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019 AGING WITH A SPINAL CORD INJURY: FACTORS ASSOCIATED WITH THE NEED FOR MORE HELP Nathania R. Liem, MD, Division of Physical Medicine and Rehabilitation, University of Ottawa; Mary Ann McColl, PhD, School of Rehabilitation Therapy, Queen's University; Will King, PhD, Department of Community Health and Epidemiology, Queen's University; Karen M. Smith, MD, Division of Physical Medicine & Rehabilitation, Queen's University Objectives: The objectives of this study were to determine 1 ; the prevalence of a decline in function as expressed by the need for more help NMH ; , 2 ; the prevalence of medical problems, and 3 ; the association between medical, injury and socio-demographic factors and the NMH, among people aging with spinal cord injury SCI ; . Methods: The study was a cross-sectional secondary analysis of a dataset n 352 ; obtained by surveying individuals with SCI in Canada, the U.S. and England. Participants had acquired an SCI at least 20 years previously. To determine the NMH outcome, participants were asked whether or not they needed more help with activities of daily living ADL ; over the past three years. Medical, injury and socio-demographic data were also obtained from the dataset. Multivariate logistic regression was used to determine the relationship between the NMH and the medical, injury and socio-demographic variables. Results: 32% needed more help to perform ADLs within the past three years. Those needing more help were significantly older 59.3 10.7 vs. 56.3 10.1 years, p 0.05 ; and had lived longer with SCI 35.3 8.1 vs. 32.5 8.1 years, p 0.05 ; . Level and completeness of SCI were not related to the NMH p 0.05 ; . The most prevalent medical problems were constipation 48% ; , bowel accidents 42% ; and pressure sores 39% ; . On multivariate analysis, constipation OR 1.97, 95% C.I. 1.19-3.26 ; , pressure sores OR 1.76, 95% C.I. 1.07-2.87 ; , female gender OR 1.96, 95% C.I. 1.04-3.70 ; and decades post injury OR 1.42, 95% C.I. 1.00-2.01 ; were significantly associated with an increased likelihood of needing more help over a three year time period. Conclusions: This study may be used to identify those individuals most at risk for a decline in function. Aggressive prevention and management of neurogenic bowel and pressure sores has the potential to maintain the independence of people 20 years post-SCI.
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Address for correspondence: Paul Grootendorst, Faculty of Pharmacy, University of Toronto 19 Russell St., Toronto, Ontario, Canada M5S 2S2. Email: paul.grootendorst utoronto ; Phone: 416-946-3994; Fax: 416-978-1833 Funding Source and Acknowledgements: Support for this project from the Health Transitions Fund, Health Canada; the Canadian Health Services Research Foundation; Brogan Inc.; the BC Ministry of Health; and the Drug Information Association is acknowledged. The views expressed herein do not necessarily represent the official policy of federal, provincial or territorial governments, or the project funders. Edward Newman provided invaluable research assistance. We thank Sean Burnett, Wendy Eyres and Suzanne Solven of the BC Ministry of Health for assistance with the collection and interpretation of the data. Paul Grootendorst is supported by a career award from the Rx&D Health Research Foundation and the Canadian Institutes of Health Research CIHR ; . Anne Holbrook is the recipient of a CIHR Career Investigator Award; Adrian Levy is supported by a Scholar award from the BC Michael Smith Foundation for Health Research. This paper is dedicated to the memory of our colleague Bernie O'Brien 1959-2004 ; . Running title: Reference pricing of NSAIDs.
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One That Got Away Some More Foucault and a Story I would like to tell you a story concerning the way in which feminist work has been received in one traditional scientific department. I tell this story because so much of it reflects some of Foucault's ideas on power and so on. First I need to amplify what he said about the role of sexuality in our society. Sexuality has become an instrument of power. 'It appears rather as an especially dense transfer point for relations of power: between men and women, young people and old people, parents and offspring, teachers and students, priests and laity, an administration and a population' Foucault 1990, p. 103 ; . One of the mechanisms by which sexuality attained its centrality, certainly by the early 19th century, was that of the hysterisation of the female body, which, according to Foucault, involved its medicalisation Foucault 1990, p. 104 ; . So, I interpret 'medicalisation of their bodies' to mean that the female body became a legitimate focus of attention for the medical profession, including the then newly emerging psychiatric profession. Indeed, as well as the medicalisation of women's bodies there are also their 'conjugal and parental obligations' Foucault 1990, p. 120 ; within the family. This hysterisation of women would presumably be part of the moves to get people to discipline themselves to avoid opprobrium from society. This goes along with discipline in schools, the military, places of employment and so on. Another observation of Foucault that is relevant for the story I about to tell is that of the interaction between the law and the medical profession. Foucault's discussion of a case of parricide in the early 19th century provides all the available documentary evidence relating to the murder of three members of his family by a young man called Pierre Rivire 1978 ; . This documentary evidence includes that of doctors and and verapamil.
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Barrie deVeber, formerly the director of Paediatric Oncology for the Children's Hospital of Western Ontario, found that the biggest challenge for his practice was getting the parents to accept that their child would probably be cured. However, by the time Barrie left paediatric oncology, the cure rate was actually 85%. Thus, his challenge was not the traditional one, of counselling parents who have unrealistic hope, but rather a new one - counselling parents who have unrealistic despair. The time lag in public perception of medical advances can lead to frightening outcomes. For example, in one case, the parents, discouraged by the relatively poor prognosis and the severe side effects of chemotherapy, requested euthanasia as they were unconvinced their child had any chance of survival, he recalls. Barrie, of course, refused and xalatan.
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