Carl F Pieper

Duke University, Durham, North Carolina, United States

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Publications (258)1013.07 Total impact

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    ABSTRACT: Hyperoxia during diving has been suggested to exacerbate hypercapnic narcosis and promote unconsciousness. We tested this hypothesis in male volunteers (12 at rest, 10 at 75 W cycle ergometer exercise) breathing each of four gases. Inspired PO2 (PIO2) was 0.21 and 1.3 atmospheres (atm) without or with an individual subject's maximum tolerable inspired CO2 (PICO2 = 0.055-0.085 atm). Measurements included end-tidal CO2 partial pressure (PETCO2), rating of perceived discomfort (RPD), expired minute ventilation (VE), and cognitive function assessed by auditory n-back test. The most prominent finding was, irrespective of PETCO2, that minute ventilation was 8-9 Lpm greater for rest or exercise with a PIO2 of 1.3 atm compared to 0.21 atm. When breathing 1.3 atm PIO2, resting subjects (but not exercising subjects) experienced more discomfort (RPD) at lower values of PETCO2 but not at higher PETCO2. PIO2 did not significantly affect the relationship of n-back score to PETCO2. Subjects completed 66 hyperoxic hypercapnic trials without incident, but five subjects stopped prematurely due to serious symptoms (tunnel vision, vision loss, dizziness, panic, exhaustion, or near-syncope) during 69 normoxic hypercapnic trials (p=0.0582). Serious symptoms during hypercapnic trials occurred only during normoxia.
    Journal of applied physiology (Bethesda, Md. : 1985). 06/2014;
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    ABSTRACT: Withholding insulin for weight control is a dangerous practice among individuals with type 1 diabetes; yet little is known about the factors associated with this behavior. Studies of nondiabetic individuals with weight concerns suggest that eating in a disinhibited manner (e.g., binge eating) predicts the use of maladaptive compensatory strategies (e.g., self-induced vomiting). The purpose of this study was to test whether individuals with type 1 diabetes are less restrained in their eating when they think their blood glucose (BG) is low and whether this contributes to insulin omission for weight control purposes and subsequently higher hemoglobin A1c (HbA1c).
    Appetite 05/2014; · 2.54 Impact Factor
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    ABSTRACT: Minimizing post-fracture bone loss is an important aspect of recovery from hip fracture, and determination of factors that affect bone mineral density (BMD) response to treatment after hip fracture may assist in the development of targeted therapeutic interventions. A post hoc analysis of HORIZON Recurrent Fracture Trial was done to determine the effect of zoledronic acid (ZOL) on total hip (TH) and femoral neck (FN) BMD in subgroups with low-trauma hip fracture. A total of 2127 patients were randomized (1:1) to yearly infusions of ZOL 5 mg (n = 1065) or placebo (n = 1062) within 90 days of operation for low-trauma hip fracture. 1486 patients with a baseline and at least one post-baseline BMD assessment at TH or FN (ZOL 745, placebo 741) were included in the analyses. Percentage change from baseline in TH and FN BMD was assessed at Months 12 and 24 and compared across subgroups of hip fracture patients. Percentage change from baseline in TH and FN BMD at Months 12 and 24 was greater (p < 0.05) in ZOL treated patients compared with placebo in most subgroups. Treatment-by-subgroup interactions (p < 0.05) indicated that a greater effect on BMD was observed for TH BMD at Month 12 in females, in patients in the lower tertile body mass index at baseline (≤ 22.6 kg/m(2) ), and in patients with baseline FN BMD T-score of ≤ -2.5; for FN BMD in patients who received ZOL for > 6 weeks post-surgery; and for TH and FN BMD in patients with a history of one or more prior fractures. All interactions were limited to the first 12 months following treatment with none observed for the 24 month comparisons. © 2014 American Society for Bone and Mineral Research.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2014; · 6.04 Impact Factor
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    ABSTRACT: ABSTRACT Background: The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment. Methods: The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging. Results: In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression. Conclusions: These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.
