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Morgan KA, Desai RH, Trocinski CW, Hollingsworth H, Dashner J, Putnam M, Stark SL. The Relationship of Exercise, Psychosocial Factors, and Social Participation Among Adults Aging With Long-Term Physical Disability: A Cross-Sectional Study. Am J Health Promot 2024; 38:683-691. [PMID: 38340072 DOI: 10.1177/08901171241233087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
PURPOSE This study investigated the relationships among exercise engagement, psychosocial factors, and social participation for adults aging with physical disabilities (AAwPD). DESIGN A cross-sectional study within a community-based cohort study of participation among AAwPD was conducted. SETTING A comprehensive survey was administered online or via telephone. PARTICIPANTS Participants were 474 individuals between the ages of 45-65, primarily living in the Midwestern United States, who reported living with a physical disability for at least 5 years. METHOD Survey questions created based on prior consolidation of activity domains assessed exercise engagement. Psychosocial health and social participation were measured using the Patient Reported Outcomes Measurement Information System. Chi-square tests, t-tests, and a general linear model were used to examine differences between exercisers and non-exercisers. RESULTS Participants who exercised reported less pain (P < .001), fatigue (P < .001), and depression (P < .001) and greater self-efficacy for management of chronic conditions (P = .002), satisfaction with participation in social roles and activities (P < .001), and ability to participate in social roles and activities (P < .001) compared with non-exercising participants. CONCLUSIONS AAwPD who exercised reported fewer secondary conditions and greater social participation. Although causal relationships cannot be drawn, and the frequency, duration, and intensity of exercise were not examined, this study lays important groundwork for future research to determine the health and participation benefits of exercise for AAwPD. Future studies should also focus on the development of exercise interventions to support successful aging with disability.
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Affiliation(s)
- Kerri A Morgan
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rachel Heeb Desai
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Courtney Weber Trocinski
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Holly Hollingsworth
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jessica Dashner
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Susan L Stark
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Wong AWK, Tomazin R, Walker K, Heeb Desai R, Hollingsworth H, Newland PK, Morgan KA. Text messaging intervention for fatigue self-management in people with stroke, spinal cord injury, and multiple sclerosis: A pilot study. Disabil Health J 2024; 17:101549. [PMID: 38001005 DOI: 10.1016/j.dhjo.2023.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Fatigue negatively impacts the function and quality of life of people with disabilities (PwD). Mobile health (mHealth) platforms are recognized as effective and accessible approaches to delivering health interventions and may show higher satisfaction by tailoring the information toward personalized needs for PwD. OBJECTIVE To evaluate the acceptability, feasibility, and participant engagement with a Short Message Service (SMS) text messaging intervention for fatigue self-management and to explore the pre- and post-score health changes in PwD. METHODS A total of 27 PwD (multiple sclerosis = 9, spinal cord injury = 9, or stroke = 9) experiencing fatigue in their daily lives participated in a 12-week self-management text messaging intervention. Participants completed a demographic survey and health outcome measures, including patient activation, self-efficacy for managing symptoms, fatigue, sleep, and satisfaction with participation in social roles before and after the intervention. Participants also completed a client satisfaction questionnaire after the intervention. We also tracked the program retention and SMS response rates over the 12-week intervention period. RESULTS Twenty-five participants completed the entire intervention (93% retention rate), and the overall SMS response rate was 84.67%, indicating high acceptability and adherence to the intervention. The mean satisfaction score was 3.18, indicating high satisfaction with the intervention. Despite finding a negligible effect on patient activation, we found a small intervention effect on self-efficacy for managing symptoms (η2 = 0.04) and moderate effects on fatigue (η2 = 0.06-0.12), sleep (η2 = 0.11), and satisfaction with participation in social roles (η2 = 0.08). CONCLUSIONS This study provides initial feasibility and health outcome change evidence to support an SMS text messaging intervention to manage fatigue in PwD.
