Lifestyle and health conditions of adults with spinal cord injury/Estilos de vida y condiciones de salud de adultos con lesion medular/Estilos de vida e condicoes de saude de adultos com lesao medular.
Spinal cord injury (SCI) is currently a serious public health problem around the world due to the increase of urban violence cases, such as accidents involving motor vehicles and assaults with firearms. (1) However, the SCI can also be caused by other conditions, such as tumors, bacterial and viral diseases, that affect the afferent and efferent nerve pathways that connect the brain and the peripheral areas. (2) The occurrence of the SCI worldwide ranges from 12.1 to 57.8 cases per million people. (3) In Brazil, data regarding this problem are not updated or consolidated, but around 7000 cases of people with SCI are reported per year. (4)
People with SCI generally have limitations that can result in major changes in their daily lives. This occurs because of the partial or complete loss of motor function and sensitivity, and also vasomotor, respiratory, bowel, bladder and sexual impairment caused by the injury. (5) The SCI is also associated with other complications, such as the increased risk of developing pressure ulcers. (6) These alterations considerably change the lifestyle of the people affected, because the consequences make it difficult for them to maintain their previous lifestyle. For example, it is typical for these people to develop an intolerance to physical activity. Therefore, susceptibility to health problems increases after the SCI, because of the risk behaviors that the injured people acquire, in detriment of the health protection habits. (7)
People with SCI have greater risk of developing cardiovascular and endocrine diseases, since most of them become inactive and tend to put on weight, because considering that after the acute and the rehabilitation stage these people usually experience musculoskeletal deficit, decreased endurance and strength and neuromuscular weakness, among others. (8)
The literature also presents evidence of the association between lifestyle and some health issues in people with SCI. Physical inactivity is associated with cardiovascular (9) and urinary tract diseases. (10) Smoking, (6) alcohol abuse (11) and poor diet (12) are also positively associated with poor health conditions. Therefore, based on the assumption that the SCI may lead to life habits that are considered risk factors for various diseases and/or health issues, the objective of this study is to investigate the lifestyle of adults with spinal cord injury and establish its association with some health issues.
The relevance of this investigation is based on the possibility to generate knowledge to allow nurses and other healthcare professionals to design educational and health promotion interventions based on the most predominant habits that are correlated with health issues. Also, to provide important information for the redevelopment of the public policies aimed at impaired people, as well as to study a population with research gaps, mainly in the North East region of Brazil.
Cross-sectional study with quantitative and analytical approach, carried out in 2010 in all of the 61 Family Primary Healthcare Units (UBSF) located in the town of Campina Grande-PB, Brazil. The target population was everyone with SCI who were enrolled in the 61 UBSF in the town. So, and taking into account the temporal, financial and logistical relevance, the sampling technique was not used but, instead, the population census was held, resulting in 47 people participating in the study. To recruit the subjects, the following were considered as inclusion criteria: to have complete or partial SCI for any etiology diagnosed by a specialist; to be 18 years old or more; to live in Campina Grande; to be registered in the Family Health Strategy (ESF); to have satisfactory cognitive function and to adhere to the study.
For data collection, the homes of the participants were visited with the Community Health Agent responsible for the respective micro-area of enrollment. At the time, a collection tool was used, and that was a form composed of 50 questions, which covered demographic variables, such as: gender, age and race; socioeconomic variables: educational level and income per person; lifestyle variables: diet, physical activities, smoking, alcohol consumption, coffee consumption; and health conditions variables: weight, height, self-reported diseases and conditions. This instrument was completed by the researcher according to the answers of each participant. Descriptive analysis with absolute and relative frequencies and inferential analysis in the intersections of the variables were performed, with the data being presented in tables. In order to verify the association between the lifestyle and the health conditions, the chi-square test was used, except when the statistical requirement of inexistence of sigma inferior to 5 was not met. In these cases, the Fisher test was performed, based on a significance level of 5% (p<0.05).
