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Jingwei Wu

Publications and source records attributed to Jingwei Wu.

12 recordsLinked to original sources
PubMed2006

What contributes more strongly to predicting QOL during 1-year recovery from treatment for clinically localized prostate cancer: 4-weeks-post-treatment depressive symptoms or type of treatment?

PURPOSE: Research on prostate cancer and quality of life (QOL) has focused on the effects of treatment type on subsequent QOL, without considering effects of depressive symptoms. The present purpose is to test the independent contribution of depressive symptoms (measured within 4 weeks after treatment) and treatment type in predicting QOL measured 4, 7, and 12 months following treatment for clinically localized prostate cancer. METHODS: The 105 patients (all Stage I-II) were newly treated with radical prostatectomy, external beam radiation (EBR) or brachytherapy. Age ranged from 42 to 80 (mean = 64); 88% Caucasian and 9% African American. Repeated measures mixed linear models were adjusted for age, race, education, and marital status. RESULTS: Depressive symptoms significantly (p < 0.01) predicted 8 of 10 disease-specific and 7 of 7 generic QOL outcomes. Treatment type significantly (p < 0.01) predicted urinary function and bowel bother but no generic QOL outcomes. CONCLUSIONS: Depressive symptoms appears to predict a wider range of QOL outcomes (measured 4-12 months after treatment) than treatment type; however, when treatment is significant its effect sizes are slightly larger than depressive symptoms. Health care providers should (1) assess depressive symptoms in prostate cancer patients before and after treatment, and (2) provide psychosocial (e.g., counseling, support groups) and pharmacologic treatment options for improving depressive symptoms.

Adult↗
PubMed2006

Correlates of health literacy in patients with chronic heart failure.

PURPOSE: Many older adults have inadequate health-related literacy, which is associated with poor health outcomes. Thus, it is important to identify determinants of health literacy. We investigated relationships between health literacy and general cognitive and sensory abilities, as well as education, health, and demographic variables, in a community sample of middle-aged and older adults. DESIGN AND METHODS: Participants were 314 community-dwelling adults (67% female, 48% African American) diagnosed with chronic heart failure recruited for a pharmacist-based intervention study to improve adherence to chronic heart failure medications. We adminstered demographic, health, education, cognitive (e.g., processing speed, working memory), and sensory measures, and the Short Test of Functional Health Literacy in Adults (STOFHLA), as part of the baseline condition of this study. RESULTS: STOFHLA scores were lower for participants who were older, less educated, male, African American, had more comorbidities, or scored lower on all cognitive ability measures. Hierarchical linear regression analyses showed that education and cognitive ability were independently associated with the STOFHLA measure and explained age differences in health literacy. IMPLICATIONS: The association of cognitive abilities and literacy has important implications for health literacy models and for interventions to reduce the impact of low health literacy on health outcomes. For example, medication instructions should be designed to reduce comprehension demands on general cognitive abilities as well as literacy skills.

Aged↗
PubMed2005

Activity and connectivity of brain mood regulating circuit in depression: a functional magnetic resonance study.

BACKGROUND: Functional imaging studies indicate that imbalances in cortico-limbic activity and connectivity may underlie the pathophysiology of MDD. In this study, using functional Magnetic Resonance Imaging (fMRI), we investigated differences in cortico-limbic activity and connectivity between depressed patients and healthy controls. METHODS: Fifteen unmedicated unipolar depressed patients and 15 matched healthy subjects underwent fMRI during which they first completed a conventional block-design activation experiment in which they were exposed to negative and neutral pictures. Next, low frequency blood oxygenation dependent (BOLD) related fluctuations (LFBF) data were acquired at rest and during steady-state exposure to neutral, positive and negative pictures. LFBF correlations were calculated between anterior cingulate cortex (ACC) and limbic regions--amygdala (AMYG), pallidostriatum (PST) and medial thalamus (MTHAL) and used as a measure of cortico-limbic connectivity. RESULTS: Depressed patients had increased activation of cortical and limbic regions. At rest and during exposure to neutral, positive, and negative pictures cortico-limbic LFBF correlations were decreased in depressed patients compared to healthy subjects. CONCLUSIONS: The finding of increased activation of limbic regions and decreased LFBF correlations between ACC and limbic regions is consistent with the hypothesis that decreased cortical regulation of limbic activation in response to negative stimuli may be present in depression.