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Affiliation(s)
- Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Rachel Tomazin
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Kim Walker
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Rachel Heeb Desai
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA.
| | - Holly Hollingsworth
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Pamela K Newland
- Goldfarb School of Nursing at Barnes Jewish College, St. Louis, MO, USA.
| | - Kerri A Morgan
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
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Putnam M, Morgan K, Hollingsworth H, Desai RH, Chen SW, Stark SL. Consistency of participation over time among persons aging with physical disability as measured by a tool designed for use among community-based organizations. Disabil Health J 2024; 17:101519. [PMID: 37739835 PMCID: PMC10842241 DOI: 10.1016/j.dhjo.2023.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Community participation measures for persons aging with disability were developed and evaluated to support community-based organizations (CBOs) with efficient assessment of change in participation and need for supports/services to facilitate participation. OBJECTIVE To evaluate a set of nine activity domain measures to broadly assess community participation and change in participation over time. METHODS A community-based sample (N = 323) of persons ages 45-65 responded to a survey with repeated measures three times annually (T1, T2, T3) between 2019 and 2022. Nine activity domain measures were developed based on extant research and evaluated with assistance from community-based support service providers. Statistical analyses employed T-tests and chi-square tests to assess change in participation over time, perceptions of participation satisfaction, and assistance needed to facilitate participation. Participants were asked if they thought changes were attributable to aging, the COVID-19 pandemic, or other factors. RESULTS Findings showed varying levels of participation across the nine activity domains, with the lowest participation rate for employment and the highest participation rates for personal leisure and managing medications across T1, T2, and T3. Change in participation over the three-year period was limited; most change was reported as activity reduction. In general, respondents indicated that reduction was due to their aging or the COVID-19 pandemic. Personal assistance, transportation, environmental modifications, and improved health were identified as factors needed to help increase participation levels. CONCLUSION The activity domain measures demonstrated efficiency in identifying participation rates and change. CBOs may deem them useful for assessing support and service needs to facilitate participation.
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Affiliation(s)
- Michelle Putnam
- School of Social Work, Simmons University, 300 the Fenway, Boston, MA 01602, USA.
| | - Kerri Morgan
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
| | - Holly Hollingsworth
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
| | - Rachel Heeb Desai
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
| | - Szu-Wei Chen
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
| | - Susan L Stark
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
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Dashner J, Espín-Tello SM, Chen SW, Hollingsworth H, Bollinger R, Morgan KA, Stark S. Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: a cross-sectional study. Disabil Rehabil 2023:1-9. [PMID: 38108275 DOI: 10.1080/09638288.2023.2293990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD). MATERIALS AND METHODS A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45-65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected. RESULTS Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls. CONCLUSIONS PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.
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Affiliation(s)
- Jessica Dashner
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Sandra M Espín-Tello
- Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Szu-Wei Chen
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Holly Hollingsworth
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Rebecca Bollinger
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Kerri A Morgan
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
| | - Susan Stark
- Program in Occupational Therapy, WA University School of Medicine in St. Louis, St. Louis, USA
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Desai RH, Hollingsworth H, Stark S, Putnam M, Eyler A, Wehmeier A, Morgan K. Social participation of adults aging with long-term physical disabilities: A cross-sectional study investigating the role of transportation mode and urban vs rural living. Disabil Health J 2023; 16:101503. [PMID: 37455234 PMCID: PMC10686629 DOI: 10.1016/j.dhjo.2023.101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Adults aging with long-term physical disabilities (AAwPDs) experience barriers in the built environment that can hinder their participation in meaningful social roles and activities. However, interventions addressing built environment barriers to participation for AAwPD are limited. OBJECTIVE The purpose of this study was to examine how the built environment and other socioenvironmental factors influence the social participation of AAwPD to inform future interventions and service provision. We hypothesized that social participation would be significantly different between AAwPD using private versus public transportation and living in urban versus rural areas. METHODS This cross-sectional study of 331 Missouri-dwelling AAwPD reports findings on relationships among transportation mode, urban versus rural residence, and ability to participate in social roles and activities using PROMIS measures. A multivariate analysis of covariance (MANCOVA) explored differences in social participation across transportation mode and residential location. Linear regression examined associations among socioenvironmental factors, individual factors, and social participation. RESULTS The MANCOVA demonstrated significant differences in social participation across transportation mode and urban versus rural residential location. Specifically, AAwPD using paratransit and living in urban areas reported significantly higher social participation than rural-dwelling individuals and private transportation users (p < .001). The linear regression revealed that individual factors served a larger role in predicting social participation than built or social environmental factors. CONCLUSIONS Our findings suggest that transportation mode plays a significant role in shaping social participation outcomes for AAwPD. However, compared to built and social environmental factors, individual factors (i.e., physical function, 'aging-with-disability' symptoms) may restrict social participation more.