In order to check the size of the association among the variables, the Contingency Coefficient and the following parameters were performed: r > 0.750 = strong association; 0.500 to 0.749 = moderate association; < 0.499 = weak association. It can be highlighted that when the association tests were performed, the lifestyle and the health conditions variables were dichotomized. In relation to the health conditions, the occurrence or absence of injury was considered (yes/no), but concerning the lifestyle, the dichotomization was based on the following criteria: (0)=more than four negative habits; (1) = less than four negative habits.
The collection in the project was only started after the approval by the Research Ethics Commission of the Universidade Estadual da Paraiba (CEPUEPB), under number 0490.0.133.000-08. In all the process, especially during data collection, the guidelines of Resolution 196/96 of the National Health Council were compiled with, especially with regard to section IV, which deals with the participants' autonomy and assures, among other rights, their free and informed consent, their privacy and confidentiality.
Socioeconomic profile and etiology of the spinal cord injury. As shown in Table 1, there were 10.8 men for each woman, and most of the participants were young or adults (46.8%), had low income (97.9%) and less than 10 years of education (87.2%). These causes combined had a greater percentage than all the others combined.
Lifestyle. Concerning the lifestyle of the participants with spinal cord injury, it can be noted in Table 2 that the consumption of legal substances was 91.5% for coffee, 36.2% for alcohol and 27.7% for cigarette. Two of three participants did not perform physical activity.
Health conditions. According to the data presented in Table 3, the most common diseases, injuries and/or health complications of the participants were stress (72.3%), insomnia (70.2%), negative feelings (70.2%), anxiety (68.1%) and muscular pain (63.8%).
When the association among the diseases, injuries and/or health complications with the presence of negative life habits was verified, statistically significant differences were found only in relation to the variables loss of appetite and constipation: 53.1% of the people with four or more negative habits and 20% of those who had three or less experienced loss of appetite ([chi square]=3.3; p=0.034) and 53.3% of those who had four or more negative habits versus 15.6% of those who had three or less experienced constipation ([chi square]=3.3; p=0.009).
The sociodemographic profile and etiologies of SCI in the present study are consistent with other researches. In this sense, the victims of spinal cord injury are generally men, (2,6,13,14) young, (2,3,6,13) non-Caucasian, with low level of education (2,13) and low income, (2,13) and whose injury was caused by firearm. (2,13) However, in a review study carried out by researchers of the Escola de Medicina do Trabalho in Madrid, Spain, it was found that the main causes of SCI in the world are motor vehicle accidents and falls, as well as that the predominance of non-traumatic etiologies increases as the age of the victims also increases. (3)
The finding about the physical inactivity among the participants of the study is a concerning factor and it can be related to the secondary complications verified. Therefore, there is great interest in the impact of the practice of sports in the lives of people with SCI. A study (14) conducted in Ontario, Canada, involving two groups of people with SCI, found that the group that was not inactive was associated with well-being and improvement in community integration. The higher frequency of emotional and/or subjective complications, such as stress, insomnia, negative feelings and anxiety may also be related to physical inactivity. A study (15) undertaken in Italy involving 52 quadriplegics and 85 paraplegics identified statistically significant differences between a group that did not perform physical activity and another group that did, concerning anxiety, extroversion and depression, which occurred more frequently in the physically inactive group.
The Ministry of Health and the Brazilian Hypertension IV Guidelines show that physical inactivity, stress, inadequate diet, alcohol consumption and smoking were among the several risks for systemic arterial hypertension (SAH). These are manifestations of the urbanized lifestyle and established post technology. (16) Therefore, the percentage of 25% of self-reported SAH cases could be expected, given that 36.2% of the participants did not perform physical activity, 27.7% are smokers, 36.2% consume alcohol and 72.3% are stressed.
