Charles Ellis

The Effects of Depression on Diabetes Knowledge, Diabetes Self-Management, and Perceived Control in Indigent Patients with Type 2 Diabetes

BACKGROUND This study was designed to assess differences in diabetes knowledge, diabetes self-management, and perceived control among depressed and nondepressed individuals in an indigent population with type 2 diabetes. RESEARCH DESIGN AND METHODS Depressed and nondepressed patients with the clinical diagnosis of type 2 diabetes were recruited from an indigent care clinic. Subjects completed validated surveys to assess diabetes knowledge, diabetes self-management, and perceived control of diabetes. We compared demographic characteristics and diabetes knowledge, diabetes self-management, and perceived control of diabetes by depression status. Statistical analysis was performed with SPSS version 14.0 (SPSS, Inc., Chicago, IL). RESULTS Of the 201 subjects with diagnosed type 2 diabetes enrolled in the study, approximately 20% n = 40) of the sample was depressed. Subjects with depression were more likely to report self-care control problems (mean = 2.2 +/- 1.0 vs. 1.5 +/- 0.6, P < 0.001) and less likely to report positive attitude (mean = 2.9 +/- 0.7 vs. 3.7 +/- 0.5, P < 0.001), self-care ability (mean = 3.2 +/- 3.6 vs. 3.7 +/- 0.5, P < 0.001), and self-care adherence (mean = 3.3 +/- 0.9 vs. 4.1 +/- 0.6, P < 0.001). Depressed patients were less likely to report perceived control of diabetes (mean = 47.7 +/- 8.5 vs. 57.8 +/- 7.4, P < 0.001). There were no significant differences in diabetes knowledge, self-care understanding, and perceived importance of self-care between depressed and nondepressed patients. CONCLUSIONS In this indigent population with type 2 diabetes, diabetes knowledge did not differ significantly by depression status, but diabetes self-management practices and perceived control of diabetes differed significantly by depression status. Patients who were depressed had poorer diabetes self-care and felt they had less control over their disease.

The Effects of Depression on Metabolic Control and Quality of Life in Indigent Patients with Type 2 Diabetes

BACKGROUND The objective of this study was to assess differences in metabolic control and health-related quality of life (QOL) among depressed and nondepressed adults in an indigent population with type 2 diabetes. RESEARCH DESIGN AND METHODS Subjects completed validated surveys to assess depression and QOL. Depression was assessed with the Center for Epidemiological Studies-Depression Scale and defined as a score of > or =16. Metabolic control (hemoglobin A1C, total cholesterol, low-density lipoprotein [LDL] cholesterol, and high-density lipoprotein [HDL] cholesterol) measures were abstracted from medical records. We compared demographic characteristics, metabolic control, and QOL by depression status. Ordinary least squares regression was used to assess differences in QOL scores and metabolic control levels by depression status adjusting for covariates. RESULTS In the study sample (n = 201), approximately 20% (n = 40) were depressed. In unadjusted analyses, subjects with depression had significantly lower SF-12 physical component summary (PCS) scores (30.4 +/- 7.3 vs. 39.6 +/- 11.8, P < 0.001) and mental component summary (MCS) scores (32.8 +/- 10.5 vs. 48.9 +/- 9.2, P < or = 0.001) and significantly higher total cholesterol (209.3 +/- 72.1 vs. 186.6 +/- 50.9, P = 0.024) compared to those without depression. No significant differences were observed by depression status in hemoglobin A1C, LDL cholesterol, and HDL cholesterol. After adjustment for relevant covariates, depressed individuals continued to have lower SF-12 PCS (36.1 vs. 39.0, P < or = 0.001) and MCS (41.6 vs. 46.8, P < or = 0.001) scores, but the difference in total cholesterol levels was no longer significant. CONCLUSIONS In an indigent sample with type 2 diabetes, depression is significantly associated with decreased physical and mental components of QOL. This finding further reinforces the importance of addressing depression in all populations with type 2 diabetes.

