Biomedical subjects

Karen M Stechuchak

Publications and source records attributed to Karen M Stechuchak.

14 recordsLinked to original sources

PubMed2006

Knowledge and risks of human immunodeficiency virus transmission among veterans with severe mental illness.

This study is among the first to examine knowledge about human immunodeficiency virus (HIV) and behavioral risks for HIV transmission among veterans with severe mental illness (SMI), a group at high risk for HIV infection. This study examined associations between accuracy of HIV knowledge, risk behaviors, and clinical and demographic characteristics in a sample of male veteran psychiatric inpatients diagnosed with SMI (N = 353). Results showed high rates of inaccurate HIV knowledge, with > 40% of patients demonstrating some inaccuracies, particularly those related to the progression and symptoms of acquired immunodeficiency syndrome. Inaccurate HIV knowledge was associated with older age, minority status, education level, marital status, no homelessness within the previous 6 months, and no reported history of illicit intranasal drug use. There is a need for more effective HIV prevention interventions for persons with SMI.

Cross-Sectional Studies↗

PubMed2005

Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis.

BACKGROUND: Hospital admissions consume a large proportion of costs for the end-stage renal disease (ESRD) program in the United States. We investigated whether a physician diagnosis of depression increases the risk for hospitalization or death in patients with ESRD receiving long-term hemodialysis (HD), independent of medical comorbidities. METHODS: Centralized Veterans Affairs (VA) databases were used to identify a population-based prevalence cohort of 1,588 male patients with ESRD receiving long-term HD in VA facilities between September 1, 2000, and September 30, 2000. International Classification of Diseases, Ninth Revision, codes were used to identify comorbidities and depression diagnosis. Negative binomial regression models were used to examine the association between depression diagnosis and number of hospitalizations and cumulative hospital days in a 2-year observation period. Logistic regression models were used to investigate the association between depression diagnosis and hospitalization, death, and death or hospitalization. RESULTS: The prevalence of physician-diagnosed depression was 14.7%. Patients with a depression diagnosis were more likely to be white and have more comorbidities. Depression diagnosis was associated with increased hospital days (rate ratio for adjusted model, 1.31; 95% confidence interval, 1.04 to 1.66) and increased number of hospitalizations (rate ratio for adjusted model, 1.30; 95% confidence interval, 1.11 to 1.52). Depression diagnosis was not statistically associated with death or the composite of death or hospitalization in adjusted models. CONCLUSION: Physician-diagnosed depression was associated significantly with both increased hospitalization rate and length of stay in patients with ESRD receiving outpatient HD in VA facilities, independent of demographics and comorbidities. Prospective studies should be conducted to assess whether treatment of depression will decrease hospitalization in these patients.

Aged↗

PubMed2005

Hormone therapy does not affect depression severity in older women.

OBJECTIVE: Although estrogens are thought to have a beneficial effect on menopausal symptoms, the role of estrogen in the etiology and treatment of depression in older women remains unclear. The authors examined the relationship between hormone therapy (HT) use and depressive symptom severity. METHODS: Authors report the findings from a cross-sectional analysis of baseline data from the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) Study, using data from 1,160 women age 60 years and older. RESULTS: Women who were taking HT were likely to be younger, White, married, and to have had at least some college education. They were also more likely to report good or better health and to have taken antidepressant medications in the past 3 months. Although HT use was associated with more severe depressive symptoms in the unadjusted analysis, it was not associated with depression severity in adjusted analyses. Although there was a trend for a differential effect of college education with HT use on depression scores, no significant interaction was found between HT and race. CONCLUSION: There was no evidence to suggest that women HT users differ from non-HT users in depressive symptom severity.

Aged↗

PubMed2005

Neuroactive steroids and suicidality in posttraumatic stress disorder.

OBJECTIVE: Recent studies suggest that neuroactive steroids may be altered in posttraumatic stress disorder (PTSD). Since high rates of suicidality accompany PTSD, the authors investigated neuroactive steroid levels and correlations to suicide attempts in veterans with this disorder. METHOD: Male veterans with PTSD enrolled in a larger study during inpatient hospitalization (N=130) were assessed for suicidal ideation or suicide attempt in the last 6 months. Serum levels of dehydroepiandrosterone (DHEA), androstenedione, testosterone, and estradiol were determined. The authors investigated associations between neuroactive steroids and suicidality. RESULTS: High rates of suicidality were observed. Close to 70% of these patients had suicidal thoughts, and 25% had attempted suicide in the last 6 months. Patients who had attempted suicide demonstrated significantly higher median DHEA levels than those who had not attempted suicide (15.6 versus 8.3 ng/ml), an association that persisted after adjustment for age. CONCLUSIONS: These findings suggest that higher DHEA levels may be linked to suicidality in veterans with PTSD and may be associated with the risk of self-harm.

