Self-reported cardiovascular disease risk factors and associated hopelessness in African American participants of a church-placed health screening program.

OBJECTIVE: This study evaluates patient inertia (PtInert) factors including hopelessness in African Americans participating in church cardiovascular screening programs in low income areas in Forsyth County, North Carolina. Patient inertia is defined as an inability to assume adequate hypertension self-management behaviors, leading to poorly controlled hypertension. Previous findings revealed hopelessness related to blood pressure (BP) control as a key PtInert factor in acute medical environment participants. DESIGN: Questionnaires were administered by facilitated interview. Clinical components of the cardiometabolic syndrome were obtained. SETTING: The study was conducted within six Forsyth County churches that were participating in cardiovascular screening programs sponsored by the Consortium for Southeastern Hypertension Control. PARTICIPANTS: 67 African Americans (72% female; 49% personal history of hypertension) with an average age of 55 years served as study participants. RESULTS: Participants without a history of hypertension were overweight, pre-hypertensive, and normocholesterolemic while those with a history of high BP receiving antihypertensive treatment were normocholesterolemic, obese, and on average had a BP of 143/75 mm Hg. Hopelessness related to BP control was found in 18% of those with a personal history of high BP. A significant relationship was found between hopelessness and family history of high BP, perceived ability to control high BP, and frustration with BP treatment. CONCLUSIONS: Our findings suggest that hopelessness, while exhibited less often in church participants as compared to previous findings in the acute medical environment, is associated with participant thoughts, feelings, and histories but is not associated with clinical components of the metabolic syndrome.

The associations of multiple dimensions of discrimination and abdominal fat in African American adults: the Jackson Heart Study.

BACKGROUND: Discrimination may be adversely associated with abdominal obesity, but few studies have examined associations with abdominal fat. PURPOSE: The purpose of this study was to examine whether discrimination was independently associated with visceral (VAT) and subcutaneous (SAT) fat and whether these associations differed by sex and age. METHODS: Participants self-reported experiences of everyday and lifetime discrimination. The main reason for and the coping response to these experiences were also reported. VAT and SAT were quantified by computed tomography. RESULTS: In fully adjusted models, higher reports of everyday discrimination were associated with greater SAT, but not VAT, volumes in men only: SAT increased by 3.6 (standard error = 1.8) cm(3) for each unit increase in the everyday discrimination score. In women, higher reports of lifetime non-racial discrimination were associated with greater VAT (71.6 ± 32.0, P < 0.05) and SAT (212.6 ± 83.6, P < 0.05), but these relationships were attenuated after controlling for body mass index. CONCLUSIONS: These cross-sectional findings do not fully support the independent hypothesis of discrimination and abdominal fat. Additional investigations involving longitudinal designs are warranted.

Factors influencing enrollment of African Americans in the Look AHEAD trial.

BACKGROUND: Many factors have been identified that influence the recruitment of African Americans into clinical trials; however, the influence of eligibility criteria may not be widely appreciated. We used the experience from the Look AHEAD (Action for Health in Diabetes) trial screening process to examine the differential impact eligibility criteria had on the enrollment of African Americans compared to other volunteers. METHODS: Look AHEAD is a large randomized clinical trial to examine whether assignment to an intensive lifestyle intervention designed to produce and maintain weight loss reduces the long-term risk of major cardiovascular events in adults with type 2 diabetes. Differences in the screening, eligibility, and enrollment rates between African Americans and members of other racial/ethnic groups were examined to identify possible reasons. RESULTS: Look AHEAD screened 28,735 individuals for enrollment, including 6226 (21.7%) who were self-identified African Americans. Of these volunteers, 12.9% of the African Americans compared to 19.3% of all other screenees ultimately enrolled (p < 0.001). African Americans no more often than others were lost to follow-up or refused to attend clinic visits to establish eligibility. Furthermore, the enrollment rates of individuals with histories of cardiovascular disease and diabetes therapy did not markedly differ between the ethnic groups. Higher prevalence of adverse levels of blood pressure, heart rate, HbA1c, and serum creatinine among African American screenees accounted for the greater proportions excluded (all p < 0.001). CONCLUSIONS: Compared to non-African Americans, African American were more often ineligible for the Look AHEAD trial due to comorbid conditions. Monitoring trial eligibility criteria for differential impact, and modifying them when appropriate, may ensure greater enrollment yields.

