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Ellis C.,Medical University of South Carolina | Ellis C.,Center for Disease Prevention and Health Interventions for Diverse Populations
Disability and Health Journal

Background: Stroke among young adults is generally considered a rare event, although few studies have considered national data. Objective: The objective of this paper was to profile stroke in young adults in the United States using a national dataset. Methods: Data from the 2007 Nationwide Inpatient Sample were examined to estimate the number of patients, mean length of stay, mean costs, and discharge disposition of young adults (aged 18-44 y) with a diagnosis of stroke. Results: Estimates indicate that 41,587 (or 4.9%) of individuals experiencing a stroke in 2007 were young adults: 32,438 had an ischemic stroke, 4662 had a subarachnoid hemorrhage, and 4487 had an intracerebral hemorrhage. The average length of stay was 4.7 days for ischemic stroke, 11.6 days for subarachnoid hemorrhage, and 11.2 days for intracerebral hemorrhage. Approximately 5% (2013) of young adults died of stroke. Most young adults were discharged routinely to home at an average cost associated with their hospital stay of $34,886 for ischemic stroke, $146,307 for subarachnoid hemorrhage, and $94,482 for intracerebral hemorrhage. Conclusions: A substantial number of young adults experience stroke in the United States at costs that are higher than those for stroke patients overall. © 2010 Elsevier Inc. All rights reserved. Source

Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations | Osborn C.Y.,Vanderbilt University
Diabetes Educator

Purpose The mechanism by which depression influences health outcomes in persons with diabetes is uncertain. The purpose of this study was to test whether depression is related to self-care behavior via social motivation and indirectly related to glycemic control via self-care behavior. Methods Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, depression, and diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the predicted pathways. Results Higher levels of depressive symptoms were significantly related to having less social support and decreased performance of diabetes self-care behavior. In addition, when depressive symptoms were included in the model, fatalistic attitudes were no longer associated with behavioral performance. Conclusions Among adults with diabetes, depression impedes the adoption of effective self-management behaviors (including physical activity, appropriate dietary behavior, foot care, and appropriate self-monitoring of blood glucose behavior) through a decrease in social motivation. © 2010 The Author(s). Source

Ellis C.,Center for Disease Prevention and Health Interventions for Diverse Populations | Ellis C.,Medical University of South Carolina | Simpson A.N.,Medical University of South Carolina | Bonilha H.,Medical University of South Carolina | And 2 more authors.

Background and Purpose-Little is known about the contribution of aphasia to the cost of care for patients who experience stroke. Methods-We retrospectively examined a cohort of South Carolina Medicare beneficiaries who experienced ischemic stroke in 2004 to determine the attributable cost of aphasia. Univariate analyses were used to compare demographic, comorbidity, and severity differences between individuals with poststroke aphasia and those without aphasia. Differences in payments by Medicare because of stroke were examined using a gamma-distributed generalized linear multivariate model. Results-Three thousand, two hundred Medicare beneficiaries experienced ischemic stroke in South Carolina in 2004, and 398 beneficiaries had poststroke aphasia. Patients with aphasia experienced longer length of stays, greater morbidity, and greater mortality than did those without aphasia. In adjusted models that controlled for relevant covariates, the attributable 1-year cost of aphasia was estimated at $1703. Conclusions-Aphasia adds to the cost of stroke-related care, above the cost of stroke alone. © 2012 American Heart Association, Inc. Source

Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations | Hernandez-Tejada M.A.,Medical University of South Carolina
Expert Review of Pharmacoeconomics and Outcomes Research

This review outlines the effect of depression on quality of life (QoL) in patients with Type 2 diabetes mellitus (T2DM). The prevalence and medical, psychological and financial burden of T2DM in the USA are briefly discussed, similar to the findings related to patients living with T2DM and depression in terms of health-related QoL. Recommendations for future research include studying mechanisms by which depression affects the QoL of T2DM patients, outlining effects of positive emotions on managing consequences of distress and depression in these patients, and developing interventions to address both depression and diabetes that minimize the treatment burden and costs for patients. © 2013 Expert Reviews Ltd. Source

Strom J.L.,Medical University of South Carolina | Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations
Current Diabetes Reports

Diabetes is one of the fastest growing chronic diseases globally and in the United States. Although preventable, type 2 diabetes accounts for 90 % of all cases of diabetes worldwide and continues to be a source of increased disability, lost productivity, mortality, and amplified health-care costs. Proper disease management is crucial for achieving better diabetes-related outcomes. Evidence suggests that higher levels of social support are associated with improved clinical outcomes, reduced psychosocial symptomatology, and the adaptation of beneficial lifestyle activities; however, the role of social support in diabetes management is not well understood. The purpose of this systematic review is to examine the impact of social support on outcomes in adults with type 2 diabetes. © Springer Science+Business Media, LLC 2012. Source

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