Joseph Eimicke - Academia.edu (original) (raw)

Papers by Joseph Eimicke

Research paper thumbnail of Black/Hispanic Disparities in a Vulnerable Post-Stroke Home Care Population

Journal of Racial and Ethnic Health Disparities, 2018

Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist... more Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist in the United States. This article examines socioeconomic and health disparities in a diverse, hypertensive sample of 495 post-stroke Black, non-Hispanic and Hispanic home health patients at risk of a recurrent stroke due to elevated systolic blood pressure (SBP), defined as SBP ≥ 140 mmHg. The article, which analyzes cross-sectional data, focuses on correlates of patients' SBPthe leading modifiable cause of stroke-and physical function-a key stroke sequela and indicator of post-stroke quality of life. Of the 495 participants, 69.7% were Black, non-Hispanic, and 30.3% Hispanic. Black participants had significantly higher mean SBP than Hispanics. After controlling for multiple potential confounders/predictors, being Black was associated with a 3.55 mmHg elevation in SBP relative to being Hispanic. There were no significant Black/Hispanic differences in physical function measures. Seven independent variables significantly predicted better physical function: being male, younger, having fewer comorbidities, lower BMI, fewer depressive symptoms, higher health literacy and current alcohol drinking (vs abstinence). Our data provide a unique comparison of homebound Black and Hispanic stroke survivors at heightened risk of recurrent stroke absent targeted intervention. The finding of a significant Black/Hispanic disparity in SBP is striking in this narrowly defined home health care population all of whom are at risk for recurrent stroke. Priority should be given to culturally tailored interventions designed to link vulnerable home care patients to continuous, responsive hypertension care.

Research paper thumbnail of Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial

Stroke, 2018

Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among... more Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents. We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates. Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; =0.09) of the intervention group ...

Research paper thumbnail of Development of a Menu Board Literacy and Self-efficacy Scale for Children

Journal of nutrition education and behavior

An instrument to measure menu board literacy (MBL) was developed to capture children's unders... more An instrument to measure menu board literacy (MBL) was developed to capture children's understanding of menu board nutrition information, including abbreviations, serving sizes and calorie ranges, and self-efficacy for using this information. A list of 55 potential items (47 MBL and 8 self-efficacy) was generated. Content validity was established by 29 registered dietitians. Cognitive interviews were conducted with 24 black and Hispanic fourth- and fifth-grade students to assess comprehension and readability. The researchers assessed reliability in 2 fourth- and fifth-grade convenience samples (n = 32 and 141, respectively) of similarly representative students. The final instrument included 20 MBL and 7 self-efficacy items. Internal consistency estimates at both pretest and posttest for the first sample were 0.88 for the MBL scale and 0.80 for the self-efficacy scale. Results for the larger sample were similar. This instrument could be used for assessing MBL and self-efficacy am...

Research paper thumbnail of The Abrams geriatric self-neglect scale: introduction, validation and psychometric properties

International Journal of Geriatric Psychiatry, 2017

Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and a... more Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and adverse health consequences, especially in the elderly. However, research has been limited by the absence of a measurement instrument that is both inclusive and specific. Our goal was to establish the psychometric properties of a quantitative instrument, the Abrams Geriatric Self-Neglect Scale (AGSS). Methods: We analyzed data from a 2007 case-control study of 71 cognitively intact communitydwelling older self-neglectors that had used the AGSS. The AGSS was validated against two "gold standards": a categorical definition of self-neglect developed by expert consensus; and the clinical judgment of a geriatric psychiatrist using chart review. Frequencies were examined for the six scale domains by source (Subject, Observer, and Overall Impression). Internal consistency was estimated for each source, and associations among the sources were evaluated. Results: Internal consistency estimates for the AGSS were rated as "good," with the Subject responses having the lowest alpha and omega (0.681 and 0.692) and the Observer responses the highest (0.758 and 0.765). Subject and Observer scores had the lowest association (0.578, p < 0.001). Using expert consensus criteria as the primary "gold standard," the Observer and Overall

Research paper thumbnail of More with Less: A Trial of Reduced-Intensity Treatment in Transplant-Ineligible Hemodialysis Patients

Journal of Palliative Medicine, 2016

Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Ofte... more Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Often these patients are elderly, with multiple comorbidities and decreased functional status. Such patients may benefit from modified treatment goals to reduce symptom burden. Objective: To demonstrate the feasibility of a trial of reduced-intensity treatment in nontransplantable patients with end-stage renal disease (ESRD). Study Design: A 6-week study randomized patients to a reduced-intensity intervention versus usual care. Intervention subjects were treated with liberalized goals for serum phosphorus and parathyroid hormone (PTH) as well as predialysis blood pressure in comparison with usual care subjects. Outcomes included assessed feasibility of recruitment, randomization, and data collection. Setting and Population: Sixteen transplant-ineligible hemodialysis patients were recruited from two urban units. Measurements: Blood pressure was recorded weekly, while serum PTH and phosphorus were assessed every 10 days. A quality-of-life measure was administered before and after the trial. Results: Of 300 patients, 51 were eligible and 16 consented. All were randomized and completed the trial. Patients in the intervention group received significantly lower doses of phosphorus binders and vitamin D analogues, and were less likely to have their dry weight reduced. All patient surveys were completed. Conclusions: High-risk hemodialysis patients may benefit from liberalized treatment guidelines but larger studies are necessary.