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Affiliation(s)
- Rachel Heeb Desai
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA.
| | - Holly Hollingsworth
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA
| | - Susy Stark
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA
| | - Michelle Putnam
- Simmons University, School of Social Work, 300 the Fenway, Boston, MA, USA
| | - Amy Eyler
- Washington University in St. Louis, One Brookings Dr., Brown School of Public Health, St. Louis, MO, USA
| | - Aimee Wehmeier
- Paraquad Center for Independent Living, 5240 Oakland Ave., St. Louis, MO, USA
| | - Kerri Morgan
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA
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Morgan KA, Heeb R, Flynn A, Sukow K, Tormey E, Tucker S, Walker K, Hollingsworth H. An observational study of personal and environmental factors associated with attendance at a community-based adaptive fitness center for adults with physical disabilities. Disabil Health J 2022; 15:101342. [PMID: 35710900 DOI: 10.1016/j.dhjo.2022.101342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Regular exercise has many benefits for adults with physical disabilities (AwPD). Despite these benefits, significant barriers to participating in exercise exist for AwPD. Community-based adaptive fitness centers promote exercise for AwPD by minimizing barriers. Research has yet to clearly examine the personal and environmental factors associated with enrollment and attendance rates of AwPD in community-based adaptive fitness centers. OBJECTIVE The purpose of our study was to explore personal and environmental factors associated with AwPD and their attendance at a community-based adaptive fitness center once enrolled. METHODS Individuals aged 18-85 with a physical disability interested in exercising were referred to a community-based adaptive fitness center. At initial assessment, participants completed demographics, health, barriers to exercise, and exercise self-efficacy (ESE) surveys. Following initial assessment, participant visits to the fitness center were tracked for six months. RESULTS Of 106 participants, 27 never visited the facility after initial assessment, and the remaining participants with six months of attendance data (n = 67) averaged 14.9 (SD = 14.2) visits. Correlation results showed a negative curvilinear relationship between number of visits and years living with disability (rs = -0.24, p < 0.05), with higher attendance associated with more recent diagnosis. Logistic and stepwise regressions showed that ESE score (β = 0.107, p = 0.026) was the only significant predictor of attending the fitness center once enrolled. CONCLUSIONS This study demonstrates the importance of understanding personal and environmental factors and assessing ESE for AwPD who are newly enrolled in a community-based adaptive fitness center.
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Affiliation(s)
- Kerri A Morgan
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States.
| | - Rachel Heeb
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Ashley Flynn
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Kayleigh Sukow
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Erin Tormey
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Susan Tucker
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Kim Walker
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Holly Hollingsworth
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
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Morgan KA, Taylor KL, Walker CW, Tucker S, Dashner JL, Hollingsworth H. Mobility Disability and Exercise: Health Outcomes of an Accessible Community-Based Center. Front Rehabilit Sci 2022; 3:836655. [PMID: 36188910 PMCID: PMC9397740 DOI: 10.3389/fresc.2022.836655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveThe purpose of this study was to determine how support and guidance provided by trained professionals during a 12-week, community-based transition exercise program, impact health outcomes and continued engagement in physical activity for persons with a mobility disability (PwMD).DesignA single arm pre-post design was used.SettingAccessible community-based health and wellness center.ParticipantsThe study included 244 PwMD using a mobility device.InterventionsParticipants completed a 12-week transition exercise program provided through an accessible community facility that provided education and support to complete endurance and strength related exercises as well as programming to encourage transition to self-directed engagement in exercise.Main Outcome MeasuresBodyweight, BMI, pain, perceived exertion, speed, and distance during cardiovascular fitness testing, and strength were measured pre and post exercise program. The number of participants that signed up for a monthly membership after the program was also monitored.ResultsFor the total group, average pain reported over previous 30 days decreased significantly (p < 0.01), current daily pain decreased significantly (p < 0.05), perceived exertion at the end of the 9-min endurance test decreased significantly (p < 0.05), and the four upper extremity strength exercises showed large, significant strength gains (p < 0.01) after the program. There was no significant change in bodyweight, BMI, or speed and distance completed during endurance testing. At the completion of the program, 76% of participants enrolled in a monthly membership at the facility with the intentions to continue to exercise regularly.ConclusionsThis study provides evidence that an accessible community-based exercise program, with a transitional component supported by trained professionals, can support the exercise goals of PwMD and improve strength, decrease pain, and may promote regular exercise adoption for PwMD.
