ABSTRACT: African Americans (AAs) have four times higher prevalence of ESRD than Caucasians. Therefore, long-term effects of kidney donation are of considerable importance in this patient population.
GFR was measured by (125)I-iothalamate clearance, 24-hour urine albumin excretion, and 24-hour BP monitoring in 33 AAs and 11 CAs who donated kidneys for transplantation 5 to 23 years previously.
Mean GFRs were 76 ± 13 and 78 ± 11 ml/min per 1.73 m(2) for AA and CA donors, respectively. Nine percent of the AA donors and none of the CA donors had GFRs below 60 ml/min per 1.73 m(2). AA donors had a tendency for lower prevalence of microalbuminuria compared with CA donors (18.1% versus 36.3%) and a tendency for higher prevalence of macroalbuminuria compared with CAs (12.1% versus 0.0%). Twenty-four percent of the AAs, and 45% of the CAs were hypertensive with mean daytime BP ≥135/85 mmHg. Only 6% of AAs had a decrease in mean nocturnal systolic BP of 10% or more as compared with daytime readings. Older age at time of donation was associated (P = 0.046) with lower GFR values compared with younger ages.
Carefully selected AA kidney donors have well preserved renal function and a low prevalence of hypertension many years after kidney donation. Abnormal albumin excretion and loss of physiologic decrease in nocturnal BP is more prevalent in AA donors than the general AA population. Older age at donation may predict lower GFR after donation.
Clinical Journal of the American Society of Nephrology 06/2011; 6(6):1474-80. · 5.23 Impact Factor
ABSTRACT: To directly compare estimates of potential depressive disorders and clinically significant depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) and Older Adult Health and Mood Questionnaire (OAHMQ) among participants with spinal cord injury (SCI).
727 participants from a hospital in the Southeastern United States were administered the PHQ-9 and OAHMQ during a follow-up survey. We compared the rates of depressive disorders using cutoff scores and diagnostic criteria for each instrument. No independent psychiatric diagnostic interviews were conducted.
The PHQ-9 and OAHMQ were significantly correlated (r = .78), and both were correlated with satisfaction with life (r = -.48, -.54). Using recommended diagnostic scoring procedures, 10.7% of participants met the diagnostic criteria for major depressive disorder with the PHQ-9; 9.3% met the criteria for major depression based on PHQ-9 > or = 10; and 19.7% based on PHQ-9 > or = 15. Using the OAHMQ, 19.7% reported probable major depression and 44.5% clinically significant symptomatology.
The measures were highly correlated overall. However, the estimated prevalence of depressive disorders varied substantially between the 2 instruments. These estimates were comparable to those previously reported for each instrument (i.e., higher rates with the OAHMQ). Therefore, differing estimates of depressive disorders reported in the literature using these instruments were largely attributable to the instruments themselves.
Rehabilitation Psychology 11/2009; 54(4):440-8. · 1.91 Impact Factor
ABSTRACT: Krause JS, Zhai Y, Saunders LL, Carter RE. Risk of mortality after spinal cord injury: an 8-year prospective study.
To evaluate a theoretical model for mortality after spinal cord injury (SCI) by sequentially analyzing 4 sets of risk factors in relation to mortality (ie, adding 1 set of factors to the regression equation at a time).
Prospective cohort study of data collected in late 1997 and early 1998 with mortality status ascertained in December 2005. We evaluated the significance of 4 successive sets of predictors (biographic and injury, psychologic and environmental, behavioral, health and secondary conditions) using Cox proportional hazards modeling and built a full model based on the optimal predictors.
A specialty hospital.
Adults (N=1386) with traumatic SCI, at least 1 year postinjury, participated. There were 224 deaths. After eliminating cases with missing data, there were 1209 participants, with 179 deceased at follow-up.
Mortality status was determined using the National Death Index and the Social Security Death Index.
The final model included 1 environmental variable (poverty), 2 behavioral factors (prescription medication use, binge drinking), and 4 health factors or secondary conditions (hospitalizations, fractures/amputations, surgeries for pressure ulcers, probable major depression).