Research paper thumbnail of Black/Hispanic Disparities in a Vulnerable Post-Stroke Home Care Population

Journal of Racial and Ethnic Health Disparities, 2018

Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist... more Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist in the United States. This article examines socioeconomic and health disparities in a diverse, hypertensive sample of 495 post-stroke Black, non-Hispanic and Hispanic home health patients at risk of a recurrent stroke due to elevated systolic blood pressure (SBP), defined as SBP ≥ 140 mmHg. The article, which analyzes cross-sectional data, focuses on correlates of patients' SBPthe leading modifiable cause of stroke-and physical function-a key stroke sequela and indicator of post-stroke quality of life. Of the 495 participants, 69.7% were Black, non-Hispanic, and 30.3% Hispanic. Black participants had significantly higher mean SBP than Hispanics. After controlling for multiple potential confounders/predictors, being Black was associated with a 3.55 mmHg elevation in SBP relative to being Hispanic. There were no significant Black/Hispanic differences in physical function measures. Seven independent variables significantly predicted better physical function: being male, younger, having fewer comorbidities, lower BMI, fewer depressive symptoms, higher health literacy and current alcohol drinking (vs abstinence). Our data provide a unique comparison of homebound Black and Hispanic stroke survivors at heightened risk of recurrent stroke absent targeted intervention. The finding of a significant Black/Hispanic disparity in SBP is striking in this narrowly defined home health care population all of whom are at risk for recurrent stroke. Priority should be given to culturally tailored interventions designed to link vulnerable home care patients to continuous, responsive hypertension care.

Research paper thumbnail of Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial

Stroke, 2018

Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among... more Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents. We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates. Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; =0.09) of the intervention group ...

Research paper thumbnail of Development of a Menu Board Literacy and Self-efficacy Scale for Children

Journal of nutrition education and behavior

An instrument to measure menu board literacy (MBL) was developed to capture children's unders... more An instrument to measure menu board literacy (MBL) was developed to capture children's understanding of menu board nutrition information, including abbreviations, serving sizes and calorie ranges, and self-efficacy for using this information. A list of 55 potential items (47 MBL and 8 self-efficacy) was generated. Content validity was established by 29 registered dietitians. Cognitive interviews were conducted with 24 black and Hispanic fourth- and fifth-grade students to assess comprehension and readability. The researchers assessed reliability in 2 fourth- and fifth-grade convenience samples (n = 32 and 141, respectively) of similarly representative students. The final instrument included 20 MBL and 7 self-efficacy items. Internal consistency estimates at both pretest and posttest for the first sample were 0.88 for the MBL scale and 0.80 for the self-efficacy scale. Results for the larger sample were similar. This instrument could be used for assessing MBL and self-efficacy am...

Research paper thumbnail of The Abrams geriatric self-neglect scale: introduction, validation and psychometric properties

International Journal of Geriatric Psychiatry, 2017

Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and a... more Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and adverse health consequences, especially in the elderly. However, research has been limited by the absence of a measurement instrument that is both inclusive and specific. Our goal was to establish the psychometric properties of a quantitative instrument, the Abrams Geriatric Self-Neglect Scale (AGSS). Methods: We analyzed data from a 2007 case-control study of 71 cognitively intact communitydwelling older self-neglectors that had used the AGSS. The AGSS was validated against two "gold standards": a categorical definition of self-neglect developed by expert consensus; and the clinical judgment of a geriatric psychiatrist using chart review. Frequencies were examined for the six scale domains by source (Subject, Observer, and Overall Impression). Internal consistency was estimated for each source, and associations among the sources were evaluated. Results: Internal consistency estimates for the AGSS were rated as "good," with the Subject responses having the lowest alpha and omega (0.681 and 0.692) and the Observer responses the highest (0.758 and 0.765). Subject and Observer scores had the lowest association (0.578, p < 0.001). Using expert consensus criteria as the primary "gold standard," the Observer and Overall

Research paper thumbnail of More with Less: A Trial of Reduced-Intensity Treatment in Transplant-Ineligible Hemodialysis Patients

Journal of Palliative Medicine, 2016

Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Ofte... more Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Often these patients are elderly, with multiple comorbidities and decreased functional status. Such patients may benefit from modified treatment goals to reduce symptom burden. Objective: To demonstrate the feasibility of a trial of reduced-intensity treatment in nontransplantable patients with end-stage renal disease (ESRD). Study Design: A 6-week study randomized patients to a reduced-intensity intervention versus usual care. Intervention subjects were treated with liberalized goals for serum phosphorus and parathyroid hormone (PTH) as well as predialysis blood pressure in comparison with usual care subjects. Outcomes included assessed feasibility of recruitment, randomization, and data collection. Setting and Population: Sixteen transplant-ineligible hemodialysis patients were recruited from two urban units. Measurements: Blood pressure was recorded weekly, while serum PTH and phosphorus were assessed every 10 days. A quality-of-life measure was administered before and after the trial. Results: Of 300 patients, 51 were eligible and 16 consented. All were randomized and completed the trial. Patients in the intervention group received significantly lower doses of phosphorus binders and vitamin D analogues, and were less likely to have their dry weight reduced. All patient surveys were completed. Conclusions: High-risk hemodialysis patients may benefit from liberalized treatment guidelines but larger studies are necessary.