    International Psychogeriatrics 05/2014; · 2.19 Impact Factor
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    ABSTRACT: This study examines the effect of posttraumatic stress disorder (PTSD) on function and physical performance in older overweight military Veterans with comorbid conditions. This is a secondary data analysis of older Veterans (mean age = 62.9 yr) participating in a physical activity counseling trial. Study participants with PTSD (n = 67) and without PTSD (n = 235) were identified. Self-reported physical function (36-item Short Form Health Survey) and directly measured physical performance (mobility, aerobic endurance, strength) were assessed. Multivariate analyses of variance controlling for demographic factors and psychiatric disorders demonstrated significant physical impairment among those with PTSD. PTSD was negatively associated with self-reported physical function, functioning in daily activities, and general health (p < 0.01). Those with PTSD also performed significantly worse on tests of lower-limb function (p < 0.05). Despite being significantly younger, Veterans with PTSD had comparable scores on gait speed, aerobic endurance, grip strength, and bodily pain compared with Veterans without PTSD. This study provides preliminary data for the negative association between PTSD and physical function in older military Veterans. These data highlight the importance of ongoing monitoring of physical performance among returning Veterans with PTSD and intervening in older overweight Veterans with PTSD, whose physical performance scores are indicative of accelerated risk of premature functional aging.
    The Journal of Rehabilitation Research and Development 05/2014; 51(2):285-296. · 1.78 Impact Factor
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    ABSTRACT: The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status. Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders. More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer. Inflammation and coagulation partially mediated the associations between attendance and function. Eight percent of the effect of attendance on ADL (p = .014), 5% of the effect on IADL (p = .003), and 8% of the effect on mobility (p = .001) limitations were due to inflammation and coagulation. Relationships between attendance and function may be due in part to lower levels of inflammation and coagulation among elders who attend services.
    Journal of Aging and Health 04/2014; · 1.56 Impact Factor
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    ABSTRACT: The recruitment of asymptomatic volunteers has been identified as a critical factor that is delaying the development and validation of preventive therapies for Alzheimer disease (AD). Typical recruitment strategies involve the use of convenience samples or soliciting participation of older adults with a family history of AD from clinics and outreach efforts. However, high-risk groups, such as ethnic/racial minorities, are traditionally less likely to be recruited for AD prevention studies, thus limiting the ability to generalize findings for a significant proportion of the aging population. A community-engagement approach was used to create a registry of 2311 research-ready, healthy adult volunteers who reflect the ethnically diverse local community. Furthermore, the registry's actual commitment to research was examined, through demonstrated participation rates in a clinical study. The approach had varying levels of success in establishing a large, diverse pool of individuals who are interested in participating in pharmacological prevention trials and meet the criteria for primary prevention research trials designed to delay the onset of AD. Our efforts suggest that entry criteria for the clinical trials need to be carefully considered to be inclusive of African Americans, and that sustained effort is needed to engage African Americans in pharmacological prevention approaches.
    Alzheimer disease and associated disorders 03/2014; · 2.88 Impact Factor
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    ABSTRACT: The recruitment of asymptomatic volunteers has been identified as a critical factor that is delaying the development and validation of preventive therapies for Alzheimer disease (AD). Typical recruitment strategies involve the use of convenience samples or soliciting participation of older adults with a family history of AD from clinics and outreach efforts. However, high-risk groups, such as ethnic/racial minorities, are traditionally less likely to be recruited for AD prevention studies, thus limiting the ability to generalize findings for a significant proportion of the aging population. A community-engagement approach was used to create a registry of 2311 research-ready, healthy adult volunteers who reflect the ethnically diverse local community. Furthermore, the registry's actual commitment to research was examined, through demonstrated participation rates in a clinical study. The approach had varying levels of success in establishing a large, diverse pool of individuals who are interested in participating in pharmacological prevention trials and meet the criteria for primary prevention research trials designed to delay the onset of AD. Our efforts suggest that entry criteria for the clinical trials need to be carefully considered to be inclusive of African Americans, and that sustained effort is needed to engage African Americans in pharmacological prevention approaches.
    , Journal of Alzheimer's Disease and Associated Disorders. 11/2013;
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    ABSTRACT: One theory of aging and disease development is that chronic injury (pathology) results in activation of regenerative processes and initial repair, with overt disease arising only after exhaustion of reparative capability leads to inadequate repair. While depletion of circulating progenitor cells (CPCs) has been noted in diabetes, the degree to which CPC depletion predates and is associated with propensity to develop overt disease is unclear. The Enhanced Fitness trial enrolled overweight/obese (body mass index >25) sedentary patients with glucose intolerance but without overt diabetes. Baseline CPCs were measured in 129 patients based on the cell surface markers CD34, CD133, and aldehyde dehydrogenase (ALDH) activity. HgbA1C, fasting insulin and glucose levels, and HOMA calculations were ascertained. Lower counts of early angiogenic CPCs identified as CD34(+), CD34(+)CD133(+), and ALDH-bright (ALDH(br)) cells were associated with impairments in glucose homeostasis as reflected by HgbA1C, but not fasting insulin, glucose, or HOMA-IR. These associations remained when corrected for age and cardiovascular risk factors. The numbers of CD34(+) and ALDH(br) CPCs were significantly lower in patients with impaired glucose tolerance. Depletion of reparative capacity as reflected by loss of CPCs may presage overt disease as exemplified in this pre-diabetes model.
