Kassandra L. Messer

Blood Pressure Control Among Persons Without and With Chronic Kidney Disease: US Trends and Risk Factors 1999―2006

Recent guidelines recommending more aggressive blood pressure control in patients with chronic kidney disease have unknown impact. We assessed trends in and predictors of blood pressure control in 8829 adult National Health and Nutrition Examination Survey 1999–2006 participants with hypertension (self-report, measured blood pressure, or use of antihypertensive medications), without (n=7178) and with (n=1651) chronic kidney disease. Uncontrolled blood pressure was defined as follows: general definition, systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg, and disease-specific definition, systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥85 mm Hg (1999–2002) and systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥80 mm Hg (2003–2006) for those with chronic kidney disease (estimated glomerular filtration rate: <60 mL/min per 1.73 m2) or diabetes mellitus (self-report). Proportions with uncontrolled blood pressure in 1999–2006 were greater in those with chronic kidney disease versus those without chronic kidney disease (51.5% versus 48.7% [general definition: P=0.122] and 68.8% versus 51.7% [disease-specific definition: P<0.001]). In those with chronic kidney disease, there were significant decreases in uncontrolled blood pressure over time (55.9% to 47.8% [general definition: P=0.011]). With adjustment for demographic, socioeconomic, and clinical variables, older age (P<0.001) and lack of antihypertensive treatment (P<0.001) were associated with uncontrolled blood pressure, regardless of chronic kidney disease status; nonwhite race (P=0.002) was associated in those without chronic kidney disease, whereas female sex (P=0.030) was associated in those with chronic kidney disease. Multiple medications (P<0.001) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (P=0.001) were associated with less uncontrolled blood pressure. Although some improvement has occurred over time, uncontrolled blood pressure remains highly prevalent, especially in subjects with chronic kidney disease and in nonwhites, older persons, and women. Therapy appears suboptimal.

Promising insights into the health related quality of life for children with severe obesity

BackgroundChildhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity.MethodsThe pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile.Results136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05).ConclusionsChildren and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life.

Adherence to a behavioral program to prevent incontinence.

This exploratory study assesses factors predicting adherence to a behavioral intervention to prevent urinary incontinence. Community-dwelling, post-menopausal women (N = 164) were taught pelvic floor muscle training (PFMT) and bladder training (BT) and followed with surveys for 1 year. Content analysis of open-ended responses coded descriptions of approaches participants used to incorporate PFMT into daily life. Exploratory bivariate and logistic regression analyses determined predictors of approach used and adherence. Results indicate women incorporated PFMT into their lives using either a routine or ad hoc approach. Those using a routine approach at 3 months were 12 times more likely to adhere (odds ratio [OR] = 12.4, confidence interval [CI] = 4.0-38.8, p < .001) at a high level at 3 months and significantly more likely to maintain that level 12 months post-intervention (OR = 2.7, CI = 1.2-6.0, p < .014). Practicing BT was related to high adherence.

Self-Efficacy as a Predictor to PFMT Adherence in a Prevention of Urinary Incontinence Clinical Trial

Past research suggests a positive correlation between self-efficacy (SE) and adherence to behavioral interventions. Less is known about SE and adherence in behavioral programs that are preventive in nature and specific to urinary incontinence (UI). Using treatment-group data from a previously reported randomized controlled trial, the authors assess the role of SE in predicting adherence to pelvic-floor muscle training (PFMT) for UI prevention in a sample of postmenopausal women. Results indicate that at 12 months follow-up, nearly 70% of participants reported medium or high adherence, performing the recommended PFMT regimen 2 to 3 times per week or more. Summary scores of both Task SE, β = .25, SE (β) = .08, p < .01, and Regulatory SE, β = .43, SE (β) = .06, p < .0001, predict adherence. Also, the authors found a modest decline in self-efficacy scores over time. These findings highlight the importance of SE in sustained behavioral change.

Evaluation of a mass mailing recruitment strategy to obtain a community sample of women for a clinical trial of an incontinence prevention intervention

Objectives: Questions exist about using mass mailings to recruit representative samples to participate in clinical trials. The MESA Prevention Study (Medical, Epidemiologic and Social Aspects of Aging), a randomized controlled clinical trial to prevent urinary incontinence (UI), utilized a mass mailing recruitment procedure to recruit a representative sample of women to participate in a behavioral modification program. This paper seeks to expand the literature of mass mailing recruitment strategies for prevention studies by describing the procedures used to recruit healthy, continent, post-menopausal women aged 55–80 years. Methods: Sociodemographic data collected from recruited subjects is compared with on-line national census data to evaluate the representativeness of the sample recruited from a purchased mailing list. Results: The mass mailing procedure resulted in 3.3% positive response. Of those that returned a positive response, 37.6% were deemed eligible at first screening. Comparisons of study demographic data with state and county census data indicate that the sample obtained was representative of the communities. Conclusions: The mass mailing strategy was an effective means of recruiting a representative sample of women, aged 55–80. Short falls and recommendations for successful community sample recruitment strategies for clinical trials in older adult women are elaborated upon.

Inpatient Health Care Utilization by Children and Adolescents With Systemic Lupus Erythematosus and Kidney Involvement

To evaluate inpatient health care utilization for children with systemic lupus erythematosus (SLE) with and without kidney disease.