Research paper thumbnail of Methodological Issues in Measuring Subjective Well-Being and Quality-of-Life: Applications to Assessment of Affect in Older, Chronically and Cognitively Impaired, Ethnically Diverse Groups Using the Feeling Tone Questionnaire

Applied Research in Quality of Life, 2017

Quality of life assessment includes measurement of positive affect. Methods artifacts associated ... more Quality of life assessment includes measurement of positive affect. Methods artifacts associated with positively and negatively worded items can manifest as negative items loading on a second factor, despite the conceptual view that the items are measuring one underlying latent construct. Negatively worded items may elicit biased responses. Additionally, item-level response bias across ethnically diverse groups may compromise group comparisons. The aim was to illustrate methodological approaches to examining method factors and measurement equivalence in an affect measure with 9 positively and 7 negatively worded items: The Feeling Tone Questionnaire (FTQ). The sample included 4,960 non-Hispanic White, 1,144 non-Hispanic Black, and 517 Hispanic community and institutional residents receiving long-term supportive services. The mean age was 82 (s.d.=11.0); 73% were female. Two thirds were cognitively impaired. Methods effects were assessed using confirmatory factor analyses (CFA), and reliability with McDonald's omega and item response theory (IRT) generated estimates. Measurement equivalence was examined using IRT-based Wald tests. Methods effects associated with negatively worded items were observed; these provided little IRT information, and as a composite evidenced lower reliability. Both 13 and 9 item positive affect scales performed well in terms of model fit, reliability, IRT information, and evidenced little differential item functioning of high magnitude or impact. Both CFA and IRT approaches provided complementary methodological information about scale performance. The 9-item affect scale based on the FTQ can be recommended as a brief quality-of

Research paper thumbnail of Depression recognition and capacity for self-report among ethnically diverse nursing homes residents: Evidence of disparities in screening

Journal of clinical nursing, Jan 19, 2017

To examine agreement between Minimum Data Set clinician ratings and researcher assessments of dep... more To examine agreement between Minimum Data Set clinician ratings and researcher assessments of depression among ethnically diverse nursing home residents using the 9-item Patient Health Questionnaire. Although depression is common among nursing homes residents, its recognition remains a challenge. Observational baseline data from a longitudinal intervention study. Sample of 155 residents from 12 long-term care units in one US facility; 50 were interviewed in Spanish. Convergence between clinician and researcher ratings was examined for 1) self-report capacity, 2) suicidal ideation, 3) at least moderate depression, 4) Patient Health Questionnaire severity scores. Experiences by clinical raters using the depression assessment were analyzed. The intraclass correlation coefficient was used to examine concordance, and Cohen's kappa to examine agreement between clinicians and researchers. Moderate agreement (κ=0.52) was observed in determination of capacity, and poor to fair agreement ...

Research paper thumbnail of Music Upper Limb Therapy-Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation

Frontiers in human neuroscience, 2016

Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disrupti... more Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disruption in one's physical body, and alters the stroke survivors' sense of self. Long-term recovery requires that bodily perception, social participation and sense of self are restored; this is challenging to achieve, particularly with a single intervention. However, rhythmic synchronization of movement to external stimuli facilitates sensorimotor coupling for movement recovery, enhances emotional engagement and has positive effects on interpersonal relationships. In this proof-of-concept study, we designed a group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), to address the physical, psychological and social domains of rehabilitation simultaneously, and investigated its effects on long-term post-stroke upper limb recovery. The study used a mixed-method pre-post design with 1-year follow up. Thirteen subjects completed the 45-min intervention twice a week for...

Research paper thumbnail of Effect of two 12-minute culturally targeted films on intent to call 911 for stroke

Neurology, May 24, 2016

We assessed the behavioral effect of two 12-minute culturally targeted stroke films on immediatel... more We assessed the behavioral effect of two 12-minute culturally targeted stroke films on immediately calling 911 for suspected stroke among black and Hispanic participants using a quasi-experimental pretest-posttest design. We enrolled 102 adult churchgoers (60 black and 42 Hispanic) into a single viewing of one of the 2 stroke films-a Gospel musical (English) or Telenovela (Spanish). We measured intent to immediately call 911 using the validated 28-item Stroke Action Test in English and Spanish, along with related variables, before and immediately after the intervention. Data were analyzed using repeated-measures analysis of variance. An increase in intent to call 911 was seen immediately following the single viewing. Higher self-efficacy for calling 911 was associated with intent to call 911 among Hispanic but not black participants. A composite measure of barriers to calling 911 was not associated with intent to call 911 in either group. A significant association was found between ...

Research paper thumbnail of Are clinical diagnoses of Alzheimer's disease and other dementias affected by education and self-reported race?

Psychological Assessment, 2012

A randomized controlled trial examined whether the diagnostic process for Alzheimer's disease and... more A randomized controlled trial examined whether the diagnostic process for Alzheimer's disease and other dementias may be influenced by knowledge of the patient's education and/or selfreported race. Four conditions were implemented: diagnostic team knows (a) race and education, (b) education only, (c) race only, or (d) neither. Diagnosis and clinical staging was established at baseline, at Wave 2, and for a random sample of Wave 3 respondents by a consensus panel. At study end, a longitudinal, "gold standard" diagnosis was made for patients with follow-up data (71%). Group differences in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis were estimated using logistic regression and generalized estimating equations. Sensitivity and specificity were examined for baseline diagnosis in relation to the gold standard, longitudinal diagnosis. Despite equivalent status on all measured variables across waves, members of the "knows race only" group were less likely than those of other groups to receive a diagnosis of dementia. At final diagnosis, 19% of the "knows race only" group was diagnosed with dementia versus 38% to 40% in the other 3 conditions (p = .038). Examination of sensitivities and specificities of baseline diagnosis in relation to the gold standard diagnosis showed a nonsignificant trend for lower sensitivities in the knowing race conditions (0.3846), as contrasted with knowing education only (0.480) or neither (0.600). The finding that knowledge of race may influence the diagnostic process in some unknown way is timely, given the recent State-of-the-Science conference on Alzheimer's disease prevention, the authors of which called for information about and standardization of the diagnostic process.