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Affiliation(s)
- Kerri A. Morgan
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
- *Correspondence: Kerri A. Morgan
| | - Kelly L. Taylor
- Occupational Therapy Program, Murray State University, Paducah, KY, United States
| | - Carla Wilson Walker
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan Tucker
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Jessica L. Dashner
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Holly Hollingsworth
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
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Morgan K, Heeb R, Walker K, Tucker S, Hollingsworth H. Impact of the COVID-19 Pandemic on Psychosocial Health of Persons With Spinal Cord Injury: Investigation of Experiences and Needed Resources. Top Spinal Cord Inj Rehabil 2022; 28:185-195. [PMID: 35521054 PMCID: PMC9009202 DOI: 10.46292/sci21-00060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Emerging evidence suggests that the COVID-19 pandemic has been accompanied by increased rates of depression and social isolation. However, we do not yet understand how the COVID-19 pandemic has affected the psychosocial health of people with spinal cord injury (PwSCI), a population that is already at risk of experiencing mental health conditions. Objectives The aims of the study were to (1) examine the impact of the pandemic on the psychosocial health of PwSCI and (2) investigate the experiences of PwSCI and resources they reported needing during the peak of the pandemic. Methods A cross-sectional survey with closed- and open-ended questions was administered to 51 PwSCI. Participants were included if they had an SCI, were 18 years or older, lived in St. Louis, Missouri, and surrounding areas, and understood English. Results Canonical correlation showed a significant association between financial security, food insecurity, and personal assistance service use and adverse psychosocial health outcomes (p < .001). Participants reported interest in resources related to COVID-19 precautions for wheelchair users as well as home exercise programming and financial assistance with utilities. Finally, qualitative analysis revealed four major themes: (1) mental health during the pandemic, (2) financial concerns and reduced access to personal assistance services, (3) feelings of social isolation prior to the pandemic, and (4) local and national authorities' handling of the pandemic. Conclusion PwSCI are impacted by the COVID-19 pandemic and reported a variety of resource needs. These findings may inform service providers, support systems, and organizations to better support PwSCI during times of crisis.
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Affiliation(s)
- Kerri Morgan
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Rachel Heeb
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kim Walker
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Sue Tucker
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Holly Hollingsworth
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Dashner J, Espin-Tello SM, Snyder M, Hollingsworth H, Keglovits M, Campbell ML, Putnam M, Stark S. Examination of Community Participation of Adults With Disabilities: Comparing Age and Disability Onset. J Aging Health 2020; 31:169S-194S. [PMID: 31718411 DOI: 10.1177/0898264318816794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Explore community participation between adults with disabilities ⩽50 and >50 years and between early-(⩽40) and late-(>40) onset disability. Method: A survey examining participation was conducted with a national convenience sample of 692 community-dwelling adults with disabilities. Results: Participants ⩽50 reported presence of more (p < .05) environmental supports for work/volunteer/education and use of transportation. Participants >50 had higher (p < .01) visits to pharmacies; higher (p < .05) evaluative quality of participation (EQOP) at gas stations, exercise facilities, beauty salons/barbers, and use of transportation (p < .01); and more difficulty participating without assistance at grocery stores (p < .05) and gas stations (p < .01). The early-onset group reported higher (p < .05) EQOP at work/volunteer/education and homes of family/friends. The late-onset group reported higher (p < .01) EQOP at exercise facilities; more (p < .05) environmental supports at pharmacies, restaurants, grocery stores (p < .01), doctors' offices (p ⩽ .01), and beauty salons/barbers (p < .01); greater (p < .01) influence of pain/fatigue; and more difficulty without assistance at grocery stores (p < .05) and gas stations (p < .01). Discussion: Understanding these differences can improve interventions to support community participation of individuals aging with disabilities.
