Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury

OBJECTIVE

To investigate: (1) the course of coronary heart disease risk factors (lipid profiles and body mass index (BMI)) in the first five years after discharge from inpatient spinal cord injury (SCI) rehabilitation and (2) the association between lifestyle (physical activity, self-care related to fitness, smoking, alcohol, body mass and low-fat diet) and coronary heart disease risk factors during that period.

DESIGN

Prospective cohort study.

PARTICIPANTS/METHODS

Individuals with SCI (N=130). Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and BMI were determined at discharge from inpatient rehabilitation and 1 and 5 years after discharge. Using multilevel regression models, the effects of lifestyle (drinking alcohol, smoking, active lifestyle and self-care) on the lipid profiles and BMI were determined.

RESULTS

After correction for lesion and personal characteristics, no changes in lipid profiles in the five years after discharge were seen, whereas the BMI increased significantly with 1.8 kg m(-2). A high percentage was at risk of cardiovascular disease due to high BMI (63-75%) or HDL (66-95%). The individuals who indicated to maintain their fitness level as good as possible and the individuals with a low BMI showed better lipid profiles. Individuals with a more active lifestyle showed higher HDL levels. Individuals who avoid smoking showed a 1.5 kg m(-2) higher BMI.

CONCLUSION

Lipid profiles seem to stabilize in the years after discharge from inpatient SCI rehabilitation, whereas the BMI increased. Lifestyle factors associated with a favorable lipid profile and BMI could be identified.

Sexual risk assessment for people with intellectual disabilities

Given that sexually offensive behavior on the part of people with intellectual disabilities has been identified as a significant problem, we developed a risk assessment questionnaire, that takes not only various static and dynamic factors into account but also environmental risk variables. Psychologists and staff members completed this Risk Inventarization Scale on Sexually Offensive Behavior of Clients with Intellectual Disabilities for 56 intellectually disabled clients with sexually offensive behavior problems. The scale contains static client variables (rated using two- or five-point likert scales and open questions) and both dynamic client and environmental variables (rated using a five-point Likert scale). Factor analyses of the dynamic client and environmental variables revealed three subscales: quality of supervision, offending behavior and emotional and social stability. Reliability analyses showed sufficient to good reliability for both the total scale (r=0.82) and the identified subscales (quality of guidance r=0.94; offending behavior r=0.75, and emotional and social stability r=0.58). Correlational analyses of the quality of guidance subscale showed high positive correlations with such static variables as values and norms, living conditions, and criminal offenses in early youth. Because both dynamic and environmental variables can be altered, the implications for treatment of the sexually offensive behavior of clients with intellectual disabilities are discussed further.