Research paper thumbnail of Glycemia, Diabetes Status, and Cognition in Middle-Aged Hispanics

Psychosomatic Medicine, 2015

To examine the association of glycemia and diabetes status with cognition among 600 Hispanics age... more To examine the association of glycemia and diabetes status with cognition among 600 Hispanics aged 55 to 64 years from Northern Manhattan. Diabetes was ascertained by history or hemoglobin A1c. Normal glucose tolerance and prediabetes were ascertained with hemoglobin A1c. Memory was assessed with the Selective Reminding Test. Executive abilities were assessed using the Color Trails 1 and 2 and verbal fluency test. The cross-sectional association of glycemia and diabetes status with cognitive performance was examined using linear regression. Participants had a mean age of 59.2 (2.9) years, 76.7% were women, and more than 65% had prediabetes or diabetes. HbA1C (β = -0.97, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and diabetes (β = -2.06, p = .001) were related with lower Selective Reminding Test total recall after adjustment for demographics, education, and vascular risk factors. Prediabetes was associated with worse performance in Color Trail 2 (β = -6.45 p = .022) after full adjustment. Higher glycemia and diabetes are related to worse memory and executive abilities in late middle age, whereas prediabetes is related only to worse executive abilities. Longitudinal follow-up is needed to understand the order and progression of these deficits.

Research paper thumbnail of Value of Ambulatory Arterial Stiffness Index and 24-h Pulse Pressure to Predict Progression of Albuminuria in Elderly People With Diabetes Mellitus

American Journal of Hypertension, May 1, 2007

Ambulatory 24-h pulse pressure predicts progression of albuminuria in people with diabetes mellit... more Ambulatory 24-h pulse pressure predicts progression of albuminuria in people with diabetes mellitus. It is not known whether the ambulatory arterial stiffness index (AASI) may add to that prediction.

Research paper thumbnail of A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study

J Amer Med Inform Assoc, 2009

Context: Telemedicine is a promising but largely unproven technology for providing case managemen... more Context: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care.

Research paper thumbnail of Improvement in diabetes self-efficacy and glycaemic control using telemedicine in a sample of older, ethnically diverse individuals who have diabetes: the IDEATel project

Age Ageing, 2008

with increasing prevalence of diabetes in older people, it is important to understand factors tha... more with increasing prevalence of diabetes in older people, it is important to understand factors that affect their outcomes. The Informatics for Diabetes Education and Telemedicine (IDEATel) project is a demonstration project to evaluate the feasibility and effectiveness of telemedicine with diverse, medically underserved, older diabetes patients. Subjects were randomised to telemedicine case management or usual care. This intervention has been shown to result in improved medical outcomes and self-efficacy. Self-efficacy refers to one&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s belief that (s)he can successfully engage in a behaviour. Self-efficacy has been shown to relate to behaviour change and glycaemic control in middle-aged individuals, but not studied in older individuals. to assess whether (a) diabetes self-efficacy relates to the primary medical outcome of glycaemic control, and to secondary outcomes (blood pressure and cholesterol), and (b) whether, after an intervention, change in diabetes self-efficacy relates to change in these medical outcomes in a group of older, ethnically diverse individuals. three waves of longitudinal data from participants in IDEATel were analysed. diabetes self-efficacy at baseline correlated with glycaemic control, blood pressure and cholesterol. An increase in diabetes self-efficacy over time was related to an improvement in glycaemic control (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), but not in blood pressure and lipid levels. The intervention was significantly related to improved self-efficacy over time (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and both directly (P = 0.022) and indirectly through self-efficacy (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) to improved glycaemic control. The mediation effect of self-efficacy was also significant (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.004). diabetes self-efficacy is a relevant construct for older diabetes patients. Thus, interventions that target enhanced self-efficacy may also result in improved glycaemic control.

Research paper thumbnail of Ambulatory Pulse Pressure and Progression of Urinary Albumin Excretion in Older Patients With Type 2 Diabetes Mellitus

We studied whether ambulatory blood pressure monitoring added to office blood pressure in predict... more We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24-hour ambulatory blood pressure measurement and a spot urine measurement of albumin-to-creatinine ratio (ACR). Measurements of albumin-to-creatinine ratio were repeated 1 and 2 years later. In bivariate analyses, ambulatory 24-hour pulse pressure was the blood pressure variable most strongly associated with follow-up ACR. Repeated-measures mixed linear models (nϭ1040) were built adjusting for baseline ACR ratio, clustered randomization, time to follow-up, and multiple covariates. When both were entered into the model, ambulatory 24-hour pulse pressure and office pulse pressure were independently associated with follow-up ACR (␤ [SE]ϭ0.010 [0.002], PϽ0.001, and 0.004 [0.001], Pϭ0.002, respectively). Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline, adjusting for all of the covariates independently associated with follow-up ACR in mixed linear models. Ambulatory 24-hour pulse pressure, but not office pulse pressure, was independently associated with progression of albuminuria (Pϭ0.015 and 0.052, respectively). The adjusted hazards ratio (95% CI) per each 10-mm Hg increment in ambulatory pulse pressure was 1.23 (1.04 to 1.42). In conclusion, ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure. (Hypertension. 2006;48:301-308.)

