexion-distraction injury managed with posterior fusion. For each case, 5 questions about expected outcomes were posed. The questions related to the proportion of patients who are pain free, the proportion who have regained full range of motion, and the patients' recreational activity restrictions and personal care and social life limitations, all at 1 year following injury, as well as the timing of return to work and length of hospital stay. Responses were analyzed and combined with the results of a systematic literature review on the same injuries to define the expected outcomes. RESULTS: The literature review identified 38 appropriate studies that met the preset inclusion criteria. Published data were available for all injuries, but not all outcomes were available for each type of injury. The survey was completed by 31 (57%) of 53 surgeons representing 24 trauma centers across North America (15), Europe (5), India (1), Mexico (1), Japan (1) and Israel (1). Consensus expert opinion supplemented the available literature and was used exclusively when published data were lacking. For example, 1 year following cast or brace treatment of a thoracolumbar burst fracture, the expected outcomes include a 40% chance of being pain free, a 70% chance of regaining pre-injury range of motion, and an expected ability to participate in high-impact exercise and contact sport with no or minimal limitation. Consensus expert opinion predicts reemployment within 4-6 months. The length of inpatient stay averages 4-5 days. CONCLUSIONS: This synthesis of the best available literature and consensus opinion of surgeons with extensive clinical experience in spine trauma reflects the optimal methodology for determining functional prognosis after thoracolumbar trauma. By providing consistent, accurate information surgeons will help patients develop realistic expectations and potentially optimize outcomes. ©AANS, 2015. Source

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