Adult↗
PubMed2005

Association between adherence measurements of metoprolol and health care utilization in older patients with heart failure.

OBJECTIVE: Data from electronic dosing monitors and published pharmacokinetic parameters were used to derive medication adherence measures for immediate-release metoprolol and examine their association with health care utilization of outpatients aged 50 years or older with heart failure. METHODS: We used a 1-compartment model and published population pharmacokinetic parameters to estimate mean plasma metoprolol concentrations for patients treated for 6 to 12 months. In the absence of directly measured plasma concentrations, we calculated the intended mean plasma concentration (Cp'(ave)) under the assumption of perfect adherence to the prescribed dose and frequency of administration. Projected mean plasma concentrations (Cp(ave)) were estimated by use of data from recorded dosing times. In addition to taking adherence (percentage of dose taken) and scheduling adherence (percentage of doses taken on schedule), we calculated the deviation from the intended exposure (DeltaCp(ave) = Cp'(ave) - Cp(ave)) and the proportion of intended exposure achieved by the patient (Cp(ave) /Cp'(ave)). We assessed the association between the adherence measures and the numbers of emergency department visits and hospital admissions experienced by the patients. RESULTS: Patients (N = 80) were aged 62 +/- 8 years. Mean DeltaCp(ave) and Cp(ave)/Cp'(ave) were 7.9 ng/mL (SD, 10.7) and 0.6 (SD, 0.3), respectively. Log-linear models adjusted for patient functional status indicated that greater deviation from the intended metoprolol exposure (DeltaCp(ave)) was associated with increased numbers of emergency department visits ( P < .0001) and hospital admissions (P < .0001). A higher proportion of intended exposure (Cp(ave) /Cp'(ave)) corresponded to a reduced number of emergency department visits (P = .0204) and hospital admissions (P = .0093). Taking adherence was univariately associated with both emergency department visits and hospital visits (P < .0001 and P = .0010, respectively). Scheduling adherence was associated with the number of emergency department visits (P = .0181) but not with the number of hospital admissions (P = .1602). Model selection procedures consistently chose the proposed measures over taking adherence and scheduling adherence. CONCLUSION: Deviation from the intended exposure and proportion of intended exposure achieved by the patient are valid adherence measures for immediate-release metoprolol and are associated with health care utilization. The potential utility of these measures for other beta-adrenergic antagonists and perhaps other cardiovascular drugs should be investigated.

Aged↗
PubMed2005

Antidepressant effect on connectivity of the mood-regulating circuit: an FMRI study.

The mechanisms by which antidepressant-induced neurochemical changes lead to physiological changes in brain circuitry and ultimately an antidepressant response remain unclear. This study investigated the effects of sertraline, a selective serotonin reuptake inhibitor antidepressant, on corticolimbic connectivity, using functional magnetic resonance imaging (fMRI). In all, 12 unmedicated unipolar depressed patients and 11 closely matched healthy control subjects completed two fMRI scanning sessions at baseline and after 6 weeks. Depressed patients received treatment with sertraline between the two sessions. During each fMRI session, subjects first completed a conventional block-design experiment. Next, connectivity between cortical and limbic regions was measured using correlations of low-frequency blood oxygen level-dependent (BOLD) fluctuations (LFBF) during continuous exposure to neutral, positive, and negative pictures. At baseline, depressed patients had decreased corticolimbic LFBF correlations compared to healthy subjects during the resting state and on exposure to emotionally valenced pictures. At rest and on exposure to neutral and positive pictures, LFBF correlation between the anterior cingulate cortex and limbic regions was significantly increased in patients after treatment. However, on exposure to negative pictures, corticolimbic LFBF correlations remained decreased in depressed patients. The results of this study are consistent with the hypothesis that antidepressant treatment may increase corticolimbic connectivity, thereby possibly increasing the regulatory influence of cortical mood-regulating regions over limbic regions.

Adult↗
PubMed2004

Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure.