Research paper thumbnail of Black/Hispanic Disparities in a Vulnerable Post-Stroke Home Care Population

Journal of Racial and Ethnic Health Disparities, 2018

Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist... more Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist in the United States. This article examines socioeconomic and health disparities in a diverse, hypertensive sample of 495 post-stroke Black, non-Hispanic and Hispanic home health patients at risk of a recurrent stroke due to elevated systolic blood pressure (SBP), defined as SBP ≥ 140 mmHg. The article, which analyzes cross-sectional data, focuses on correlates of patients' SBPthe leading modifiable cause of stroke-and physical function-a key stroke sequela and indicator of post-stroke quality of life. Of the 495 participants, 69.7% were Black, non-Hispanic, and 30.3% Hispanic. Black participants had significantly higher mean SBP than Hispanics. After controlling for multiple potential confounders/predictors, being Black was associated with a 3.55 mmHg elevation in SBP relative to being Hispanic. There were no significant Black/Hispanic differences in physical function measures. Seven independent variables significantly predicted better physical function: being male, younger, having fewer comorbidities, lower BMI, fewer depressive symptoms, higher health literacy and current alcohol drinking (vs abstinence). Our data provide a unique comparison of homebound Black and Hispanic stroke survivors at heightened risk of recurrent stroke absent targeted intervention. The finding of a significant Black/Hispanic disparity in SBP is striking in this narrowly defined home health care population all of whom are at risk for recurrent stroke. Priority should be given to culturally tailored interventions designed to link vulnerable home care patients to continuous, responsive hypertension care.

Research paper thumbnail of Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial

Stroke, 2018

Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among... more Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents. We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates. Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; =0.09) of the intervention group ...

Research paper thumbnail of Development of a Menu Board Literacy and Self-efficacy Scale for Children

Journal of nutrition education and behavior

An instrument to measure menu board literacy (MBL) was developed to capture children's unders... more An instrument to measure menu board literacy (MBL) was developed to capture children's understanding of menu board nutrition information, including abbreviations, serving sizes and calorie ranges, and self-efficacy for using this information. A list of 55 potential items (47 MBL and 8 self-efficacy) was generated. Content validity was established by 29 registered dietitians. Cognitive interviews were conducted with 24 black and Hispanic fourth- and fifth-grade students to assess comprehension and readability. The researchers assessed reliability in 2 fourth- and fifth-grade convenience samples (n = 32 and 141, respectively) of similarly representative students. The final instrument included 20 MBL and 7 self-efficacy items. Internal consistency estimates at both pretest and posttest for the first sample were 0.88 for the MBL scale and 0.80 for the self-efficacy scale. Results for the larger sample were similar. This instrument could be used for assessing MBL and self-efficacy am...

Research paper thumbnail of The Abrams geriatric self-neglect scale: introduction, validation and psychometric properties

International Journal of Geriatric Psychiatry, 2017

Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and a... more Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and adverse health consequences, especially in the elderly. However, research has been limited by the absence of a measurement instrument that is both inclusive and specific. Our goal was to establish the psychometric properties of a quantitative instrument, the Abrams Geriatric Self-Neglect Scale (AGSS). Methods: We analyzed data from a 2007 case-control study of 71 cognitively intact communitydwelling older self-neglectors that had used the AGSS. The AGSS was validated against two "gold standards": a categorical definition of self-neglect developed by expert consensus; and the clinical judgment of a geriatric psychiatrist using chart review. Frequencies were examined for the six scale domains by source (Subject, Observer, and Overall Impression). Internal consistency was estimated for each source, and associations among the sources were evaluated. Results: Internal consistency estimates for the AGSS were rated as "good," with the Subject responses having the lowest alpha and omega (0.681 and 0.692) and the Observer responses the highest (0.758 and 0.765). Subject and Observer scores had the lowest association (0.578, p < 0.001). Using expert consensus criteria as the primary "gold standard," the Observer and Overall

Research paper thumbnail of More with Less: A Trial of Reduced-Intensity Treatment in Transplant-Ineligible Hemodialysis Patients

Journal of Palliative Medicine, 2016

Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Ofte... more Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Often these patients are elderly, with multiple comorbidities and decreased functional status. Such patients may benefit from modified treatment goals to reduce symptom burden. Objective: To demonstrate the feasibility of a trial of reduced-intensity treatment in nontransplantable patients with end-stage renal disease (ESRD). Study Design: A 6-week study randomized patients to a reduced-intensity intervention versus usual care. Intervention subjects were treated with liberalized goals for serum phosphorus and parathyroid hormone (PTH) as well as predialysis blood pressure in comparison with usual care subjects. Outcomes included assessed feasibility of recruitment, randomization, and data collection. Setting and Population: Sixteen transplant-ineligible hemodialysis patients were recruited from two urban units. Measurements: Blood pressure was recorded weekly, while serum PTH and phosphorus were assessed every 10 days. A quality-of-life measure was administered before and after the trial. Results: Of 300 patients, 51 were eligible and 16 consented. All were randomized and completed the trial. Patients in the intervention group received significantly lower doses of phosphorus binders and vitamin D analogues, and were less likely to have their dry weight reduced. All patient surveys were completed. Conclusions: High-risk hemodialysis patients may benefit from liberalized treatment guidelines but larger studies are necessary.