The occurrence of pain in the subjects of this study corroborates the literature. (17) A study (13) developed in the city of Fortaleza, Brazil, involving 32 people with SCI, found low score in the pain factor in relation to the quality of life of the participants and a 56.3% frequency of neuropathic pain, and pain was also a low score factor in another study about the quality of life of people with SCI conducted in a medium-sized town located in the Northeast region of Brazil. (18) Yet, a research (19) conducted by north-American researchers showed the average pain intensity was moderate and that the painful discomfort in the lower limbs was greater. Regarding the nutritional aspect of the participants, three factors may possibly be related: coffee consumption, constipation and loss of appetite. Coffee is contraindicated for people who are at risk of constipation or have constipation, since this substance has constipating properties that can increase flatulence. (8) Constipation, in turn, may cause a lack of desire to ingest the daily diet. As a result of an insufficient diet and poor liquid intake, the volume of stools decreases, thus contributing to constipation. (20)
Although it is possible to find associations between isolated factors, this study sought to find associations between some diseases, injuries and/or self-reported complications and sets of life habits, because it is believed that an outcome is influenced by various causes, which means that its occurrence is affected by several existing contextual factors. From this perspective, the loss of appetite and constipation were associated with the occurrence of four or more negative life habits. This finding follows the national and international beliefs about the existence of problems with the diet and defecation among people with SCI. (17,20) A study (17) conducted in a hospital of the Escola Sao Paulo, Brazil, identified the nursing diagnosis according to the North American Nursing Diagnosis Association (NANDA), in relation to people with SCI admitted to a Orthopedics and Traumatology Unit, and constipation was diagnosed in 30% of the cases. But a research (20) conducted by scientists in Vancouver, Canada, points out the neurogenic intestine as a serious complication after a SCI and indicates, through a broad integrative review, the need to establish an effective bowel routine for this demand, as well as that the studies with stronger evidence are substantially linked to pharmacological therapies, rather than alternative therapies.
As for the implications of this study to the practice of nurses who provide care to people with SCI, it is believed that it is necessary to develop interventions based on education and health promotion, considering that most participants are physically inactive and drink coffee at least twice a day. The prevention actions should be focused on these people and their families, since the set of life habits can result in poor health conditions. In this context, it should be noted that, under the Family Health Strategy, the active participation of the family and the community in general support new ways of thinking and doing things in healthcare. (21) Thus, nurses should also include the caregivers of people with SCI in their care planning, seeking to offer support to family members, who are generally uninformed caregivers. It is necessary to identify their potential and provide health education to overcome possible knowledge gaps. (22)
It can also be highlighted that the nursing team should pay special attention to their guidance about the habits that may prevent diet and defecation issues. Therefore, the following actions are important: to encourage the consumption of liquids, to advise about the perfect diet, to indicate going to the toilette always at the same time, to teach abdominal massage, to recommend change of positions and avoidance of lying down position, to stimulate coughing, to support and educate the caregivers within the family, and to encourage the practice of physical activity. (8,20) Concerning the limitations of the study, the first one identified was the inability to identify some anthropometric data (weight and height) of the participants, since not all of them were in conditions to stand up for the measurements to be taken. In order to avoid bias, the BMI calculation was not performed, which would be an important indicator of the objectives of this research. Another limitation was the small sample size, which decreased the changes of generalizing the results to other populations. It can also be pointed out as a limiting factor of the study the collection of information through self-report, since the respondents could have made mistakes that would lead to occasional discrepancies between the answers and the actual situation. At last, the cross sections make it difficult to determine the directionality of associations due to the risk of bias of the reverse causality, since factors of protection, risk and outcomes are simultaneously verified.
A significant part of the participants showed to have life habits considered negative, and it was also found that most of them have four or more negative life habits at the same time. Although with low statistical intensity, association between four or more negative life habits simultaneously and the health conditions related to loss of appetite and constipation was identified, which are factors related to diet and defecation, respectively, and the nursing team should pay special attention to such conditions in the education and health promotion. It is suggested the development of effective technologies to verify measures such as weight, height and the BMI of paraplegic and quadriplegic people; the replication of this research in other cities; and the development of studies with greater power of evidence in relation to the verification of the use of non-pharmacological interventions for the prevention or treatment of complications in people with SCI.
Article associated with the investigation: "Socioeconomic profile and health conditions of adults with spinal cord injury".
Funding: National Scientific and Technological Development Council. Call MCT/CNPq 014/2008--UNIVERSAL
Conflict of interests: none.
Receipt date: Jun 6, 2013.