Diabetes and adverse mental health among African Americans.

This article reviews the connection between diabetes and adverse mental health among African Americans. Concern about safe insulin prescribing and administration is raised, and the importance of integrated physical and mental health care in the prevention and control of diabetes is highlighted.

Constructing common cohorts from trials with overlapping eligibility criteria: implications for comparing effect sizes between trials.

BACKGROUND: Comparing findings from separate trials is necessary to choose among treatment options, however differences among study cohorts may impede these comparisons. PURPOSE: As a case study, to examine the overlap of study cohorts in two large randomized controlled clinical trials that assess interventions to reduce risk of major cardiovascular disease events in adults with type 2 diabetes in order to explore the feasibility of cross-trial comparisons METHODS: The Action for Health in Diabetes (Look AHEAD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials enrolled 5145 and 10,251 adults with type 2 diabetes, respectively. Look AHEAD assesses the efficacy of an intensive lifestyle intervention designed to produce weight loss; ACCORD tests pharmacological therapies for control of glycemia, hyperlipidemia, and hypertension. Incidence of major cardiovascular disease events is the primary outcome for both trials. A sample was constructed to include participants from each trial who appeared to meet eligibility criteria and be appropriate candidates for the other trial's interventions. Demographic characteristics, health status, and outcomes of members and nonmembers of this constructed sample were compared. RESULTS: Nearly 80% of Look AHEAD participants were projected to be ineligible for ACCORD; ineligibility was primarily due to better glycemic control or no early history of cardiovascular disease. Approximately 30% of ACCORD participants were projected to be ineligible for Look AHEAD, often for reasons linked to poorer health. The characteristics of participants projected to be jointly eligible for both trials continued to reflect differences between trials according to factors likely linked to retention, adherence, and study outcomes. LIMITATIONS: Accurate ascertainment of cross-trial eligibility was hampered by differences between protocols. CONCLUSIONS: Despite several similarities, the Look AHEAD and ACCORD cohorts represent distinct populations. Even within the subsets of participants who appear to be eligible and appropriate candidates for trials of both modes of intervention, differences remained. Direct comparisons of results from separate trials of lifestyle and pharmacologic interventions are compromised by marked differences in enrolled cohorts.

Is ApoE epsilon4 associated with cognitive functioning in African Americans diagnosed with Alzheimer Disease? An exploratory study.

OBJECTIVE: The effect of the apolipoprotein epsilon4 allele (ApoE epsilon4) on cognitive performance in patients with probable Alzheimer disease (AD) has been studied in primarily Caucasian samples. The aim of this exploratory study was to examine whether the presence of ApoE epsilon4 is associated with cognitive performance in African American AD patients. METHODS: A cross-sectional, retrospective design was used to address the study objective. Data were extracted from the records of 65 African American patients who participated in the National Institutes of Health-National Institute on Aging (NIH-NIA) Emory University Alzheimer Disease Center Registry. Inclusion criteria were a clinical diagnosis of probable AD, cognitive testing using the Mattis Dementia Rating Scale and the Consortium to Establish a Registry for Alzheimer Disease (CERAD) neuropsychological battery, and ApoE genotyping. RESULTS: Seventy percent of the patients were ApoE epsilon4 positive. Multiple regression analyses indicated that ApoE epsilon4 was significantly associated with poorer design copying (CERAD Constructional Praxis subtest), but other significant relationships were not observed between positive epsilon4 status and cognitive performance. CONCLUSIONS: These preliminary findings suggest that the ApoE epsilon4 allele is not strongly associated with a particular pattern of cognitive functioning in African Americans once they are diagnosed with AD. However, these findings require replication in a large prospectively recruited and population-based sample of African American AD patients before firm conclusions can be reached.

Emergency department patients self-report higher patient inertia, hopelessness, and harmful lifestyle choices than community counterparts.