Research paper thumbnail of Black/Hispanic Disparities in a Vulnerable Post-Stroke Home Care Population

Journal of Racial and Ethnic Health Disparities, 2018

Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist... more Significant racial and ethnic disparities in stroke risk factors, occurrence and outcomes persist in the United States. This article examines socioeconomic and health disparities in a diverse, hypertensive sample of 495 post-stroke Black, non-Hispanic and Hispanic home health patients at risk of a recurrent stroke due to elevated systolic blood pressure (SBP), defined as SBP ≥ 140 mmHg. The article, which analyzes cross-sectional data, focuses on correlates of patients' SBPthe leading modifiable cause of stroke-and physical function-a key stroke sequela and indicator of post-stroke quality of life. Of the 495 participants, 69.7% were Black, non-Hispanic, and 30.3% Hispanic. Black participants had significantly higher mean SBP than Hispanics. After controlling for multiple potential confounders/predictors, being Black was associated with a 3.55 mmHg elevation in SBP relative to being Hispanic. There were no significant Black/Hispanic differences in physical function measures. Seven independent variables significantly predicted better physical function: being male, younger, having fewer comorbidities, lower BMI, fewer depressive symptoms, higher health literacy and current alcohol drinking (vs abstinence). Our data provide a unique comparison of homebound Black and Hispanic stroke survivors at heightened risk of recurrent stroke absent targeted intervention. The finding of a significant Black/Hispanic disparity in SBP is striking in this narrowly defined home health care population all of whom are at risk for recurrent stroke. Priority should be given to culturally tailored interventions designed to link vulnerable home care patients to continuous, responsive hypertension care.

Research paper thumbnail of Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial

Stroke, 2018

Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among... more Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents. We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates. Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; =0.09) of the intervention group ...

Research paper thumbnail of Development of a Menu Board Literacy and Self-efficacy Scale for Children

Journal of nutrition education and behavior

An instrument to measure menu board literacy (MBL) was developed to capture children's unders... more An instrument to measure menu board literacy (MBL) was developed to capture children's understanding of menu board nutrition information, including abbreviations, serving sizes and calorie ranges, and self-efficacy for using this information. A list of 55 potential items (47 MBL and 8 self-efficacy) was generated. Content validity was established by 29 registered dietitians. Cognitive interviews were conducted with 24 black and Hispanic fourth- and fifth-grade students to assess comprehension and readability. The researchers assessed reliability in 2 fourth- and fifth-grade convenience samples (n = 32 and 141, respectively) of similarly representative students. The final instrument included 20 MBL and 7 self-efficacy items. Internal consistency estimates at both pretest and posttest for the first sample were 0.88 for the MBL scale and 0.80 for the self-efficacy scale. Results for the larger sample were similar. This instrument could be used for assessing MBL and self-efficacy am...

Research paper thumbnail of The Abrams geriatric self-neglect scale: introduction, validation and psychometric properties

International Journal of Geriatric Psychiatry, 2017

Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and a... more Objective: Self-neglect is an imprecisely defined entity with multiple clinical expressions and adverse health consequences, especially in the elderly. However, research has been limited by the absence of a measurement instrument that is both inclusive and specific. Our goal was to establish the psychometric properties of a quantitative instrument, the Abrams Geriatric Self-Neglect Scale (AGSS). Methods: We analyzed data from a 2007 case-control study of 71 cognitively intact communitydwelling older self-neglectors that had used the AGSS. The AGSS was validated against two "gold standards": a categorical definition of self-neglect developed by expert consensus; and the clinical judgment of a geriatric psychiatrist using chart review. Frequencies were examined for the six scale domains by source (Subject, Observer, and Overall Impression). Internal consistency was estimated for each source, and associations among the sources were evaluated. Results: Internal consistency estimates for the AGSS were rated as "good," with the Subject responses having the lowest alpha and omega (0.681 and 0.692) and the Observer responses the highest (0.758 and 0.765). Subject and Observer scores had the lowest association (0.578, p < 0.001). Using expert consensus criteria as the primary "gold standard," the Observer and Overall

Research paper thumbnail of More with Less: A Trial of Reduced-Intensity Treatment in Transplant-Ineligible Hemodialysis Patients

Journal of Palliative Medicine, 2016

Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Ofte... more Background: An increasing proportion of hemodialysis patients are ineligible for transplant. Often these patients are elderly, with multiple comorbidities and decreased functional status. Such patients may benefit from modified treatment goals to reduce symptom burden. Objective: To demonstrate the feasibility of a trial of reduced-intensity treatment in nontransplantable patients with end-stage renal disease (ESRD). Study Design: A 6-week study randomized patients to a reduced-intensity intervention versus usual care. Intervention subjects were treated with liberalized goals for serum phosphorus and parathyroid hormone (PTH) as well as predialysis blood pressure in comparison with usual care subjects. Outcomes included assessed feasibility of recruitment, randomization, and data collection. Setting and Population: Sixteen transplant-ineligible hemodialysis patients were recruited from two urban units. Measurements: Blood pressure was recorded weekly, while serum PTH and phosphorus were assessed every 10 days. A quality-of-life measure was administered before and after the trial. Results: Of 300 patients, 51 were eligible and 16 consented. All were randomized and completed the trial. Patients in the intervention group received significantly lower doses of phosphorus binders and vitamin D analogues, and were less likely to have their dry weight reduced. All patient surveys were completed. Conclusions: High-risk hemodialysis patients may benefit from liberalized treatment guidelines but larger studies are necessary.

