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Joyce A Cramer

Publications and source records attributed to Joyce A Cramer.

25 records · Page 2Linked to original sources
PubMed2003

Neuropsychological correlates of suboptimal adherence to metformin.

The goal of this study was to determine if neuropsychological function is associated with adherence to prescribed medication. Altogether, 79 patients with type II diabetes at a VA primary care clinic had adherence to the antihyperglycemic drug metformin measured with MEMS caps over a 4-week period. They completed several tests of neuropsychological function: Mini-Mental Status Exam (MMSE), Trails A and B, Stroop, Digit Span, Digit Symbol, and Grooved Pegboard. In separate multivariate analyses, Stroop word score and time to complete Trails B were independently associated with adherence, as was age. Secondary analyses of the relationship between neuropsychological variables and other adherence-related measures were conducted. Low scores on the MMSE and non-Caucasian ethnicity were associated with missed appointments. None of the neuropsychological variables were associated with glycosylated hemoglobin. These results suggest that cognitive abilities should be considered when counseling patients concerning their adherence.

Adult↗
PubMed2003

The influence of comorbid depression on seizure severity.

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.

Adult↗
PubMed2002

Development of a new seizure severity questionnaire: initial reliability and validity testing.

PURPOSE: This report describes the initial steps for development of a new scale to assess seizure severity as a treatment response. METHODS: Standard methodology was used to develop the test instrument. Item generation was performed by selecting items from other questionnaires, and asking patients and epileptologists about seizure components. Face and content validity were assessed in a pilot study with patients and observers. The questionnaire was formatted as a structured interview for a reliability study. Construct validity was assessed with three existing questionnaires. Inter-rater reliability and test-retest reliability were performed as two independent ratings on one day, and one re-interview. RESULTS: Based on item generation and pilot testing (33 patients, 28 observers), the Seizure Severity Questionnaire (SSQ) was organized into warning, activity-movement, and recovery (cognitive, emotional, and physical aspects) stages of seizures. Questions reviewed duration, severity, bothersomeness and overall ratings, and the most bothersome aspect of seizures. The mean SSQ Summary Score was 5.78+/-3.24, inter-rater reliability was 0.76 (N=91), and test-retest reliability was 0.74 (N=63). Construct validity showed statistically significant correlations with other scales. CONCLUSION: This study has explored the psychometric properties of the SSQ for face and content validity, inter-rater and test-retest reliability, and construct validity. The Summary Score reliably represents the major components of seizures.

Adult↗
PubMedDate not supplied

Effects of illicit drug use on adherence to prescribed antiretroviral medication.

This exploratory analysis compared adherence to antiretroviral medication on days that illicit drugs were used and on matched abstinence days in twelve subjects who used MEMS caps during participation in a clinical trial. Adherence on drug use days was lower in seven subjects, higher in one, and the same in four. Three subjects maintained 100% adherence despite illicit substance use on studied days. Thus, in a subset of patients, the actions involved in procuring drugs and the acute effects of using them contribute to non-adherence on those specific drug use days, associated with substance abuse. (Am J Addict 2003;12:455-458)

Adult↗