Persistent Racial Disparity in Stroke Hospitalization and Economic Impact in Young Adults in the Buckle of Stroke Belt

Background and Purpose— Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina. Methods— Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430–434, 436, 437.1). Age- and race-stroke–specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites. Results— Of the 84 179 stroke hospitalizations, 31 137 (37.0%) were from patients aged <65 years and 29 846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged ≥65 years) for both blacks and whites (P<0.001) but increased among the younger group (aged <65 years; P=0.004); however, this increase was mainly driven by a 17.3% rise among blacks (P=0.001), with no difference seen among whites (P=0.84). Of hospital charges totaling

Poststroke Knowledge and Symptom Awareness: A Global Issue for Secondary Stroke Prevention

2.77 billion,

Racial Differences in Poststroke Rehabilitation Utilization and Functional Outcomes

453.2 million (16.4%) are associated with racial disparity (79.6% from patients aged <65 years). Thirty-day stroke mortality rates decreased in all age-race-stroke–specific groups (P<0.001). Conclusions— The stroke hospitalization rate increased in the young blacks only, which results in a severe and persistent racial disparity. It highlights the urgent need for a racial disparity reduction in the younger population to alleviate the healthcare burden.

Preventable hospital admissions among the homeless in California: A retrospective analysis of care for ambulatory care sensitive conditions

Background: Stroke survivors are at a substantial risk of repeat stroke. Despite this, many stroke survivors continue their unhealthy prestroke lifestyles. Lack of knowledge related to stroke and stroke risk has been proposed as one contributor to the continuance of unhealthy lifestyles. A comprehensive literature currently exists related to knowledge of stroke and its risk factors and recognition of stroke symptoms in the general population, but less is known about these issues among stroke survivors who are at a higher risk for stroke. The purpose of this review was to examine stroke knowledge among stroke survivors. Methods: Data sources were MEDLINE, CINAHL and the Cochrane Library, and the reference lists of published papers were searched to identify relevant studies. We extracted data related to stroke knowledge (general and risk factors) and symptom awareness from studies designed to examine stroke knowledge among stroke survivors. For the study design, we completed a systematic review of stroke knowledge (general information, stroke symptoms and risk factors) among stroke survivors. Standardized and nonstandardized measurements were taken of: (1) general stroke knowledge, i.e. cause, type (ischemic vs. hemorrhage), location, body parts affected and what action to take in the event of having a stroke, (2) stroke awareness (common warning signs and symptoms such as: weakness/numbness, confusion/difficulty speaking, difficulty seeing in one or both eyes, difficulty walking, headache of no known cause) and (3) knowledge or identification of common stroke risk factors (e.g. high blood pressure, high blood sugar,high cholesterol,obesityand smoking). Due to limited information on outcomes and the heterogeneity of the studies, a formal meta-analysis was not conducted. Instead, we completed a qualitative aggregation of study findings. Results: Data from 18 studies spanning 8 countries and including 8,147 participants met the inclusion criteria for this review. These studies offer evidence that many stroke survivors do not have a greater knowledge of stroke despite their having experienced such a life-changing event. Conclusions: Due to their limited knowledge, many stroke survivors may not engage in the required preventive behaviors for good health and reducing the risk of a stroke recurring. More specifically, stroke survivors may understand the cause of their stroke but not be able to identify many stroke symptoms or common stroke risk factors. Stroke education programs should be designed to improve stroke knowledge and facilitate the actions necessary for reducing stroke risk.

Recovery of cohesion in narrative discourse after left-hemisphere stroke.