Research paper thumbnail of Methodological Issues in Measuring Subjective Well-Being and Quality-of-Life: Applications to Assessment of Affect in Older, Chronically and Cognitively Impaired, Ethnically Diverse Groups Using the Feeling Tone Questionnaire

Applied Research in Quality of Life, 2017

Quality of life assessment includes measurement of positive affect. Methods artifacts associated ... more Quality of life assessment includes measurement of positive affect. Methods artifacts associated with positively and negatively worded items can manifest as negative items loading on a second factor, despite the conceptual view that the items are measuring one underlying latent construct. Negatively worded items may elicit biased responses. Additionally, item-level response bias across ethnically diverse groups may compromise group comparisons. The aim was to illustrate methodological approaches to examining method factors and measurement equivalence in an affect measure with 9 positively and 7 negatively worded items: The Feeling Tone Questionnaire (FTQ). The sample included 4,960 non-Hispanic White, 1,144 non-Hispanic Black, and 517 Hispanic community and institutional residents receiving long-term supportive services. The mean age was 82 (s.d.=11.0); 73% were female. Two thirds were cognitively impaired. Methods effects were assessed using confirmatory factor analyses (CFA), and reliability with McDonald's omega and item response theory (IRT) generated estimates. Measurement equivalence was examined using IRT-based Wald tests. Methods effects associated with negatively worded items were observed; these provided little IRT information, and as a composite evidenced lower reliability. Both 13 and 9 item positive affect scales performed well in terms of model fit, reliability, IRT information, and evidenced little differential item functioning of high magnitude or impact. Both CFA and IRT approaches provided complementary methodological information about scale performance. The 9-item affect scale based on the FTQ can be recommended as a brief quality-of

Research paper thumbnail of Depression recognition and capacity for self-report among ethnically diverse nursing homes residents: Evidence of disparities in screening

Journal of clinical nursing, Jan 19, 2017

To examine agreement between Minimum Data Set clinician ratings and researcher assessments of dep... more To examine agreement between Minimum Data Set clinician ratings and researcher assessments of depression among ethnically diverse nursing home residents using the 9-item Patient Health Questionnaire. Although depression is common among nursing homes residents, its recognition remains a challenge. Observational baseline data from a longitudinal intervention study. Sample of 155 residents from 12 long-term care units in one US facility; 50 were interviewed in Spanish. Convergence between clinician and researcher ratings was examined for 1) self-report capacity, 2) suicidal ideation, 3) at least moderate depression, 4) Patient Health Questionnaire severity scores. Experiences by clinical raters using the depression assessment were analyzed. The intraclass correlation coefficient was used to examine concordance, and Cohen's kappa to examine agreement between clinicians and researchers. Moderate agreement (κ=0.52) was observed in determination of capacity, and poor to fair agreement ...

Research paper thumbnail of Music Upper Limb Therapy-Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation

Frontiers in human neuroscience, 2016

Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disrupti... more Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disruption in one's physical body, and alters the stroke survivors' sense of self. Long-term recovery requires that bodily perception, social participation and sense of self are restored; this is challenging to achieve, particularly with a single intervention. However, rhythmic synchronization of movement to external stimuli facilitates sensorimotor coupling for movement recovery, enhances emotional engagement and has positive effects on interpersonal relationships. In this proof-of-concept study, we designed a group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), to address the physical, psychological and social domains of rehabilitation simultaneously, and investigated its effects on long-term post-stroke upper limb recovery. The study used a mixed-method pre-post design with 1-year follow up. Thirteen subjects completed the 45-min intervention twice a week for...

Research paper thumbnail of Effect of two 12-minute culturally targeted films on intent to call 911 for stroke

Neurology, May 24, 2016

We assessed the behavioral effect of two 12-minute culturally targeted stroke films on immediatel... more We assessed the behavioral effect of two 12-minute culturally targeted stroke films on immediately calling 911 for suspected stroke among black and Hispanic participants using a quasi-experimental pretest-posttest design. We enrolled 102 adult churchgoers (60 black and 42 Hispanic) into a single viewing of one of the 2 stroke films-a Gospel musical (English) or Telenovela (Spanish). We measured intent to immediately call 911 using the validated 28-item Stroke Action Test in English and Spanish, along with related variables, before and immediately after the intervention. Data were analyzed using repeated-measures analysis of variance. An increase in intent to call 911 was seen immediately following the single viewing. Higher self-efficacy for calling 911 was associated with intent to call 911 among Hispanic but not black participants. A composite measure of barriers to calling 911 was not associated with intent to call 911 in either group. A significant association was found between ...

Research paper thumbnail of Are clinical diagnoses of Alzheimer's disease and other dementias affected by education and self-reported race?

Psychological Assessment, 2012

A randomized controlled trial examined whether the diagnostic process for Alzheimer's disease and... more A randomized controlled trial examined whether the diagnostic process for Alzheimer's disease and other dementias may be influenced by knowledge of the patient's education and/or selfreported race. Four conditions were implemented: diagnostic team knows (a) race and education, (b) education only, (c) race only, or (d) neither. Diagnosis and clinical staging was established at baseline, at Wave 2, and for a random sample of Wave 3 respondents by a consensus panel. At study end, a longitudinal, "gold standard" diagnosis was made for patients with follow-up data (71%). Group differences in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis were estimated using logistic regression and generalized estimating equations. Sensitivity and specificity were examined for baseline diagnosis in relation to the gold standard, longitudinal diagnosis. Despite equivalent status on all measured variables across waves, members of the "knows race only" group were less likely than those of other groups to receive a diagnosis of dementia. At final diagnosis, 19% of the "knows race only" group was diagnosed with dementia versus 38% to 40% in the other 3 conditions (p = .038). Examination of sensitivities and specificities of baseline diagnosis in relation to the gold standard diagnosis showed a nonsignificant trend for lower sensitivities in the knowing race conditions (0.3846), as contrasted with knowing education only (0.480) or neither (0.600). The finding that knowledge of race may influence the diagnostic process in some unknown way is timely, given the recent State-of-the-Science conference on Alzheimer's disease prevention, the authors of which called for information about and standardization of the diagnostic process.

