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BCIT Citations Collection

A Canada-wide survey of chronic respiratory disease and spinal cord injury
With advances in acute care for individuals with spinal cord injury (SCI), chronic conditions are becoming a central focus.1–3 More specifically, impairments in respiratory function are one of the leading causes of morbidity and mortality among individuals with SCI,4 and have significant economic burden. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which has a major impact on cough effectiveness and susceptibility to infection.5–7 Prior studies have typically focused on breathing mechanics and pneumonia in the acute stages of SCI, but there is a dearth of evidence regarding secondary chronic conditions, such as asthma and chronic obstructive pulmonary disease (COPD), among SCI populations. In the general population, risk factors for the development of asthma and COPD include genetic, sociodemographic, and environmental components.8,9 In addition, traffic pollution and occupational exposures, and indoor exposure to pollutants such as mold, increase susceptibility to both diseases. However, that SCI may be an independent risk factor for COPD and asthma (or vice versa) has not been previously examined. It thus remains unknown whether there is a higher prevalence of chronic respiratory diseases (after adjustment for potential confounders) in individuals with SCI. The current study addresses this knowledge gap by utilizing the national Canadian Community Health Survey, which comprises comprehensive, up-to-date, cross-sectional data. Our aim was to estimate the prevalence of chronic respiratory outcomes in the SCI population, to compare their odds with a non-SCI population, and to investigate this relationship after controlling for confounders., Peer-reviewed article, Published. Received September 18, 2014; Accepted December 09, 2014.
Optimal scaling of weight and waist circumference to height for adiposity and cardiovascular disease risk in individuals with spinal cord injury
Study Design: Observational cross-sectional study. Objectives: Body mass index (BMI), measured as a ratio of weight (Wt) to the square of height (Wt/Ht(2)), waist circumference (WC) and waist-to-height ratio (WHtR) are common surrogate measures of adiposity. It is not known whether alternate scaling powers for height might improve the relationships between these measures and indices of obesity or cardiovascular disease (CVD) risk in individuals with spinal cord injury (SCI). We aimed to estimate the values of 'x' that render Wt/Ht(x) and WC/Ht(x) maximally correlated with dual energy x-ray absorptiometry (DEXA) total and abdominal body fat and Framingham Cardiovascular Risk Scores. Setting: Canadian public research institution. Methods: We studied 27 subjects with traumatic SCI. Height, Wt and body fat measurements were determined from DEXA whole-body scans. WC measurements were also obtained, and individual Framingham Risk Scores were calculated. For values of 'x' ranging from 0.0 to 4.0, in increments of 0.1, correlations between Wt/Ht(x) and WC/Ht(x) with total and abdominal body fat (kg and percentages) and Framingham Risk Scores were computed. Results: We found that BMI was a poor predictor of CVD risk, regardless of the scaling factor. Moreover, BMI was strongly correlated with measures of obesity, and modification of the scaling factor from the standard (Wt/Ht(2)) is not recommended. WC was strongly correlated with both CVD risk and obesity, and standard measures (WC and WHtR) are of equal predictive power. Conclusion: On the basis of our findings from this sample, alterations in scaling powers may not be necessary in individuals with SCI; however, these findings should be validated in a larger cohort., Peer-reviewed article, Published. Received 25 February 2014; revised 1 May 2014; accepted 1 August 2014; published online 30 September 2014.