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Affiliation(s)
- Jessica Dashner
- Washington University School of Medicine in St. Louis, MO, USA
| | | | - Makenna Snyder
- Washington University School of Medicine in St. Louis, MO, USA
| | | | | | | | | | - Susan Stark
- Washington University School of Medicine in St. Louis, MO, USA
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Stark S, Somerville E, Conte J, Keglovits M, Hu YL, Carpenter C, Hollingsworth H, Yan Y. Feasibility Trial of Tailored Home Modifications: Process Outcomes. Am J Occup Ther 2018; 72:7201205020p1-7201205020p10. [PMID: 29280722 DOI: 10.5014/ajot.2018.021774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to conduct a process evaluation to examine the implementation of a randomized controlled trial of home modifications designed to reduce the risk of falls and improve daily activity performance among community-dwelling older adults. METHOD A process evaluation was conducted alongside a blinded, randomized sham-controlled trial (n = 92). Participants were followed for 1 yr after intervention. The process evaluation was framed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS The treatment group improved daily activity performance over 12 mo compared with the sham control group (F = 4.13; p = .024). The intervention elements and dose were delivered with greater than 90% accuracy. Participants reported a 91% adherence rate at 12 mo. CONCLUSION The complex intervention of home modifications examined in this study is acceptable to older adults, is feasible, and can be delivered with high fidelity for frail, community-dwelling older adults.
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Affiliation(s)
- Susan Stark
- Susan Stark, PhD, OTR/L, is Assistant Professor of Occupational Therapy, Neurology, and Social Work, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
| | - Emily Somerville
- Emily Somerville, OTD, OTR/L, is Occupational Therapist, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Jane Conte
- Jane Conte, MEd, is Clinical Research Coordinator, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Marian Keglovits
- Marian Keglovits, MSCI/OTD, is Occupational Therapist, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Yi-Ling Hu
- Yi-Ling Hu, MSOT, is Rehabilitation and Participation Science Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Christopher Carpenter
- Christopher Carpenter, MD, MSc, is Associate Professor of Medicine, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Holly Hollingsworth
- Holly Hollingsworth, PhD, is Research Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- Yan Yan, MD, PhD, is Professor of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
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Gray DB, Welch PM, Hollingsworth H. Comparing Perspectives of People with Disabilities and Professionals on the ICIDH-2 Beta-1. Journal of Disability Policy Studies 2016. [DOI: 10.1177/104420730001100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The World Health Organization is revising the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). As part of the revision process, 51 individuals in the United States completed a survey. The respondents included people with and without disabilities and rehabilitation-related professionals. This article reports areas of agreement and disagreement on several changes proposed for the ICIDH-2. Results indicate agreement for the need to classify activities rather than disabilities, to replace "handicap" with "participation restriction," and to include environmental factors in the classification. Policy implications include tracking the influence of policy changes on the activities performed and on participation in major life activities by people classified as impaired in motor or mental capacity. Including the classification of environmental factors could encourage a confluence of the social and biological models of disability that would provide a richer understanding of the interactions between people with disabilities and their surroundings.
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Perlmutter MS, Bhorade A, Gordon M, Hollingsworth H, Engsberg JE, Carolyn Baum M. Home lighting assessment for clients with low vision. Am J Occup Ther 2014; 67:674-82. [PMID: 24195901 DOI: 10.5014/ajot.2013.006692] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The goal was to develop an objective, comprehensive, near-task home lighting assessment for older adults with low vision. METHOD A home lighting assessment was developed and tested with older adults with low vision. Interrater and test-retest reliability studies were conducted. Clinical utility was assessed by occupational therapists with expertise in low vision rehabilitation. RESULTS Interrater reliability was high (intraclass correlation coefficient [ICC] = .83-1.0). Test-retest reliability was moderate (ICC = .67). Responses to a Clinical Utility Feedback Form developed for this study indicated that the Home Environment Lighting Assessment (HELA) has strong clinical utility. CONCLUSION The HELA provides a structured tool to describe the quantitative and qualitative aspects of home lighting environments where near tasks are performed and can be used to plan lighting interventions. The HELA has the potential to affect assessment and intervention practices of rehabilitation professionals in the area of low vision and improve near-task performance of people with low vision.