Androstenedione↗

PubMed2005

Lifetime sexual and physical victimization among male veterans with combat-related post-traumatic stress disorder.

Because of the high prevalence of post-traumatic stress disorder (PTSD) among veteran men and the limited research on victimization in this group, we recruited 133 male veterans with combat-related PTSD from a psychiatric inpatient unit and assessed them for lifetime physical and sexual trauma. Results indicated that 96% of the sample had experienced some form of victimization over their lifetimes; 60% reported childhood physical abuse, 41% childhood sexual abuse, 93% adulthood physical assault, and 20% adulthood sexual assault. In the preceding year alone, 46% experienced either physical or sexual assault. These findings support the need for routine inquiry into the histories of noncombat victimization in this cohort. Determining the lifetime history of trauma exposure may have implications for vulnerability to subsequent development of PTSD and the risk of future violence.

Adolescent↗

PubMed2004

Who doesn't receive carotid endarterectomy when appropriate?

OBJECTIVE: The purpose of this study was to identify clinical and nonclinical factors associated with failure to perform carotid endarterectomy (CEA) in patients with clinically appropriate indications. We analyzed data from a prospective cohort study performed at five Veterans Affairs medical centers. Patients were referred for carotid artery evaluation if they had at least 50% stenosis in one carotid artery, had no history of CEA, and were independently classified preoperatively as appropriate candidates for CEA, according to clinical criteria. The primary outcome was receipt of CEA within 6 months of evaluation. Data were collected by medical record review and interview regarding clinical status, and patient and physician perception of the risks and benefits of CEA. RESULTS: Among clinically appropriate candidates for CEA, 66.8% (n = 233) did not undergo the operation. Compared with patients who did undergo CEA, a greater proportion of these patients had no symptoms (68.7% vs 45.7%; P <.001). A twofold greater proportion of patients who did not undergo CEA were in the highest quartile of reported aversion to surgery. Moreover, a fourfold greater proportion were perceived by their physicians to be at less than 5% risk for future stroke without the operation, and more than a twofold greater proportion were believed to experience less than 5% efficacy from the operation by their providers (P <.01). In multivariable analyses, four characteristics were significantly associated with whether an appropriate candidate did not receive CEA: asymptomatic disease, less than 70% stenosis, high expressed aversion to surgery score, and low (<5%) provider-perceived efficacy of the operation. CONCLUSION: Among patients in the Veterans Affairs health care system who are clinically appropriate candidates for CEA, those who did not receive the operation were less likely to have symptomatic disease or high-grade carotid artery stenosis, but were more likely to report high aversion to surgery and to have a provider who believed CEA would not be efficacious.

Aged↗

PubMed2004

Patient risk perceptions for carotid endarterectomy: which patients are strongly averse to surgery?

BACKGROUND AND PURPOSE: Patient risk perception for surgery may be central to their willingness to undergo surgery. This study examined potential factors associated with patient aversion of surgery. METHODS: This is a secondary data analysis of a prospective cohort study that examined patients referred for evaluation of carotid artery stenosis at five Veterans Affairs Medical Centers. The study collected demographic, clinical, and psychosocial information related to surgery. This analysis focused on patient response to a question assessing their aversion to surgery. RESULTS: Among the 1065 individuals, at the time of evaluation for carotid endarterectomy (CEA), 66% of patients had no symptoms, 16% had a transient ischemic attack, and 18% had stroke. Twelve percent of patients referred for CEA evaluation were averse to surgery. In adjusted analyses, increased age, black race, no previous surgery, lower level of chance locus of control, less trust of physicians, and less social support were significantly related to greater likelihood of surgery aversion among individuals referred for CEA evaluation. Patient degree of medical comorbidity and a validated measure of preoperative risk score were not associated with increased aversion to surgery. CONCLUSIONS: In previous work, aversion to CEA was associated with lack of receipt of CEA even after accounting for patient clinical appropriateness for surgery. We identified important patient characteristics associated with aversion to CEA. Interventions designed to assist patient decision making should focus on these more complex factors related to CEA aversion rather than the simple explanation of clinical usefulness.

Aged↗

PubMed2004

Use of psychiatric and medical health care by veterans with severe mental illness.