PURPOSE: The association of medication adherence, knowledge, and skills with emergency department (ED) visits by patients 50 years of age or older with congestive heart failure (CHF) was studied. METHODS: The patients in this study were enrolled in the usual care group of an ongoing trial of patients with CHF to determine the effects of a pharmacy-based intervention on relevant outcomes. Participants' medication knowledge and skills were assessed during individual interviews. Medication knowledge assessed patients' knowledge of the dosage, frequency, and indication of each of their CHF medications. The medications skills assessment evaluated patients' dexterity (ability to open medication bottles), literacy (ability to read labels), and ability to distinguish colors of tablets and capsules. Medication adherence to CHF drugs was calculated from electronic monitors and prescription-refill records over a six-month period. The primary outcomes of this study were the numbers of all-cause cardiovascular and CHF-specific ED visits during a six-month period. Log-linear regression models were used to analyze the effects of medication knowledge, skill, and adherence on ED visits. RESULTS: Sixty-one patients participated in this study. Multivariate log-linear models adjusted for demographic variables showed that lower medication adherence (p < 0.001) and an inability to read standard prescription and auxiliary labels (p = 0.002) were associated with an increased number of cardiovascular-related ED visits. Knowledge of the prescribed dose was associated with CHF-specific ED visits (p < 0.001). CONCLUSION: Greater medication knowledge, skills, and adherence were associated with fewer ED visits among patients 50 years of age or older with CHF in an urban, teaching medical center.

Adult↗
PubMed2004

Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure.

BACKGROUND: Medications can improve the functioning and health-related quality of life of patients with chronic heart failure (CHF) and reduce morbidity, mortality, and costs of treatment. However, patients may not adhere to therapy. Patients with complex medication regimens and low health literacy are at risk for nonadherence. OBJECTIVE: The primary goal of this project is to develop and assess a multilevel pharmacy-based program to improve patient medication adherence and health outcomes for elderly CHF patients with low health literacy. METHODS: In this 4-year, controlled trial, patients aged 50 years with a diagnosis of CHF who are being treated at Wishard Health Services (Indianapolis, Indiana) are randomly assigned to pharmacist intervention or usual care. Intervention patients receive 9 months of pharmacist support and 3 months of postintervention follow-up. The intervention involves a pharmacist providing verbal and written education, icon-based labeling of medication containers, and therapeutic monitoring. The pharmacist identifies patients' barriers to appropriate drug use, coaches them on overcoming these barriers, and coordinates medication use issues with their primary care providers. Daily updates of relevant monitoring data are delivered via an electronic medical record system and stored in a personal computer system designed to support pharmacist monitoring and facilitate documentation of interventions. To measure medication adherence objectively, electronic monitoring lids are used on all CHF medications for patients in both study groups. Other assessments include self-reported medication adherence, results of echocardiography (eg, ejection fraction), brain natriuretic peptide concentrations, and health-related quality of life. Health services utilization, refill adherence, and cost data derive from electronic medical records. After completion of this study, the data can be used to assess the effectiveness and cost-effectiveness of our intervention. RESULTS: One hundred twenty-two patients have been assigned to receive the intervention and 192 to receive usual care. CONCLUSIONS: Our study aims to improve patients' knowledge and self-management of their medication and to improve medication monitoring in a multilevel pharmacy-based intervention. By doing so, we intend that the intervention will improve the health outcomes of elderly patients with CHF.

Aged↗
PubMed2004

Return for results after herpes simplex virus type 2 screening.

OBJECTIVE: The objective of this study was to evaluate factors associated with return for results of type-specific herpes simplex virus (HSV) screening. METHODS: Participants receiving type-specific HSV testing were asked to return for results 2 weeks after testing. Predictors of return included demographics, herpes-related knowledge and attitudes, and past sexual behaviors. RESULTS: A total of 820 sexually active subjects (age, 14-30 years; 41% male) received HSV screening and 578 (70%) returned for results. Higher probability of return for HSV testing results was significantly associated with older age (odds ratio [OR], 1.06), female gender (OR, 1.57), enrollment at sites other than the county sexually transmitted disease clinic (OR, 1.70-4.71), and heightened level of perceived HSV vulnerability (OR, 1.07). Lower probability of return was associated with having more than 1 recent sex partner (OR, 0.46). CONCLUSIONS: Lower rates of return of high-risk patients suggest the need to focus resources on receipt of test results.