The results supported the major premise of the theoretical model that risk factors are more important the more proximal they are in a theoretical chain of events leading to mortality. According to this model, mortality results from declining health, precipitated by high-risk behaviors. These findings may be used to target those who are at high risk for early mortality as well as to direct interventions to the particular risk factor.
Archives of physical medicine and rehabilitation 10/2009; 90(10):1708-15. · 2.18 Impact Factor
ABSTRACT: To identify the association of 2 distinct psychologic constructs, personality and purpose in life (PIL), with risk of early mortality among persons with spinal cord injury (SCI).
Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005.
A large rehabilitation hospital in the southeastern United States.
Adults (N=1386) with traumatic SCI, at least 1 year postinjury.
We first evaluated the significance of a single psychologic predictor (a total of 6 scales) while controlling for biographic and injury predictors using Cox proportional hazards modeling and subsequently built a comprehensive model based on an optimal group of psychologic variables.
There were a total of 224 (16.2%) observed deaths in the full sample. The total number of deaths was reduced to 164 in the final statistical model (of 1128 participants) because of missing data. All 6 psychologic factors were statistically significant in the model that was adjusted for biographic and injury factors, whereas only 3 psychologic factors were retained in the final comprehensive model, including 2 personality scales (Impulsive Sensation Seeking, Neuroticism-Anxiety) and the PIL scale. The final comprehensive model only modestly improved the overall prediction of survival compared with the model with only biographic and injury variables, because the pseudo-R(2) increased from 0.121 to 0.129, and the concordance increased from 0.730 to 0.747.
The results affirm the importance of psychologic factors in relation to survival after SCI.
Archives of physical medicine and rehabilitation 05/2009; 90(4):628-33. · 2.18 Impact Factor
ABSTRACT: Shiftwork among health care workers impacts upon the safety and health of both employees and patients.
To characterize shiftwork-related attitudes, behaviours, symptoms and coping strategies among health care workers, two validated questionnaires (the Standard Shiftwork Index and the Pressure Management Indicator) were used to identify factors predicting shiftwork adaptation.
Participants (n = 376, response rate 25%) were grouped according to their work schedule (days, permanent evenings, rotating days plus evenings, permanent nights or relief and combined shifts). Indicators of lifestyle, work organization, sleep disruption, health and pressure management among workers on irregular shifts were compared with participants on day shifts, after adjustment for gender, age and marital status. Principal components analysis and ordinal logistic regression were used among irregular shiftworkers to identify factors predicting schedule adaptation.
Night and relief/combined shiftworkers reported a greater ability to accommodate irregular schedules and disrupted sleep, but were also more likely to report work-related impacts than day workers. Permanent night workers generally reported poorer health, more absenteeism and less job satisfaction than day workers. Factors associated with optimal work performance or schedule contentment among shiftworkers included adequate sleep, evening circadian preference, increased age and organizational satisfaction. Reduced work performance or schedule discontent was associated with sleep/wake difficulties and poor health.
This study confirmed previous research and identified factors that can be targeted for the development of more effective shiftwork adaptation programmes in a health care setting (sleep timing and duration, exercise and optimal health and organizational satisfaction).
Occupational Medicine 04/2009; 59(3):159-66. · 1.14 Impact Factor
ABSTRACT: Metabolites of estrogen (estrone-3-glucuronide [E1G]) and melatonin (6-hydroxymelatonin sulfate [6-OHMS]) were characterized among women living in a community with increased radiofrequency (RF) exposure from radio and television transmitters.
RF spot measurements, and personal 60-Hz magnetic field and residential parameters were collected. Overnight urine samples were assayed for E1G and 6-OHMS excretion.
Among premenopausal women, there were no associations between RF or 60-Hz nonionizing radiation and E1G or 6-OHMS excretion. Among postmenopausal women, increased residential RF exposures, transmitter proximity and visibility, and temporally stable 60-Hz exposures were significantly associated with increased E1G excretion. This association was strongest among postmenopausal women with low overnight 6-OHMS levels.
RF and temporally stable 60-Hz exposures were associated with increased E1G excretion among postmenopausal women. Women with reduced nocturnal 6-OHMS excretion may represent a sensitive subgroup.
Journal of Occupational and Environmental Medicine 11/2007; 49(10):1149-56. · 2.06 Impact Factor