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Affiliation(s)
- Monica S Perlmutter
- Monica S. Perlmutter, OTD, OTR/L, SCLV, is Assistant Professor of Occupational Therapy and Ophthalmology, Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, Campus Box 8085, St. Louis, MO 63108;
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Stark SL, Roe CM, Grant EA, Hollingsworth H, Benzinger TL, Fagan AM, Buckles VD, Morris JC. Preclinical Alzheimer disease and risk of falls. Neurology 2013; 81:437-43. [PMID: 23803314 DOI: 10.1212/wnl.0b013e31829d8599] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We determined the rate of falls among cognitively normal, community-dwelling older adults, some of whom had presumptive preclinical Alzheimer disease (AD) as detected by in vivo imaging of fibrillar amyloid plaques using Pittsburgh compound B (PiB) and PET and/or by assays of CSF to identify Aβ₄₂, tau, and phosphorylated tau. METHODS We conducted a 12-month prospective cohort study to examine the cumulative incidence of falls. Participants were evaluated clinically and underwent PiB PET imaging and lumbar puncture. Falls were reported monthly using an individualized calendar journal returned by mail. A Cox proportional hazards model was used to test whether time to first fall was associated with each biomarker and the ratio of CSF tau/Aβ₄₂ and CSF phosphorylated tau/Aβ₄₂, after adjustment for common fall risk factors. RESULTS The sample (n = 125) was predominately female (62.4%) and white (96%) with a mean age of 74.4 years. When controlled for ability to perform activities of daily living, higher levels of PiB retention (hazard ratio = 2.95 [95% confidence interval 1.01-6.45], p = 0.05) and of CSF biomarker ratios (p < 0.001) were associated with a faster time to first fall. CONCLUSIONS Presumptive preclinical AD is a risk factor for falls in older adults. This study suggests that subtle noncognitive changes that predispose older adults to falls are associated with AD and may precede detectable cognitive changes.
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Affiliation(s)
- Susan L Stark
- Program in Occupational Therapy, Washington University, St. Louis, MO, USA.
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Carpenter C, Hollingsworth H, Skebba T, Twaalfhoven E, Stark S. 75 What Factors Prolong the Emergency Department Length of Stay Amongst Geriatric Adults? Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hollingsworth H, Gray DB. Structural equation modeling of the relationships between participation in leisure activities and community environments by people with mobility impairments. Arch Phys Med Rehabil 2010; 91:1174-81. [PMID: 20684897 DOI: 10.1016/j.apmr.2010.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 04/20/2010] [Accepted: 04/21/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the linkages between the constructs of participation and the environment for a set of leisure activities (attending concerts, attending movies, attending sporting events). DESIGN Self-report surveys of the influence of the environment on participation were analyzed using structural equation modeling. Temporal, evaluative, and health-related aspects of leisure activities were selected as latent variables associated with participation. The environmental construct consisted of the latent variables of the influence on participation of the natural, interpersonal, built, background, and supportive environments. SETTING Midwestern United States. PARTICIPANTS A purposive sample of people (N=604) with mobility limitations. INTERVENTION None. MAIN OUTCOME MEASURES Measures of relationships between participation in leisure activities and the environment of people with mobility limitations. RESULTS Structural equation modeling can be an important tool for empirically examining the contributions of the component latent variables of participation and the environment. CONCLUSIONS A model that fits participation by people with disabling conditions in their environment can provide guidance for community-based interventions and person-based therapies.
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Affiliation(s)
- Holly Hollingsworth
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA.
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Stark SL, Edwards DF, Hollingsworth H, Gray DB. Validation of the Reintegration to Normal Living Indexin a population of community-dwelling people with mobility limitations. Arch Phys Med Rehabil 2005; 86:344-5. [PMID: 15706566 DOI: 10.1016/j.apmr.2004.03.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To validate the Reintegration to Normal Living Index (RNLI) in a population of community-dwelling adults with mobility limitations. DESIGN Cross-sectional survey. SETTING Community. PARTICIPANTS Six hundred four people between the ages of 18 and 80 years who had a mobility limitation, lived in the community, and had been discharged from rehabilitation for at least 1 year. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The RNLI. RESULTS The RNLI is a reliable measure of community reintegration. A 2-factor structure emerged from a principal components analysis that indicates there are 2 subscales of the RNLI in a population with mobility impairments. CONCLUSIONS The RNLI is a reliable and valid measure for studies of community integration among people living with long-term consequences of a chronic health condition.