Risk behaviors and health care use among 396 initially hospitalized veterans with severe mental illnesses were examined. Health care use was abstracted from Veterans Affairs databases (March 1998 to June 2000) for one year after hospital discharge. Lifetime intravenous drug use was related to increased use of outpatient services, and current alcohol use was related to decreased health care use. Patients with posttraumatic stress disorder had greater use of medical outpatient services than patients with schizophrenia-spectrum disorders, although they had longer hospital stays. These results highlight that veterans with severe mental illness receive more treatment in medical than psychiatric health clinics.

HIV Infections↗

PubMed2004

A pilot study of inexpensive sleep-assessment devices.

Polysomnography (PSG), the gold standard sleep-assessment methodology, is impractical for many applications. Although alternative assessment methodologies are available, it is not clear which most correlates with PSG measures. This study compared sleep log (SL), actigraphy (ACT), and the REMview (RV) device for estimating PSG sleep measures. Thirty-three participants with various sleep-disorder diagnoses underwent 1 night of monitoring with PSG, RV, ACT, and SL. RV provided accurate estimates of most sleep variables. The accuracy of ACT and SL estimates depended on the sleep variable. These findings indicate that the selection of an alternative methodology should consider the sleep measure of interest in addition to the relative merits and drawbacks of each device.

Adult↗

PubMed2004

Racial differences in hepatitis B and hepatitis C and associated risk behaviors in veterans with severe mental illness.

Racial differences in the seroprevalence of and risks for hepatitis B (HBV) and hepatitis C (HCV) were examined in military veterans with severe mental illnesses (SMI). Participants (376; 155 Caucasian, 221 African American) were inpatients at a Veterans Affairs (VA) psychiatric unit in Durham, N.C., from 1998 to 2000. Prevalence rates of HBV and HCV were 21.3% and 18.9%, respectively. African Americans had a higher HBV seroprevalence than did Caucasians: 27.6% versus 12.3%; odds ratio (OR) 2.73; 95% confidence interval (CI)=1.55, 4.79. Although not statistically significant, HCV seroprevalence was also higher for African Americans than it was for Caucasians: 21.3% versus 15.5%; OR=1.47; 95% CI=0.86, 2.53. No racial difference was observed for injection drug use (IDU), the strongest risk indicator for both HBV and HCV. Multivariable analyses indicated that African-American race, IDU, and multiple sex partners in the past six months were related to an increased risk of HBV, whereas IDU and smoking crack cocaine were both independently related to an increased risk of HCV. Thus, veterans with SMI--particularly African-American veterans--have high rates of HBV and HCV infection. African-American veterans have significantly higher rates of HBV than do Caucasian veterans, which persist after controlling for prominent risk behaviors.

Adult↗

PubMed2003

Gender differences in hepatitis C infection and risks among persons with severe mental illness.

OBJECTIVES: The authors assessed gender differences in hepatitis C infection and associated risk behaviors among persons with severe mental illness. METHOD: S: The sample consisted of 777 patients (251 women and 526 men) from four sites. RESULTS: Across sites, the rate of hepatitis C infection among men was nearly twice that among women. Clear differences were noted in hepatitis C risk behaviors. Men had higher rates of lifetime drug-related risk behaviors: needle use (23.1 percent compared with 12.5 percent), needle sharing (17.6 percent compared with 7.7 percent), and crack cocaine use (45.2 percent compared with 30.8 percent). Women had significantly higher rates of lifetime sexual risk behaviors: unprotected sex in exchange for drugs (17.8 percent compared with 11.2 percent), unprotected sex in exchange for money or gifts (30.6 percent compared with 17 percent), unprotected vaginal sex (94 percent compared with 89.7 percent), and anal sex (33.7 percent compared with 22.6 percent). Gender appeared to modify some sex risks. Unprotected sex in exchange for drugs increased the risk of hepatitis C seropositivity for both men and women. In the multivariate model, gender was not significantly associated with hepatitis C seropositivity after adjustment for other risk factors. CONCLUSION: S: Gender differences in the lifetime rates of drug risks explain the higher rates of hepatitis C infection among men with severe mental illness.

Acute Disease↗

PubMed2002

Racial variations in postoperative outcomes of carotid endarterectomy: evidence from the Veterans Affairs National Surgical Quality Improvement Program.

