Cognitive mapping in persons newly diagnosed with type 2 diabetes.

PURPOSE: The purpose of this study was to determine the issues and perceptions of persons newly diagnosed (within last 3 months) with type 2 diabetes. METHODS: In this qualitative study, 16 adults newly diagnosed with type 2 diabetes were recruited, who completed a demographic, lifestyle, and diabetes management questionnaire and then were interviewed using cognitive mapping. Participants were asked to write words or phrases that came to mind when thinking about living with diabetes. From these words, common concepts were identified, grouped into clusters, and reduced into categories. Associations were sought between demographics and categories. RESULTS: A total of 260 Post-It notes were written, from which 123 concepts were identified and grouped into 24 clusters. The most frequent concept was eat, and the 3 most frequent clusters were food, negative emotions, and diabetes and its complications. The 9 categories, in order of frequency, were as follows: (1) need to (self-management), (2) concerns, (3) "I'm sick", (4) emotional distress, (5) loss, (6) the no's (limitations), (7) fears and complications, (8) have to (medical management), and (9) coping. Persons with a college education and a later interview date since diagnosis were associated with the concepts in the need to and have to categories. Concepts in the I'm sick category were associated with lower income and Hispanic ethnicity. CONCLUSIONS: Diabetes educators should consider this holistic representation of the issues and perceptions reflected in the common concepts, clusters, and categories expressed by persons newly diagnosed with diabetes.

Sex differences in disease severity among patients with systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus (SLE), a prototypical autoimmune disease, often results in comorbidities from exposure to medications as well as from chronic inflammation. Identification of gender-based differences in comorbidities and disease severity may assist health practitioners in providing optimum care for those living with SLE. OBJECTIVE: The purpose of this study, which utilized hospital discharge data collected during a 7-year period to garner a large SLE patient sample, was to determine the effect of gender on SLE comorbidities and disease severity. METHODS: Patients were hospitalized in the Dallas-Fort Worth metropolitan statistical area between 1999 and 2005 and had a diagnosis of SLE. The sample consisted of 14,829 patients with SLE, 10% of which were male. ANOVAs were conducted to test for differences between males and females for disease severity, age, length of stay in the hospital, total hospital charges, and number of autoimmune diseases. Disease severity was measured with the SLE comorbidity index, which weights 14 conditions in SLE. We identified the top 30 comorbidities as well as the odds of experiencing the secondary illnesses by gender. RESULTS: Male patients had significantly greater disease severity compared with female patients. Additionally, female patients had more autoimmune diagnoses compared with male patients. Male patients were more likely to have cardiovascular and renal comorbidities compared with female patients. Female patients had significantly greater odds of diagnoses of urinary tract infection, hypothyroidism, depression, esophageal reflux, asthma, and fibromyalgia. CONCLUSIONS: Although the prevalence of SLE among males is rare, male patients have the potential for greater disease severity and are more likely to suffer from cardiovascular and renal disease. Gender differences in disease severity should be further evaluated, but with the added recommendation to develop an index with conditions more indicative of active SLE.

The impact of race and ethnicity on disease severity in systemic lupus erythematosus.

OBJECTIVES: Systemic lupus erythematosus (SLE) can result in comorbidities and high disease severity. The aim of this study was to evaluate the effects of age, sex, race, ethnicity, cost of hospitalization, length of stay, and payor source on SLE disease severity scores. DESIGN: Epidemiological study. SETTING: Hospital discharge data were obtained from the DFW Hospital Council (DFWHC), for 65,535 patients hospitalized in the North Texas Dallas-Fort Worth (DFW) Metropolitan Statistical Area (MSA) from 1999-2005 with at least one autoimmune disease. PATIENTS: Of the 65,535 autoimmune patients, 14,829 patients had SLE as a diagnosis. The sample was assessed for disease severity according to the SLE comorbidity Index. MAIN OUTCOME: Disease severity, SLE comorbidities. RESULTS: SLE patients were younger and more than five times more likely to have multiple autoimmune diseases. More than one third of Hispanic patients were on Medicaid or self-pay and more likely to have higher disease severity. Race (Caucasian), sex (female), and payor source (PPO/POS) predicted lower disease severity scores. SLE was predictive of eight of the fourteen SLE-CI diseases, with greatest effects observed for nephritis (OR = 3.30, P < .0001), chronic renal failure (OR = 3.36, P < .0001), pericarditis (OR = 3.2, P < .0001), and pleuritis (OR = 2.06, P < .0001). Non-Caucasian patients were more likely to have chronic renal failure, nephritis, congestive heart failure, pericarditis and pleuritis. CONCLUSIONS: The comorbidities that exist in SLE vary according to ethnicity. It is paramount for physicians to be cognizant of these disparities and make appropriate referrals.