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Affiliation(s)
- Susan L Stark
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
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Harbour JW, Brantley MA, Hollingsworth H, Gordon M. Association between choroidal pigmentation and posterior uveal melanoma in a white population. Br J Ophthalmol 2004; 88:39-43. [PMID: 14693770 PMCID: PMC1771924 DOI: 10.1136/bjo.88.1.39] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS It is well known that light skin pigmentation is a risk factor for cutaneous melanoma. The aim of this study was to investigate the analogous association between choroidal pigmentation and posterior uveal melanoma. METHODS Cross sectional study of 65 consecutive patients diagnosed with posterior uveal melanoma (melanoma group) and 218 consecutive patients referred for general retinal evaluation (control group). All patients were white. A clinical grading system for estimating choroidal pigmentation was developed and histologically validated in seven patients. RESULTS Melanoma patients with light iris colour were significantly more likely to have darker choroidal pigmentation than controls (p = 0.005). Darker choroidal pigmentation was associated histologically with increased density of choroidal melanocytes (p = 0.005). CONCLUSIONS Increased choroidal pigmentation, as a result of an increase in the density of pigmented choroidal melanocytes, is not protective but may actually be a risk factor for the development of posterior uveal melanoma in white patients. This finding may have implications for understanding the pathogenesis of uveal melanoma.
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Affiliation(s)
- J W Harbour
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Box 8069, 660 S. Euclid Avenue, St Louis, MO 63110, USA.
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Harbour JW, Brantley MA, Hollingsworth H, Gordon M. Association between posterior uveal melanoma and iris freckles, iris naevi, and choroidal naevi. Br J Ophthalmol 2004; 88:36-8. [PMID: 14693769 PMCID: PMC1771959 DOI: 10.1136/bjo.88.1.36] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate the association between posterior uveal melanoma and iris freckles, iris naevi, and choroidal naevi. METHODS Cross sectional study of 65 patients with posterior uveal melanoma and 218 controls. Iris colour, iris freckles, iris naevi, and choroidal naevi were recorded for each eye of each patient. RESULTS Iris freckles were present in 40 (61.5%) patients with melanoma and 135 (61.9%) controls (p = 0.494). Iris naevi were present in four (6.2%) patients with melanoma and nine (4.1%) controls (p = 0.955). Choroidal naevi were present in 12 (18.5%) patients with melanoma and 38 (17.4%) controls (p = 0.815). CONCLUSION This study did not detect an association between posterior uveal melanoma and iris freckles, iris naevi, or choroidal naevi.
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Affiliation(s)
- J W Harbour
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Box 8069, 660 S. Euclid Avenue, St Louis, MO 63110, USA.
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Diringer MN, Edwards DF, Aiyagari V, Hollingsworth H. Factors associated with withdrawal of mechanical ventilation in a neurology/neurosurgery intensive care unit. Crit Care Med 2001; 29:1792-7. [PMID: 11546988 DOI: 10.1097/00003246-200109000-00023] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to identify factors associated with the decision to withdraw mechanical ventilation from patients in a neurology/neurosurgery intensive care unit. Specifically, the following factors were considered: the severity of the neurologic illness, the healthcare delivery system, and social factors. DESIGN Retrospective analysis of prospectively collected clinical database. SETTING Neurology/neurosurgery intensive care unit of a large academic tertiary care hospital. PATIENTS Patients were 2,109 nonelective admissions to the neurology/neurosurgery intensive care unit who received mechanical ventilation over a period of 82 months. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The average age was 56 +/- 19.7 yrs, 53% were male, and 81% were functionally normal before admission. The median Glasgow Coma Scale score was 14, the average Acute Physiology and Chronic Health Evaluation II severity of illness score was 13.5 +/- 8.3, and probability of death was 18.2 +/- 22.0%. Mechanical ventilation was withdrawn from 284 (13.5%). Factors that were independently associated with withdrawal of mechanical ventilation were as follows: more severe neurologic injury [admission Glasgow Coma Scale score (odds ratio 0.86/point, confidence interval 0.82-0.90), diagnosis of subarachnoid hemorrhage (odds ratio 2.44, confidence interval 1.50-3.99), or ischemic stroke (odds ratio 1.72, confidence interval 1.13-2.60)], older age (odds ratio 1.04/yr, confidence interval 1.03-1.05), and higher Acute Physiology and Chronic Health Evaluation II probability of death (odds ratio 1.03/%, confidence interval 1.02-1.04). Mechanical ventilation was less likely to be withdrawn if patients were African-American (odds ratio 0.50, confidence interval 0.36-0.68) or had undergone surgery (odds ratio 0.44, confidence interval 0.2- 0.67). Marital status, premorbid functional status, clinical service (neurology vs. neurosurgery), attending status (private vs. academic), and type of health insurance were not associated with decisions to withdraw mechanical ventilation. CONCLUSIONS We conclude that decisions to withdraw mechanical ventilation in the neurology/neurosurgery intensive care unit are based primarily on the severity of the acute neurologic condition and age but not on characteristics of the healthcare delivery system. Care is less likely to be withdrawn from African-American patients or those who had surgery.