Patient inertia is defined as an individual's failure to take responsibility for proactive lifestyle change and health conditions including hypertension. Generalized and hypertension-specific patient inertia factors were compared in 110 patients (48% women; 52% African American) from a Forsyth County, NC, emergency department (ED) and 104 community members (79% women; 70% African American) using the patient inertia-facilitated survey Patient Inertia-36. Statistically, more ED than community participants added salt to food at the table and consumed fast foods 5 to 7 days a week. ED patients agreed less often with health literacy questions about salt and BP. Hypertension associated Patient inertia questions asked of 45 ED and 40 community participants with a personal history of hypertension revealed a statistically higher sense of hopelessness surrounding blood pressure management in ED participants. Past BP control experiences of family members had statistically greater impact on community participants regarding their own BP control. Using a logistic regression model, advancing age and being surveyed in the ED were correlated with hopelessness towards BP control. ED patients make unhealthier diet choices and possess heightened generalized and hypertension-specific patient inertia including hopelessness towards controlling their BP that increases with age. These factors may contribute to this population's poor BP control, particularly self-efficacy barriers.

Preliminary findings exploring the social determinants of Black males' lay health perspectives.

The unequal discussion of Black males' health is a pressing social problem. This study addressed Black males' lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men's health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic-medical settings, (d) hyperactive masculinity fatigue, and (e) the gay-straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement.

One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the Look AHEAD study.

Depressed individuals are frequently excluded from weight loss trials because of fears that weight reduction may precipitate mood disorders, as well as concerns that depressed participants will not lose weight satisfactorily. The present study examined participants in the Look AHEAD study to determine whether moderate weight loss would be associated with incident symptoms of depression and suicidal ideation, and whether symptoms of depression at baseline would limit weight loss at 1 year. Overweight/obese adults with type 2 diabetes (n = 5,145) were randomly assigned to an Intensive Lifestyle Intervention (ILI) or a usual care group, Diabetes Support and Education (DSE). Of these, 5,129 participants completed the Beck Depression Inventory (BDI) and had their weight measured at baseline and 1 year. Potentially significant symptoms of depression were defined by a BDI score ≥10. Participants in ILI lost 8.6 ± 6.9% of initial weight at 1 year, compared to 0.7 ± 4.8% for DSE (P < 0.001, effect size = 1.33), and had a reduction of 1.4 ± 4.7 points on the BDI, compared to 0.4 ± 4.5 for DSE (P < 0.001, effect size = 0.23). At 1 year, the incidence of potentially significant symptoms of depression was significantly lower in the ILI than DSE group (6.3% vs. 9.6%) (relative risk (RR) = 0.66, 95% confidence interval (CI) = 0.5, 0.8; P < 0.001). In the ILI group, participants with and without symptoms of depression lost 7.8 ± 6.7% and 8.7 ± 6.9%, respectively, a difference not considered clinically meaningful. Intentional weight loss was not associated with the precipitation of symptoms of depression, but instead appeared to protect against this occurrence. Mild (or greater) symptoms of depression at baseline did not prevent overweight/obese individuals with type 2 diabetes from achieving significant weight loss.

Hypertension associated with neurocognitive performance among persons with type 2 diabetes: a brief report.

Background Among persons with type 2 diabetes (T2DM) it is not known whether the presence of hypertension could have a detrimental effect on learning ability and whether repeated exposure to information changes the amount of information retained. The aim of this study was to determine cross-sectional evidence for a differential burden to cognitive functioning among persons with T2DM and comorbid hypertension (HTN).Methods This study performed a cross-sectional, retrospective analysis, by medical chart review, of patients with a diagnosis of T2DM.Results Medical records information for history of HTN, age, gender and cognitive performance scores were recorded and analysed for 112 T2DM patients, with an average age of 60 years (SD = 13.84). Differences in cognitive performance scores were compared between patients with and without a history of HTN. The results show that participants who were diagnosed with hypertension produced lower average Rey Auditory-Verbal Learning Test scores than individuals who are not diagnosed with hypertension. Trial 2 was the only trial to prove significant with a P-value of 0.041.Conclusions Our results support previous studies showing that HTN is associated with increased risk to learning and memory functioning, although the degree of interference with these cognitive functions could not be determined from our research. Recognising that people diagnosed with HTN may be at risk for poorer learning and memory skills, future research can investigate how the length of time with the diseases affects learning and memory, and how medication management can attenuate cognitive learning and memory performance.

