This study was undertaken to identify the employment status of individuals before and after spinal cord injury (SCI), the factors influencing return to work and the reasons why return to previous employment status were difficult, delayed or not achieved. The study identified when individuals were ready to address return to employment issues as well as the resources that may be required to support return to work. Postal questionnaires were sent to 242 individuals, aged 16 years and above, who were admitted to the Stanmore spinal cord injury centre (SCIC) with acute, traumatic SCI between 1998 and 2003. Forty-two percent of respondents returned to paid employment however, only 26% actually remained in employment. Reasons for non-return to or cessation of employment were primarily related to respondents' health, access to transport and training. Twenty-five percent of respondents described themselves as long-term sick, particularly those with cervical injuries. Physical intensity of work activities altered after injury. For those returning to paid employment, family and employer support was reported to be most commonly available and beneficial . Those respondents who had more structured support schemes had found them beneficial. Approximately half of respondents stated they were ready to address return to work during their admission. Findings suggest that vocational advice and education should be available following a SCI, particularly for those with a cervical injury or those working in heavy or strenuous jobs before injury.
Objectives The COVID-19 pandemic has impacted mental health at a population level. Families of children with health vulnerabilities have been disproportionately affected by pandemic-related policies and service disruptions as they substantially rely on the health and social care system. We elicited the impact of the COVID-19 pandemic on children with health and disability-related vulnerabilities, their families, and their health care providers (HCPs). Methods Children with diverse health vulnerabilities (cardiac transplantation, respiratory conditions, sickle cell disease, autism spectrum disorder, mental health issues, and nearing the end of life due to a range of underlying causes), as well as their parents and HCPs, participated in semi-structured interviews. Data were analyzed using qualitative content analysis in determining themes related to impact and recommendations for practice improvement. Results A total of 262 participants (30 children, 76 parents, 156 HCPs) were interviewed. Children described loneliness and isolation; parents described feeling burnt out; and HCPs described strain and a sense of moral distress. Themes reflected mental health impacts on children, families, and HCPs, with insufficient resources to support mental health; organizational and policy influences that shaped service delivery; and recommendations to enhance service delivery. Conclusion Children with health vulnerabilities, their families and HCPs incurred profound mental health impacts due to pandemic-imposed public health restrictions and care shifts. Recommendations include the development and application of targeted pandemic information and mental health supports. These findings amplify the need for capacity building, including proactive strategies and mitigative planning in the event of a future pandemic.
Résumé Objectifs La pandémie de COVID-19 a influé sur la santé mentale de la population. Les familles des enfants qui ont des vulnérabilités en matière de santé ont été démesurément touchées par les politiques liées à la pandémie et les perturbations aux services, car elles s’appuient beaucoup sur le système de soins de santé et de services sociaux. Les chercheurs ont établi les répercussions de la pandémie de COVID-19 sur les enfants ayant des vulnérabilités en matière de santé physique et des incapacités, les familles et les professionnels de la santé. Méthodologie Des enfants ayant diverses vulnérabilités en matière de santé (transplantation cardiaque, affections respiratoires, anémie falciforme, trouble du spectre de l’autisme, troubles de santé mentale et approche de la fin de vie en raison d’une série de causes sous-jacentes), leurs parents et leurs professionnels de la santé ont participé à des entrevues semi-structurées. Les chercheurs ont utilisé des méthodes d’analyse qualitative et en ont extrait les thèmes liés aux effets et les recommandations en vue d’améliorer la pratique. Résultats Au total, 262 participants (30 enfants, 76 parents, 156 professionnels de la santé) ont été interviewés. Les enfants ont décrit leur solitude et leur isolement, les parents, leur épuisement, et les professionnels de la santé, la pression ressentie et un sentiment de détresse morale. Les thèmes reflétaient les effets de la pandémie sur la santé mentale des enfants, des familles et des professionnels de la santé, de même que les ressources insuffisantes pour soutenir la santé mentale, les influences organisationnelles et politiques qui ont façonné la prestation des services et les recommandations pour améliorer la prestation de ces services. Conclusion Les restrictions sanitaires imposées par la pandémie et les modifications aux soins ont eu de profondes répercussions sur la santé mentale des enfants qui ont des vulnérabilités en matière de santé, les familles et les professionnels de la santé. Les recommandations incluent la rédaction et l’adoption d’information ciblée sur la pandémie et la mise en œuvre de services de soutien en santé mentale. Ces résultats amplifient la nécessité de renforcer les capacités, y compris des stratégies proactives et la planification de mesures d’atténuation du risque dans l’éventualité d’une future pandémie.
BCR) following either radiotherapy or other local ablative therapies of prostate cancer. Previous studies have assessed long-term oncologic results to include overall disease survival in addition to freedom from starting ADT. We aim to assess oncologic outcomes in addition to de novo stricture, fistula, urinary incontinence, and erectile dysfunction rates.METHODS: We retrospectively reviewed all men who underwent salvage cryotherapy following external beam radiation therapy (EBRT), proton beam therapy, primary cryotherapy, and brachytherapy at our institution from 2005 through 2019. Functional and oncologic outcomes were assessed. Biochemical recurrence-free survival was defined based on a combination of the Phoenix and Astro criteria and analyzed using Kaplan-Meier statistics.RESULTS: Of the total 85 patients included, 71 had primary EBRT, 9 had brachytherapy, 3 had combined EBRT and brachytherapy, and 2 had proton beam therapy. All patients had negative staging workups prior to salvage therapy. Recto-urethral fistulas occurred in 2 patients (2.3%), 21 patients (24.4%) developed urethral strictures, and 23 patients (26.7%) reported de novo incontinence requiring pads. 5-year overall biochemical free survival was 49%. A total of 53% of subjects had biochemical recurrence with a mean time of 39 months after salvage treatment. Overall cancer specific survival was 86% and metastasis free survival was 77.9%. There was not a statistically significant correlation identified between pretreatment PSA and timing to BCR R 2 [0.05 p[0.129. One patient did not have a PSA response after salvage cryotherapy and went on to develop metastatic disease.CONCLUSIONS: Salvage cryotherapy remains one of the few potentially curative interventions following primary radiotherapy for prostate cancer. This study highlights the necessity for patient counseling given the side effect profile.
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