CONTEXT: Black patients and Hispanic patients receive carotid endarterectomy (CEA) at lower rates than white patients. It is unclear whether worse surgical outcomes are influencing clinical decision-making regarding use of the operation among minority group patients. OBJECTIVE: To determine if there are racial differences in postoperative outcomes for patients undergoing CEA at Veterans Affairs (VA) medical centers. DESIGN: Secondary analysis of data from an ongoing, prospective study on surgical quality and outcomes in the VA health care system. SETTING: One hundred thirty-two VA Medical Centers that were part of the VA National Surgical Quality Improvement Program. PATIENTS: A cohort of 6551 men (91.4% white, 5.3% black, and 3.3% Hispanic) who had CEA performed between October 1, 1994 and September 30, 1997. MAIN OUTCOME MEASURES: Primary outcomes were stroke or death and stroke, myocardial infarction (MI), or death within 30 days of the operation. RESULTS: Thirty-day postoperative rates of stroke or death and of stroke, MI, or death were generally low for all racial/ethnic groups, ranging between 2.6% and 6.5%. Within clinical states that define indications for CEA, rates were also low (1.6% to 3.2%) among asymptomatic patients across racial/ethnic groups. However, among patients with transient ischemic attack (TIA), Hispanic patients had significantly worse outcomes than white patients with a postoperative rate of stroke or death of 10.5% (P < 0.05) and stroke, MI, or death of 13.2% (P < 0.05) compared with 3.1% to 3.5% for white patients. Hispanic patients did not differ from black patients for stroke, death/stroke, death, or MI. CONCLUSION: Rates of major postoperative complications after CEA are low within the VA and similar across racial/ethnic groups with the possible exception of Hispanic men with TIA. Further investigation of this elevated complication rate among Hispanic men with TIA may be warranted.

Black or African American↗

PubMedDate not supplied

Improving depression outcomes in older adults with comorbid medical illness.

BACKGROUND: Depression is common in older adults and often coexists with multiple chronic diseases, which may complicate its diagnosis and treatment. OBJECTIVE: To determine whether or not the presence of multiple comorbid medical illnesses affects patient response to a multidisciplinary depression treatment program. DESIGN, SETTING AND PARTICIPANTS: Preplanned analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (> or =60 years), which was performed at 18 primary care clinics from eight health care organizations in five states across the United States from July 1999 to August 2001. INTERVENTION: Intervention patients had access for up to 12 months to a depression care manager, supervised by a psychiatrist and a primary care expert, who offered education, care management and support of antidepressant management by the patient's primary care physician, or provided brief psychotherapy (Problem-Solving Treatment in Primary Care). MEASUREMENTS: Depression, quality of life (QOL; scale of 0-10) and mental health component score (MCS) of the Short-Form 12 assessed at baseline, 3, 6 and 12 months. RESULTS: Patients suffered from an average of 3.8 chronic medical conditions. Although patients with more chronic medical conditions had higher depression severity at baseline, the number of chronic diseases did not affect the likelihood of response to the IMPACT intervention when compared to care as usual. Intervention patients experienced significantly lower depression during all follow-up time points as compared with patients in usual care independent of other comorbid illnesses (P<.001). Intervention patients were also more likely to experience substantial response (at least a 50% reduction in depressive symptoms) regardless of the number of comorbidities, to experience improved MCS-12 scores at 3 and 12 months, and to experience improved QOL. CONCLUSIONS: The presence of multiple comorbid medical illnesses did not affect patient response to a multidisciplinary depression treatment program. The IMPACT collaborative care model was equally effective for depressed older adults with or without comorbid medical illnesses.

Aged↗

PubMedDate not supplied

Implementing a disease management intervention for depression in primary care: a random work sampling study.

We describe the daily work activities of 13 Depression Clinical Specialists (DCSs) at 7 national sites who served as care managers in an effective multisite randomized trial of a disease management model for depression in primary care. DCSs carried portable random-reminder beepers for a total of 147 consecutive workdays and recorded 4,030 work activities. Patient care activity comprised the largest percentage of the workday, 49.4% (95% confidence interval [CI], 42.0 to 56.7%), followed by research-related activity, 18.3 % (95% CI, 14.7 to 21.9%), administrative work, 17.9% (95% CI, 12.2 to 23.7%), personal time, 9.4% (95% CI, 5.4 to 13.4%), and time in transit, 5.1% (95% CI, 2.8 to 7.4%). The DCSs delivered 19.2% (95% CI, 14.4 to 24.1%) of direct patient care by telephone. The DCSs spent a significant portion of the day alone 48.7% (95% CI, 43.3 to 54.1%), followed by time spent with patients, 37.5% (95% CI, 31.6 to 43.3%). Less than 10% (7.8%) (95% CI, 5.1 to 10.6%) of their time was spent with local study staff. Less than 4% of their time was spent with other health care providers. Our results demonstrate that the DCSs' time was primarily devoted to clinical care, a significant portion of which was delivered by telephone. They functioned independently, making efficient use of the limited amount of time that they interacted with other health care providers. This information will be helpful to those who may wish to implement this disease management strategy.

Depressive Disorder↗