Approval date: Feb 10, 2014.
(1.) Cavalcante KMH, Carvalho ZMF, Barbosa IV, Rolim GA. Experience of the sexuality by people with spinal cord injury. Rev RENE. 2008; 9(1):27-35.
(2.) Blanes L, Carmagnani MIS, Ferreira LM. Quality of life and self-esteen of persons with paraplegia living in Sao Paulo, Brazil. Qual Life Res. 2009; 18:15-21.
(3.) Berga MELV, Castellotea JM, Mahillo-Fernandezc I, Pedro-Cuestac J. Incidence of Spinal Cord Injury Worldwide: A Systematic Review. Neuroepidemiology. 2010; 34:184-92
(4.) Utida C, Truzzi JC, Bruschini H, Simonetti R, Cedenho AP Srougi M et al. Male infertility in spinal cord trauma. Int Braz J Urol. 2008; 31(4):375-83.
(5.) Galvin LR, Godfrey HPD. The impact of coping on emotional adjustment to spinal cord injury (SCI): review of the literature and application of a stress appraisal and coping formulation. Spinal Cord. 2001; 39(12):615-27.
(6.) Krause JS, Broderick L. Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. Arch Phys Med Rehabil. 2007; 85:1257-64.
(7.) Krause JS, McArdle JJ, Pickelsimer E, Reed KS. A Latent Variable Structural Path Model of Health Behaviors After Spinal Cord Injury. J Spinal Cord Med. 2009; 32(2):162-74.
(8.) Vasconcelos AS, Franca ISX, Coura AS, Sousa FS, Souto RQ, Cartaxo HGO. Nursing interventions on the needs of people with spinal cord injury: an integrative review. Online Braz J Nurs. [Internet] 2010. [cited 2012 Mar 11]; 9(2). Available from: http://www.objnursing.uff.br/index.php/nursing/ article/view/j.1676-4285.2010.3000/674
(9.) Demirel S, Demirel G, Tukek T, Erk O, Yilmaz H. Risk factors for coronary heart disease in patients with spinal cord injury in Turkey. Spinal Cord. 2001; 39(3):134-8.
(10.) Davies DS, McColl MA. Lifestyle risks for three disease outcomes in spinal cord injury. Clin Rehabil. 2002; 16(1):96-108.
(11.) Tate DG, Forchheimer M, Krause JS, Meade M, Bombardier CH. Patterns of alcohol and substance use and abuse in persons with spinal cord injury risk factors and correlates. Arch Phys Med Rehabil. 2004; 85:1837-47.
(12.) Tomey KM, Chen DM, Wang X, Braunschweig Cl. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil. 2005; 4:664-71.
(13.) Vall J, Braga AB, Almeida PC. Study of the quality of life in people with traumatic spinal cord injury. Arq Neuro-Psiquiatr. 2006; 64(2-B):451-5.
(14.) McVeigh SA, Hitzig SL, Craven C. Influence of Sport Participation on Community Integration and Quality of Life: A Comparison Between Sport Participants and Non-Sport Participants With Spinal Cord Injury. J Spinal Cord Med. 2009; 32(2):115-24.
(15.) Gioia M, Cerasa A, Lucente A, Brunelli S, Castellano V, Traballesi M. Psychological impact of sports activity in spinal cord injury patients. Scand J Med Sci Sports. 2006; 16(6):412-6.
(16.) Sociedade Brasileira de Cardiologia. Sociedade Brasileira de Hipertensao. Sociedade Brasileira de Nefrologia. VI Brazilian Guidelines on Hypertension. Arq Bras Cardiol. 2010; 95(1 supl.1):1-51.
(17.) Cafer CR, Barros ALBL, Lucena AF, Mahl MLS, Michel JLM. Nursing diagnoses and interventions proposal al for patients with spinal cord lesion. Acta Paul Enferm. 2005; 18(4):347-53.
(18.) Franca ISX, Coura AS, Franca EG, Basilio NNV, Souto RQ. Quality of life of adults with spinal cord injury: a study using the WHOQOL-bref. Rev Esc Enferm USP 2011; 45(6):1364-71.