Research paper thumbnail of Glycemia, Diabetes Status, and Cognition in Middle-Aged Hispanics

Psychosomatic Medicine, 2015

To examine the association of glycemia and diabetes status with cognition among 600 Hispanics age... more To examine the association of glycemia and diabetes status with cognition among 600 Hispanics aged 55 to 64 years from Northern Manhattan. Diabetes was ascertained by history or hemoglobin A1c. Normal glucose tolerance and prediabetes were ascertained with hemoglobin A1c. Memory was assessed with the Selective Reminding Test. Executive abilities were assessed using the Color Trails 1 and 2 and verbal fluency test. The cross-sectional association of glycemia and diabetes status with cognitive performance was examined using linear regression. Participants had a mean age of 59.2 (2.9) years, 76.7% were women, and more than 65% had prediabetes or diabetes. HbA1C (β = -0.97, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and diabetes (β = -2.06, p = .001) were related with lower Selective Reminding Test total recall after adjustment for demographics, education, and vascular risk factors. Prediabetes was associated with worse performance in Color Trail 2 (β = -6.45 p = .022) after full adjustment. Higher glycemia and diabetes are related to worse memory and executive abilities in late middle age, whereas prediabetes is related only to worse executive abilities. Longitudinal follow-up is needed to understand the order and progression of these deficits.

Research paper thumbnail of Value of Ambulatory Arterial Stiffness Index and 24-h Pulse Pressure to Predict Progression of Albuminuria in Elderly People With Diabetes Mellitus

American Journal of Hypertension, May 1, 2007

Ambulatory 24-h pulse pressure predicts progression of albuminuria in people with diabetes mellit... more Ambulatory 24-h pulse pressure predicts progression of albuminuria in people with diabetes mellitus. It is not known whether the ambulatory arterial stiffness index (AASI) may add to that prediction.

Research paper thumbnail of A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study

J Amer Med Inform Assoc, 2009

Context: Telemedicine is a promising but largely unproven technology for providing case managemen... more Context: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care.

Research paper thumbnail of Improvement in diabetes self-efficacy and glycaemic control using telemedicine in a sample of older, ethnically diverse individuals who have diabetes: the IDEATel project

Age Ageing, 2008

with increasing prevalence of diabetes in older people, it is important to understand factors tha... more with increasing prevalence of diabetes in older people, it is important to understand factors that affect their outcomes. The Informatics for Diabetes Education and Telemedicine (IDEATel) project is a demonstration project to evaluate the feasibility and effectiveness of telemedicine with diverse, medically underserved, older diabetes patients. Subjects were randomised to telemedicine case management or usual care. This intervention has been shown to result in improved medical outcomes and self-efficacy. Self-efficacy refers to one&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s belief that (s)he can successfully engage in a behaviour. Self-efficacy has been shown to relate to behaviour change and glycaemic control in middle-aged individuals, but not studied in older individuals. to assess whether (a) diabetes self-efficacy relates to the primary medical outcome of glycaemic control, and to secondary outcomes (blood pressure and cholesterol), and (b) whether, after an intervention, change in diabetes self-efficacy relates to change in these medical outcomes in a group of older, ethnically diverse individuals. three waves of longitudinal data from participants in IDEATel were analysed. diabetes self-efficacy at baseline correlated with glycaemic control, blood pressure and cholesterol. An increase in diabetes self-efficacy over time was related to an improvement in glycaemic control (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), but not in blood pressure and lipid levels. The intervention was significantly related to improved self-efficacy over time (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and both directly (P = 0.022) and indirectly through self-efficacy (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) to improved glycaemic control. The mediation effect of self-efficacy was also significant (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.004). diabetes self-efficacy is a relevant construct for older diabetes patients. Thus, interventions that target enhanced self-efficacy may also result in improved glycaemic control.

Research paper thumbnail of Ambulatory Pulse Pressure and Progression of Urinary Albumin Excretion in Older Patients With Type 2 Diabetes Mellitus

We studied whether ambulatory blood pressure monitoring added to office blood pressure in predict... more We studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow-up in a multiethnic cohort of older people with type-2 diabetes mellitus. Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24-hour ambulatory blood pressure measurement and a spot urine measurement of albumin-to-creatinine ratio (ACR). Measurements of albumin-to-creatinine ratio were repeated 1 and 2 years later. In bivariate analyses, ambulatory 24-hour pulse pressure was the blood pressure variable most strongly associated with follow-up ACR. Repeated-measures mixed linear models (nϭ1040) were built adjusting for baseline ACR ratio, clustered randomization, time to follow-up, and multiple covariates. When both were entered into the model, ambulatory 24-hour pulse pressure and office pulse pressure were independently associated with follow-up ACR (␤ [SE]ϭ0.010 [0.002], PϽ0.001, and 0.004 [0.001], Pϭ0.002, respectively). Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline, adjusting for all of the covariates independently associated with follow-up ACR in mixed linear models. Ambulatory 24-hour pulse pressure, but not office pulse pressure, was independently associated with progression of albuminuria (Pϭ0.015 and 0.052, respectively). The adjusted hazards ratio (95% CI) per each 10-mm Hg increment in ambulatory pulse pressure was 1.23 (1.04 to 1.42). In conclusion, ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure. (Hypertension. 2006;48:301-308.)