Mental ability performance among adults with type 2 diabetes in primary care.

Aim and method The present university-based outpatient clinic, cross-sectional study assessed cognitive performance in a sample of 137 adults, with the primary objective of determining differences in cognitive performance as a function of gender and hypertension status in a type 2 diabetes cohort.Results Approximately 64% of the sample was 65 years old and younger, and 50 subjects had > 13 years of education. Global mental ability scores were relatively similar by age grouping, and higher-ordered cognitive functioning and reading literacy were strongly correlated, r (98) = 0.62, P < 0.01. Approximately 30% of the sample posted global mental ability scores in the slow learner range on tasks measuring attention, immediate memory and verbal reasoning. Males achieved higher cognitive functioning scores compared to females on multiple mental ability tasks. The presence of hypertension was associated with significantly worse cognitive performance compared to those subjects without hypertension, t = 2.11, P = 0.03. Approximately 57% of the hypertension group was classified as mild cognitive impaired.Conclusion While approximately half of the general population can be expected to demonstrate an average range of performance on cognitive ability measures, such an expectation could be inappropriately generalised to persons diagnosed with type 2 diabetes, even among those who were high school educated.

Self-reported influences of hopelessness, health literacy, lifestyle action, and patient inertia on blood pressure control in a hypertensive emergency department population.

BACKGROUND: In response to almost universally recorded poor blood pressure (BP) control rates, we developed a novel health paradigm model to examine the mindset behind BP control barriers. This approach, termed patient inertia (PtInert), is defined as an individual's failure to take responsibility for health conditions and proactive change. METHODS: PtInert was evaluated through a survey instrument conducted in 85 subjects with a prior history of hypertension seen in an emergency department. The survey tool encompassed the Wide Range Achievement Test 4, the brief symptom inventory, and a PtInert questionnaire. RESULTS: Fifty percent of patients reported slight psychological distress (psychosomatic > anxiety > depression), with 61% possessing hopelessness surrounding complications from high BP no matter their actions. An unanticipated finding was that patients who had a low reading proficiency (83.1 + 16.4 Wide Range Achievement Test 4 standard score) self-reported high levels of hypertension health literacy. Less than half of patients transferred this health literacy into lifestyle changes in diet, exercise, and medication adherence. Although patients felt that they could control their BP and frequently thought about better BP control, 55% of the subjects had uncontrolled hypertension (>140/90 mm Hg). CONCLUSION: Hypertensive patients visiting our emergency department perceive themselves to have adequate hypertension health-related literacy that was not transferred into hypertension health protective behavioral practices. Psychological distress and a sense of hopelessness surrounding BP control contribute to the lack of protective behavioral health practices. Further evaluations of PtInert methods to promote successful proactive change and adherence warrant further study.

Applicability of the 15-item versions of the Judgement of Line Orientation Test for individuals with traumatic brain injury.

PRIMARY OBJECTIVE: To determine if short forms (i.e. 15 item) of the Judgment of Line Orientation (JOLO) test are equivalent to the full JOLO (i.e. 30 item). RESEARCH DESIGN: Retrospective analysis of JOLO test performance. METHODS AND PROCEDURES: Seventy-two persons with TBI evaluated at a Midwestern University neuropsychology laboratory were administered the JOLO test, Form V, as part of a larger battery of neuropsychological tests. Short forms (i.e. odd and even number short forms) were correlated with the 30 item to determine equivalency of forms. The Statistical Package for the Social Sciences (version 10) was used for the data analyses (SPSS). MAIN OUTCOMES AND RESULTS: Pearson's correlations indicate that the JOLO odd and even short forms are significantly correlated with the full JOLO score (r = 0.90 and 0.93, respectively), and that 100% of the participants' estimated JOLO full score fell within 2 points of the actual full JOLO score. CONCLUSIONS: The results confirm the validity of the short forms of the JOLO for persons with TBI and that gender effects were not significant.