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Affiliation(s)
- M N Diringer
- Neurology/Neurosurgery Intensive Care Unit, Department of Neurology and Neurological Surgery, Washington University, St. Louis, MO, USA
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Abstract
BACKGROUND Artificial neural network (ANN) analysis methods have led to more sensitive diagnosis of myocardial infarction and improved prediction of mortality in breast cancer, prostate cancer, and trauma patients. Prognostic studies have identified early clinical and radiographic predictors of mortality after intracerebral hemorrhage (ICH). To date, published models have not achieved the accuracy necessary for use in making decisions to limit medical interventions. We recently reported a logistic regression model that correctly classified 79% of patients who died and 90% of patients who survived. In an attempt to improve prediction of mortality we computed an ANN model with the same data. OBJECTIVE To determine whether an ANN analysis would provide a more accurate prediction of mortality after ICH when compared with multiple logistic regression models computed using the same data. METHODS Analyses were conducted on data collected prospectively on 81 patients with supratentorial ICH. Multiple logistic regression was used to predict hospital mortality, then an ANN analysis was applied to the same data set. Input variables were age, gender, race, hydrocephalus, mean arterial pressure, pulse pressure, Glasgow Coma Scale score, intraventricular hemorrhage, hydrocephalus, hematoma size, hematoma location (ganglionic, thalamic, or lobar), cisternal effacement, pineal shift, history of hypertension, history of diabetes, and age. RESULTS The ANN model correctly classified all patients (100%) as alive or dead compared with 85% correct classification for the logistic regression model. A second ANN verification model was equally accurate. The ANN was superior to the logistic regression model on all objective measures of fit. CONCLUSIONS ANN analysis more effectively uses information for prediction of mortality in this sample of patients with ICH. A well-validated ANN may have a role in the clinical management of ICH.
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Affiliation(s)
- D F Edwards
- Department of Neurology & Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Weinberger M, Hollingsworth H, Feuerstein IM, Young NS, Pizzo PA. Successful surgical management of neutropenic enterocolitis in two patients with severe aplastic anemia. Case reports and review of the literature. ACTA ACUST UNITED AC 1993. [PMID: 8422192 DOI: 10.1001/archinte.1993.00410010127013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe two patients with severe aplastic anemia in whom neutropenic enterocolitis developed while they were undergoing treatment at the National Institutes of Health. Both patients had progressive symptoms while receiving optimal medical management and both underwent and survived surgical intervention despite continued prolonged neutropenia in the perioperative period. This experience contrasts with six cases reported in the literature and suggests that surgery can be employed even in patients with profound neutropenia. Thus, in patients who remain persistently septic or who develop clinical deterioration despite medical management or who have other indications for surgical intervention, neutropenia should not be a contraindication to the appropriate or necessary procedure.
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Affiliation(s)
- M Weinberger
- Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md
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Abstract
We have isolated a mutant of E. coli whose maximal rate of synthesis of lac mRNA is 25-fold greater than that of its parental wild-type strain. The mutant also shows alterations in the kinetics of beta-galactosidase synthesis, the functional half-life of beta-galactosidase mRNA, and the properties of lac repressor.
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