    Journal of diabetes and its complications 09/2013; · 2.11 Impact Factor
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    ABSTRACT: Advancing age is associated with an increase in physical impairment, functional limitations, disability, and loss of independence. Regular physical activity conveys health benefits, but the yield on physical function in the elderly, is less clear. Current exercise guidelines are focused predominantly on aerobic programs despite evidence that age-associated declines are mediated by peripheral tissue changes. The Fit for Life trial proposes a new paradigm of exercise training for the elderly that uses a low-mass high-repetition training regimen specifically focused on peripheral tissue beds or body regions (Regional Specific Training Stimulus-RSTS). RSTS is designed to deliver a localized stimulus to the peripheral vasculature, bone and muscle, without imposing a significant central cardiorespiratory strain. The purpose of this study is three-fold; 1) derive effect sizes from the RSTS intervention by which to power a subsequent larger, confirmatory trial; 2) assess fidelity of the RSTS intervention; 3) to assess the interrelationship of the primary endpoints of physical impairment/fitness (VO2peak, 1 repetition maximal contraction) and function (Senior Fitness Test scores) following two versions of a 4 + 8 week protocol Men and women over 70 years, at risk for losing independence will be randomized to either 4 weeks of RSTS or "aerobic" exercise, followed by an identical 8 weeks of progressive whole-body training (aerobic plus resistance). The guiding hypothesis is that the magnitude of adaptation after 12 weeks will be greatest in those initially randomized to RSTS. Possible mediators of the intervention effect - physical impairment/fitness and function relationship, including vascular function, muscle mass, strength, and physiology will also be assessed.
    Contemporary clinical trials 07/2013; · 1.51 Impact Factor
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    ABSTRACT: Diurnal cortisol is a marker of HPA-axis activity that may be one of the biological mechanisms linking stressors to age-related health declines. The current study identified day-centered profiles of diurnal cortisol among 1101 adults living in the United States. Participants took part in up to four consecutive days of salivary cortisol collection, assessed at waking, 30min post-waking, before lunch, and before bedtime. Growth mixture modeling with latent time basis was used to estimate common within-day trajectories of diurnal cortisol among 2894 cortisol days. The 3-class solution provided the best model fit, showing that the majority of study days (73%) were characterized by a Normative cortisol pattern, with a robust cortisol awakening response (CAR), a steep negative diurnal slope, coupled with low awakening and bedtime levels. Relative to this profile, diurnal cortisol on the remainder of days appeared either elevated throughout the day (20% of days) or flattened (7% of days). Relative to the normative trajectory, the elevated trajectory was distinguished by a higher morning cortisol level, whereas the flattened trajectory was characterized by a high bedtime level, with weaker CAR and diurnal slope parameters. Relative to the normative profile, elevated profile membership was associated with older age and cigarette smoking. Greater likelihood of the flattened cortisol pattern was observed among participants who were older, male, smoked cigarettes, used medications that are known to affect cortisol output, and reported poorer health. The current study demonstrates the value of a day-centered growth mixture modeling approach to the study of diurnal cortisol, showing that deviations from the classic robust rhythm of diurnal cortisol are associated with older age, male sex, use of medications previously shown to affect cortisol levels, poorer health behaviors, and poorer self-reported health.