(19.) Ullrich PM, Jensen MP, Loeser JD, Cardenas DD. Pain intensity, pain interference and characteristics of spinal cord injury. Spinal Cord. 2009; 46(6):451-455.
(20.) Krassioukov A, Eng LL, Claxton G, Sakakibara BM, Shum S. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord. 2010; 48:718-33. 21 22
(21.) Roecker S, Marcon SS. Educacao em saude. Relatos das vivencias de enfermeiros com a Estrategia da Saude Familiar. Invest Educ Enferm. 2011; 29(3):381-90.
(22.) Benjumeaa CC. El cuidado familiar: una revision critica. Invest Educ Enferm. 2009; 27(1): 96102.
Inacia Satiro Xavier de Franca  Bertha Cruz Enders  Alexsandro Silva Coura  Giovanna Karinny Pereira Cruz  Jamilly da Silva Aragao  Deborah Raquel Carvalho de Oliveira 
 Nurse, Ph.D. Professor at Universidade Estadual da Paraiba (UEPB), Campina Grande/PB, Brazil.
 Nurse, Ph.D. Professor at Universidade Federal do Rio Grande do Norte (UFRN). Natal/RN, Brazil.
 Nurse, Ph.D. Professor at UEPB, Campina Grande/PB, Brazil.
 Nurse, Master's student at UFRN. Natal/ RN, Brazil.
 Nurse, Master's student at UEPB. Campina Grande/PB, Brazil.
 Nurse, Master's student at UFRN. Natal/ RN, Brazil.
Table 1. Socioeconomic profile and etiology of the spinal cord injury of the adult participants. Campina Grande--PB. Brazil, 2010 Variables n % Male 43 91.5 Age 19 - 39 years old 22 46.8 40 - 60 years old 20 42.6 61 - 81 years old 5 10.6 Race Brown 18 38.3 Caucasian 15 31.9 Black 14 29.8 Educational level Primary school 19 40.4 Literate 17 36.2 High School 6 12.8 Illiterate 5 10.6 Income per person Less than the minimum wage 46 97.9 One minimum wage 1 2.1 Etiology Firearm 15 31.9 Fall 13 27.7 Body impact 5 10.6 Post-surgery 5 10.6 Neoplasms 3 6.4 Car accident 3 6.4 Schistosomiasis 2 4.3 Diving 1 2.1 Table 2. Lifestyle of 47 people with spinal cord injury. Campina Grande--PB. Brasil, 2010 Variables n % Smoking 13 27.7 1 - 10 cigarettes/day 8 17.0 11 - 20 cigarettes/day 5 10.7 Alcohol consumption 17 36.2 Everyday 1 2.1 Weekends 5 10.6 Socially 11 23.4 Coffee consumption 43 91.5 1 time/day 14 29.8 2 - 4 times/day 19 40.4 > 4 times/day 10 21.3 Physical activity 17 36.2 Everyday 7 14.9 2 - 3 times/week 7 14.9 Occasionally 3 6.4 Table 3. Self-reported diseases, injury and-or health complications of people with spinal cord injury. Campina Grande--PB. Brasil, 2010 Variables n % Stress 34 72.3 Insomnia 33 70.2 Negative feelings 33 70.2 Anxiety 32 68.1 Muscular pain 30 63.8 Headache 23 48.9 Loss of appetite 20 42.6 Disease 18 38.3 Heartburn 17 36.2 Fatigue 16 34.0 Pressure ulcer 16 34.0 Urinary incontinence 14 29.8 Constipation 13 27.7 Hypertension 12 25.5 Cough 11 23.4 Urinary tract infection 8 17.0 Wheezing 7 14.9 Expectoration 7 14.9 Dyspnea 2 4.3
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|Title Annotation:||Original article|
|Author:||de Franca, Inacia Satiro Xavier; Enders, Bertha Cruz; Coura, Alexsandro Silva; Cruz, Giovanna Karinn|
|Publication:||Investigacion y Educacion en Enfermeria|
|Date:||May 1, 2014|
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