OBJECTIVE To examine racial differences in poststroke rehabilitation utilization and functional outcomes. DESIGN Observational follow-up study. SETTING Designated stroke center. PARTICIPANTS Stroke survivors (N=162; 106 whites and 56 blacks) surveyed at 1 year poststroke. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Twenty-question measure of activities of daily living (ADL) and instrumental activities of daily living (IADL) performance, life participation, and driving. One-year follow-up data collected from stroke survivors as part of the Stroke Education and Prevention-South Carolina Project were examined for racial disparities in rehabilitation utilization and functional outcomes. RESULTS Analyses revealed no significant differences between blacks and whites for rehabilitation utilization. In multivariate comparisons controlling for stroke severity, blacks were less likely to report independence in overall functional performance and domain-specific measures of toileting, walking, transportation, laundry, and shopping. Blacks also reported less independence in driving at 1-year follow-up. CONCLUSIONS Blacks were less likely to report independence in performing ADL and IADL at 1 year poststroke after controlling for stroke severity. Racial disparities were reported in ADL and IADL performance despite a lack of racial differences in rehabilitation utilization. Future studies are needed to further understand the reason for this disparity in reported functional independence.

Global coherence during discourse production in adults: a review of the literature.

BackgroundLimited research exists that investigates hospital admissions for ambulatory care sensitive conditions (ACSCs) among the homeless, who frequently lack a usual source of care. This study profiled ACSC admissions for homeless patients.MethodsBivariate analyses and logistic regression were completed to investigate ACSC and non-ACSC admissions among homeless patients using the 2010 California State Inpatient Database.ResultsHomeless patients admitted for an ACSC were mostly male, non-Hispanic white, and on average 49.9 years old. In the predictive model, the odds of an ACSC admission among homeless patients increased when they were black, admitted to the emergency department or transferred from another health facility. Having Medicare was associated with a decreased odds of an ACSC admission.ConclusionsSpecific characteristics are associated with a greater likelihood of an ACSC admission. Research should examine how these characteristics contribute to ACSC hospitalizations and findings should be linked to programs designed to serve as a safety-net for homeless patients to reduce hospitalizations.

Gender Differences in Stroke Recognition Among Stroke Survivors

Little is known about the recovery of narrative discourse after stroke. While several studies have analyzed the recovery of language in individuals with aphasia, few known studies exist on the recovery of narrative discourse in stroke survivors, particularly those who have not been diagnosed with aphasia. In this study, we evaluated the cohesiveness of narrative discourse in a cohort of individuals who had suffered a left-hemisphere stroke and had not been diagnosed with expressive language impairment. We analyzed their narrative discourse at 1, 6, and 12 months poststroke. Our findings indicate that, while the mean number of cohesive ties in narrative discourse remained generally constant during the first year poststroke, the percentage correct use of cohesive ties increased significantly during the same time period. These findings suggest that subtle disruptions in expressive language can be present initially in narrative discourse, and recovery from these disruptions can occur naturally over time.

Narrative Discourse Cohesion in Early Stage Parkinson’s Disease

BACKGROUND Global coherence is a metric of expressive language performance that represents the speakers ability to initiate, plan and maintain a topic of discussion. Studies indicate that disruptions of global coherence can occur during the ageing process and following neurological disease or injury. However, little is known about the specific impact that the ageing process, disease or injury has on global coherence during discourse production. AIMS To review the literature on global coherence in adult populations and assess the impact that age, disease or injury has on global coherence during expressive language tasks. METHODS & PROCEDURES We completed an in-depth search of Medline and PyschInfo (1990-2014) to identify studies of global coherence in adult populations. We identified studies that included a comparison group and utilized a measure of global coherence during expressive language production among adults. OUTCOMES & RESULTS Twenty studies comprised of 692 study participants who met inclusion criteria were identified for the review of the literature. Studies included participants without neurological impairments and individuals with aphasia, traumatic brain injury, dementia, generalized memory impairment and other neurological conditions. Study results indicated global coherence is an expressive language skill that is influenced by the ageing process and neurological disease or injury. CONCLUSIONS & IMPLICATIONS Although evidence indicated that global coherence is negatively influenced by ageing and neurological disease/injury, the heterogeneity of study populations, measurement tools and study designs were limiting factors in determining the exact nature by which these factors impact the skill of global coherence.