    Psychoneuroendocrinology 06/2013; · 5.14 Impact Factor
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    ABSTRACT: BACKGROUND: Aging is marked by a decline in physical function. Although the biological underpinnings for this remain unclear, loss of regenerative capacity has been proposed as one cause of the loss of physical function that occurs over time. The quantity of circulating progenitor cells (CPCs) may be one reflection of regenerative capability. We sought to determine whether certain specific CPC subpopulations were associated with physical function. METHODS: Baseline CPCs were measured in 129 randomized participants in the Enhanced Fitness clinical trial based on the cell surface markers CD34, CD133, CD146, and CD14 and aldehyde dehydrogenase (ALDH) activity. Physical function was assessed using usual and rapid gait speed, 6-minute walk distance, chair stand time, and balance time. RESULTS: Low counts of early angiogenic CPCs identified as CD34(+), CD34(+)CD133(+), and ALDH-bright (ALDH(br)) cells were associated with low usual gait speed (p < .005, p < .001, and p < .007), rapid gait speed (p < .001, p < .003, and p < .001), and 6-minute walking distance (all comparisons p < .001), and longer time required to complete five chair stands (p < .006, p < .002, and p < .004). CPC counts of mature endothelial or monocytic markers were not associated with physical function. CONCLUSIONS: The numbers of CD34(+) and ALDH(br) CPCs are significantly lower in patients with impaired physical function. Further studies are needed to determine the underlying causes for this association.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 05/2013; · 4.31 Impact Factor
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    ABSTRACT: Objective To evaluate ankle joint abnormalities in a knee osteoarthritis (OA) cohort. Methods Participants (n = 159) with symptomatic and radiographic OA in at least one knee underwent technetium-99m methylene diphosphonate bone scan (scored 0–3) of the ankles and forefeet. Knee radiographs were graded for OA features of joint space narrowing (JSN) and osteophyte (OST). Ankle symptoms and history of ankle injury were assessed by self-report. Knee alignment was measured from a long-limb radiograph. Ankle radiographs were obtained on those who returned for follow-up (n = 138) and were graded for ankle tibiotalar JSN and OST. Design Ankle scintigraphic abnormalities were frequent (31% of individuals, one-third bilateral). Ankle symptoms were reported by 23% of individuals and history of ankle injury by 24%. Controlling for gender, age, body mass index (BMI), and contralateral predictor, ankle scintigraphic abnormalities were associated with: ipsilateral ankle symptoms (P = 0.005); contralateral knee JSN (P = 0.001), knee OST (P = 0.006) and knee malalignment (P = 0.08); and history of ankle injury or surgery of either ankle (P < 0.0001). At follow-up, scintigraphic abnormalities of the ankle were strongly associated with presence of tibiotalar radiographic OA (P < 0.0001). Conclusions Although considered rare, we observed a high prevalence of radiographic features of ankle OA in this knee OA cohort. History of overt ankle injury did not appear to account for the majority of ankle abnormalities. These results are consistent with a probable kinematic association of knee OA pathology and contralateral ankle abnormalities and suggest that interventions targeting mechanical factors may be needed to prevent ankle OA in the setting of knee OA.
    Osteoarthritis and Cartilage 01/2013; 21(11):1693–1699. · 4.26 Impact Factor
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    ABSTRACT: In high income, developed countries, health status tends to improve as income increases, but primarily through the 50(th)-66(th) percentile of income. It is unclear whether the same limitation holds in middle income countries, and for both general assessments of health and specific conditions. Data were obtained from Brazil, a middle income country. In-person interviews with a representative sample of community residents age ≥60 (N=6963), in the southern state of Rio Grande do Sul, obtained information on demographic characteristics including household income and number of persons supported, general health status (self-rated health, functional status), depression, and seven physician-diagnosed, self-reported health conditions. Analyses used household income (adjusted for number supported and economies of scale) together with higher order income terms, and controlled for demographics and comorbidities, to ascertain nonlinearity between income and general and specific health measures. In fully controlled analyses income was associated with general measures of health (linearly with self-rated health, nonlinearly with functional status). For specific health measures there was a consistent linear association with depression, pulmonary disorders, renal disorders, and sensory impairment. For musculoskeletal, cardiovascular (negative association), and gastrointestinal disorders this association no longer held when comorbidities were controlled. There was no association with diabetes. Contrary to findings in high income countries, the association of household-size-adjusted income with health was generally linear, sometimes negative, and sometimes absent when comorbidities were controlled.
    PLoS ONE 01/2013; 8(9):e73930. · 3.73 Impact Factor
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    ABSTRACT: OBJECTIVES: To examine whether performance on a brief memory test is related to functional outcomes in older individuals undergoing low-vision rehabilitation (LVR) for macular disease. DESIGN: Observational cohort study of individuals receiving outpatient LVR. SETTING: Academic center. PARTICIPANTS: Ninety-one individuals (average age 80.1) with macular disease. MEASUREMENTS: Memory was assessed at baseline using a 10-word list; memory deficit was defined as immediate recall of two or fewer words. Vision-related function was measured using the 25-item Visual Function Questionnaire (VFQ-25) administered at baseline and during subsequent interviews (mean follow-up, 115 days). Linear mixed models were constructed to compare average trajectories of four VFQ-25 subscales: near activities, distance activities, dependency, and role difficulty. RESULTS: The 29.7% of participants with memory deficits tended to decline in ability to accomplish activities that involved near vision. Controlling for age, sex, and education, the functional trajectory of participants with memory deficit differed significantly from that of those with better memory (P = .002), who tended to report improvements in ability to accomplish near activities. CONCLUSION: Of older adults receiving LVR for macular disease, those with memory deficits experienced worse functional trajectories in their ability to perform specific visually mediated tasks. A brief memory screen may help explain variability in rehabilitation outcomes and identify individuals who might require special accommodations.