Adolescent↗
PubMed2004

Factors predicting the acceptance of herpes simplex virus type 2 antibody testing among adolescents and young adults.

BACKGROUND: The rates and determinants of acceptance of herpes simplex virus type 2 (HSV-2) testing have not been adequately studied. OBJECTIVES: The objective of this study was to identify factors associated with acceptance of HSV-2 antibody testing in individuals with no history of genital herpes. STUDY: We conducted a cross-sectional survey study followed by the offer of free HSV-2 serologic testing at an urban sexually transmitted disease (STD) clinic, 2 general adult medical clinics, an urban university campus, and an urban adolescent medicine clinic. A total of 1199 individuals aged 14 to 30 years completed the survey and were offered testing. RESULTS: A total of 68.4% accepted HSV-2 testing. Factors independently associated with acceptance were female sex, older age, having an STD history, having 1 or more sexual partners in the last 6 months, perceived vulnerability to HSV-2 infection, and perceived benefits of HSV-2 testing. Fear of needles predicted rejection of testing, as did attending a general medical clinic versus an STD clinic and nonwhite race. CONCLUSION: There is a substantial interest in HSV-2 antibody testing across a variety of settings. Those at greatest behavioral and historic risk for HSV-2 infection, women, and persons whose health beliefs are consistent with testing are more likely to accept serologic testing when it is offered.

Adolescent↗
PubMed2004

Predictors of herpes simplex virus type 2 antibody positivity among persons with no history of genital herpes.

BACKGROUND: The demographic, historical, and behavioral factors that predict a positive herpes simplex virus type 2 (HSV-2) antibody test in persons without a history of genital herpes have not been well-defined. METHODS: Individuals (age 14-30 years) without a history of genital herpes completed a questionnaire and were offered free HSV-2 antibody testing. Factors from the questionnaire were correlated with the HSV-2 antibody result. RESULTS: Univariate analysis showed that female gender was significantly associated with positive test results. In gender-specific, multiple logistic regression models, a positive HSV-2 antibody test among men was associated with older age, non-white race, and a history of sexually transmitted disease (STD). Gender-specific symptom scores from the questionnaire were not predictive in either gender, but the gender-common symptom score was marginally predictive of a positive HSV-2 antibody test in women. Among women, older age, non-white race, and STD history predicted a positive test. CONCLUSIONS: Among young persons with no history of genital herpes who agreed to HSV-2 antibody testing, increasing age, non-white race, and a history of an STD were predictors of a positive test. A history of frequent pain, itching, burning, and rashes in the anogenital region was marginally associated with positive HSV-2 tests in women. These results might help guide selective use of HSV-2 antibody screening.

Adolescent↗
PubMedDate not supplied

Patient perception and provider assessment of severity of heart failure as predictors of hospitalization.

OBJECTIVE: To assess the agreement between 2 methods of assigning New York Heart Association (NYHA) functional class to patients with chronic heart failure (CHF): deriving NYHA class from self-report interview data versus clinician assignment. To then determine the ability of each method to predict all-cause hospitalization. METHODS: Adults with CHF > or = 50 years old from an urban health system in Indianapolis, Indiana, were administered the Kansas City Cardiomyopathy Questionnaire (a validated CHF symptom questionnaire) at baseline. Patient self-reported functional data were then used to derive NYHA class. Clinical providers who were blinded to patients' questionnaire data independently assessed NYHA functional class. We used a weighted kappa statistic to evaluate the agreement between the NYHA class from patient-derived and that from provider-assigned methods. We then assessed the ability of patient and provider NYHA to predict time to hospitalization using Cox proportional hazards models. RESULTS: Of 156 patients with complete 6-month follow-up (mean age 63 years +/- 9 SD, 53% African American, and 68% women), the correlation coefficient was 0.43 between the patient-derived and provider-assigned NYHA methods. The weighted kappa statistic was 0.278, and the 95% confidence interval was 0.18 to 0.37, indicating only slight agreement. Patients classified themselves in worse categories than did their providers. Provider-assigned NYHA was a better predictor of hospitalization (P = .06). CONCLUSIONS: There is only slight agreement between patient-derived and clinician-assigned NYHA functional class. A different approach with patients may be needed if providers hope to use patients' reports to identify those at risk for hospitalization.

Aged↗