    Journal of the American Geriatrics Society 11/2012; · 3.98 Impact Factor
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    ABSTRACT: In order to assess the effect of gray matter volumes and cortical thickness on antidepressant treatment response in late-life depression, the authors examined the relationship between brain regions identified a priori and Montgomery-Åsberg Depression Rating Scale (MADRS) scores over the course of an antidepressant treatment trial. In a nonrandomized prospective trial, 168 patients who were at least 60 years of age and met DSM-IV criteria for major depression underwent MRI and were enrolled in a 12-week treatment study. Exclusion criteria included cognitive impairment or severe medical disorders. The volumes or cortical thicknesses of regions of interest that differed between the depressed group and a comparison group (N=50) were determined. These regions of interest were used in analyses of the depressed group to predict antidepressant treatment outcome. Mixed-model analyses adjusting for age, education, age at depression onset, race, baseline MADRS score, scanner, and interaction with time examined predictors of MADRS scores over time. Smaller hippocampal volumes predicted a slower response to treatment. With the inclusion of white matter hyper-intensity severity and neuropsychological factor scores, the best model included hippocampal volume and cognitive processing speed to predict rate of response over time. A secondary analysis showed that hippocampal volume and frontal pole thickness differed between patients who achieved remission and those who did not. These data expand our understanding of the prediction of treatment course in late-life depression. The authors propose that the primary variables of hippocampal volume and cognitive processing speed, subsuming other contributing variables (episodic memory, executive function, language processing) predict antidepressant response.
    American Journal of Psychiatry 11/2012; 169(11):1185-93. · 14.72 Impact Factor
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    ABSTRACT: The Comprehensive Assessment of the Long-term Effects of Reducing Intake of Energy Phase 2 (CALERIE) study is a systematic investigation of sustained 25% calorie restriction (CR) in non-obese humans. CALERIE is a multicenter (3 clinical sites, one coordinating center), parallel group, randomized controlled trial. Participants were recruited, screened, and randomized to the CR or control group with a 2:1 allocation. Inclusion criteria included ages 21-50years for men and 21-47years for women, and a body mass index (BMI) of 22.0≤BMI<28.0kg/m(2). Exclusion criteria included abnormal laboratory markers, significant medical conditions, psychiatric/behavioral problems, and an inability to adhere to the rigors of the evaluation/intervention schedule. A multi-stage screening process (telephone screen and 3 in-clinic visits) was applied to identify eligible participants. Recruitment was effective and enrollment targets were met on time. 10,856 individuals contacted the clinical sites, of whom 9787 (90%) failed one or more eligibility criteria. Of the 1069 volunteers who started the in-clinic screening, 831 (78%) were either ineligible or dropped. 238 volunteers were enrolled (i.e., initiated the baseline evaluations), 220 were randomized, and 218 started the assigned intervention (2% from the first screening step). This study offered lessons for future multi-center trials engaging non-disease populations. Recruitment strategies must be tailored to specific sites. A multi-disciplinary screening process should be applied to address medical, physical, and psychological/behavioral suitability of participants. Finally, a multi-step screening process with simple criteria first, followed by more elaborate procedures has the potential to reduce the use of study resources.
    Contemporary clinical trials 09/2012; 34(1):10-20. · 1.51 Impact Factor
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    ABSTRACT: To determine whether a home-based multicomponent physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus. Controlled clinical trial. Primary care clinics of the Durham Veterans Affairs (VA) Medical Center between September 29, 2008, and March 25, 2010. Three hundred two overweight (body mass index 25-45 kg/m(2) ), older (60-89) outpatients with impaired glucose tolerance (fasting blood glucose 100-125 mg/dL, glycosylated hemoglobin (HbA1c) <7%) randomly assigned to a PAC intervention group (n = 180) or a usual care control group (n = 122). A 12-month, home-based multicomponent PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and customized mailed materials. All study participants, including controls, received a consultation in a VA weight management program. The primary outcome was a homeostasis model assessment of insulin resistance (HOMA-IR), calculated from fasting insulin and glucose levels at baseline and 3 and 12 months. HbA1c was the secondary indicator of glycemic control. Other secondary outcomes were anthropometric measures and self-reported physical activity, health-related quality of life, and physical function. There were no significant differences between the PAC and control groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose (P < .001), and other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in the PAC group (P < .001) and not in the usual care group. Home-based telephone counseling increased physical activity levels but was insufficient to improve glycemic indicators in older outpatients with prediabetes mellitus.
    Journal of the American Geriatrics Society 09/2012; 60(9):1655-62. · 3.98 Impact Factor
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    ABSTRACT: OBJECTIVE This study investigated the relationship between positive and negative religious coping and quality of life among outpatients with schizophrenia. METHODS Interviews were conducted with 63 adults in the southeastern United States. Religious coping was measured by the 14-item RCOPE and quality of life by the World Health Organization Quality of Life-BREF. Data were examined via descriptive bivariate statistics and controlled analyses. RESULTS Most participants reported participation in private religious or spiritual activities (91%) and participation in public religious services or activities (68%). Positive religious coping was related to the quality-of-life facet of psychological health (r=.28, p=.03). Negative religious coping and quality of life were inversely related (r=-.30, p=.02). Positive religious coping was associated with psychological health in the reduced univariate general linear model (B=.72, p=.03, adjusted R2=.08). CONCLUSIONS Greater awareness of the importance of religion in this population may improve cultural competence in treatment and community support.
    Psychiatric services (Washington, D.C.) 08/2012; · 2.81 Impact Factor
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    ABSTRACT: Objective: To assess the importance of spirituality and religious coping among outpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder living in three countries. Method: A total of 276 outpatients (92 from Geneva, Switzerland, 121 from Trois-Rivières, Canada, and 63 from Durham, North Carolina), aged 18-65, were administered a semi-structured interview on the role of spirituality and religiousness in their lives and to cope with their illness. Results: Religion is important for outpatients in each of the three country sites, and religious involvement is higher than in the general population. Religion was helpful (i.e., provided a positive sense of self and positive coping with the illness) among 87% of the participants and harmful (a source of despair and suffering) among 13%. Helpful religion was associated with better social, clinical and psychological status. The opposite was observed for the harmful aspects of religion. In addition, religion sometimes conflicted with psychiatric treatment. Conclusions: These results indicate that outpatients with schizophrenia or schizoaffective disorder often use spirituality and religion to cope with their illness, basically positively, yet sometimes negatively. These results underscore the importance of clinicians taking into account the spiritual and religious lives of patients with schizophrenia.
    The International Journal of Psychiatry in Medicine 07/2012; 44(1):29-52. · 1.15 Impact Factor

Publication Stats

7k Citations
1,013.07 Total Impact Points

Institutions

  • 1999–2014
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
  • 1996–2014
    • Duke University Medical Center
      • • Department of Psychiatry
      • • Department of Medicine
      • • Department of Psychiatry and Behavioral Science
      • • Center for the Study of Aging and Human Development
      • • Department of Anesthesiology
      Durham, North Carolina, United States
    • U.S. Department of Veterans Affairs
      • Geriatric Research, Education and Clinical Center (GRECC)
      Washington, D. C., DC, United States
  • 2006–2012
    • Washington University in St. Louis
      • Department of Psychiatry
      Saint Louis, MO, United States
    • University of Miami
      • Miller School of Medicine
      Coral Gables, FL, United States
  • 2011
    • University of Texas Health Science Center at San Antonio
      • Division of Geriatrics, Gerontology and Palliative Medicine
      San Antonio, TX, United States
  • 2006–2011
    • University of Pittsburgh
      • School of Medicine
      Pittsburgh, PA, United States
  • 2007
    • University of Leuven
      Louvain, Flanders, Belgium
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2003–2006
    • University of Minnesota Twin Cities
      • • Department of Experimental and Clinical Pharmacology
      • • College of Pharmacy
      Minneapolis, MN, United States
    • St. Vincent Health
      Indianapolis, Indiana, United States
    • University of Maryland, Baltimore
      • Department of Psychiatry
      Baltimore, MD, United States
  • 2005
    • Philadelphia College of Pharmacy and Science
      Philadelphia, Pennsylvania, United States
  • 2004
    • Palo Alto Research Center
      Palo Alto, California, United States
  • 1995
    • North Carolina Central University
      Durham, North Carolina, United States