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Indianapolis, IN, United States

Ringer J.M.,Roudebush Veterans Administration Medical Center | Lysaker P.H.,Indiana University
Journal of Nervous and Mental Disease | Year: 2014

Heightened levels of anger and dysregulated expression of anger have been associated with poorer outcomes and treatment response for persons with schizophrenia spectrum disorders. Less is known, however, about the psychological processes that determine the extent to which anger is expressed in a more versus less adaptive manner. To explore this issue, this study gathered reports of anger expression style in 88 persons with schizophrenia or schizoaffective disorder using the State-Trait Anger Expression Inventory, Second Edition. The authors additionally assessed anxiety, suspiciousness, emotion recognition, self-esteem, and cumulative trauma history. Correlations and multiple regression analyses showed that outward anger control, that is, the suppression of anger, was predicted by lower levels of suspiciousness, poorer emotion recognition, and reduced anxiety. Participants who endorsed greater anxiety and had experiencedmore traumatic events reported a heightened tendency to express anger both inwardly and outwardly. © 2014 by Lippincott Williams & Wilkins.

Liangpunsakul S.,Indiana University | Liangpunsakul S.,Roudebush Veterans Administration Medical Center | Haber P.,University of Sydney | McCaughan G.W.,University of Sydney
Gastroenterology | Year: 2016

Alcoholic liver diseases comprise a spectrum of clinical disorders and changes in liver tissue that can be detected by pathology analysis. These range from steatosis to more severe signs and symptoms of liver disease associated with inflammation, such as those observed in patients with alcoholic hepatitis or cirrhosis. Although the relationship between alcohol consumption and liver disease is well established, severe alcohol-related morbidities develop in only a minority of people who consume alcohol in excess. Inter-individual differences in susceptibility to the toxic effects of alcohol have been studied extensively - they include pattern of alcohol consumption, sex, environmental factors (such as diet), and genetic factors, which vary widely among different parts of the world. Alcoholic liver disease is becoming more common in many parts of Asia, but is decreasing in Western Europe. Treatment approaches, including availability of medications, models of care, and approach to transplantation, differ among regions. © 2016 AGA Institute.

Supakul R.,Indiana University | Liangpunsakul S.,Roudebush Veterans Administration Medical Center
Translational Research | Year: 2011

The mechanisms underlying alcohol-induced hepatic steatosis are complex, involving the disturbance of several signaling pathways. We have gained a better understanding of the role of the innate immune system in the liver and its effects on lipid metabolism and uncovered a number of circulating factors that can influence the response of the liver to ethanol. In this report, we will focus on the potential role of ceramide on AMP-activated protein kinase, as a mediator of alcohol-induced hepatic steatosis. © 2011 Mosby, Inc. All rights reserved.

Jinjuvadia R.,Ford Motor Company | Liangpunsakul S.,Indiana University | Liangpunsakul S.,Roudebush Veterans Administration Medical Center
Journal of Clinical Gastroenterology | Year: 2015

Background: Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease which accounts for significant morbidity, mortality, and financial burden. Aim of this study is to evaluate temporal trend of hospitalizations from AH and evaluate its financial impact. Methods: The National Inpatient Sample databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals aged 21 years and older were included. The hospitalizations with primary diagnosis of AH were captured by ICD-9 codes. The national estimates of hospitalization were derived using sample weights provided by National Inpatient Sample. Simple linear regression method was used to assess trends in mortality and length of stay over time. Results: We observed the increased in total cases of AH-related hospitalization from 249,884 (0.66% of total admission in 2002) to 326,403 (0.83% of total admission in 2010). The significant increase in the total admission rate was attributable mainly to the rise in inpatient hospitalization for secondary diagnosis of AH (0.48% in 2002 to 0.67% in 2010). Most of the AH-related hospitalization were males. Hepatic encephalopathy was found to be the most common admitting diagnosis for individuals hospitalized with secondary diagnosis of AH (8.9% in 2002 and 8.6% in 2010). There was a significant decrease in inpatient mortality for primary diagnosis of AH from 10.07% (in 2002) to 5.76% (in 2010) (absolute risk reduction: 4.3%). Average cost of hospitalization related to primary diagnosis of AH was $27,124 and $46,264 in 2002 and 2010, respectively. After adjusting for inflation, the additional cost of each hospitalization seemed to increase by 40.7% in 2010 compared with 2002 (additional cost per hospitalization $11,044 in 2010 compared with 2002). Federal (Medicare) or state (Medicaid) supported health insurance program are the main primary expected payers for these AH hospitalizations (∼25% to 29%). Despite increase in cost per hospitalization, length of stay for hospitalization due to primary diagnosis of AH was not observed to decrease substantially over time (6.7 d in 2002 to 6.1 d in 2010). Conclusions: AH-related hospitalization continued to increase during the study period, despite the decrease in the in-hospital mortality rate. Substantial increases in health care cost and utilization among hospitalized AH patients were observed. © 2014 Wolters Kluwer Health, Inc.

Debella Y.T.,University of Indianapolis | Giduma H.D.,University of Indianapolis | Light R.P.,University of Indianapolis | Agarwal R.,University of Indianapolis | Agarwal R.,Roudebush Veterans Administration Medical Center
Clinical Journal of the American Society of Nephrology | Year: 2011

Summary Background and objectives Whether chronic kidney disease (CKD) should also be considered a coronary disease equivalent like diabetes is not clear. Design, setting, participants, & methods Veterans with and without diabetes and with and without CKD were prospectively recruited. A competing Cox regression model was used to describe the risk of myocardial infarction (MI) in the two groups (CKD and diabetes) over a decade of follow-up. Results The incidence rate of MI in those without CKD was 0.047/yr and in those with CKD was 0.206/yr. Multivariate adjustment revealed the incident rate ratio for MI in CKD as 3.5 and for diabetes mellitus as 2.5. The cumulative incidence for MI was influenced by CKD and diabetes. CKD was associated with a subhazard ratio for MI of 3.74; in contrast, diabetes was associated with a subhazard ratio for MI of 2.6. For the outcome of all-cause mortality, after multivariate adjustment, CKD was associated with a hazard ratio (HR) of 1.86, which was similar to the HR of 2.27 for prevalent coronary artery disease. The HR for diabetes was NS at 1.35. Conclusions CKD is associated with a risk of death similar to that of established coronary artery disease and higher than that of diabetes mellitus. CKD is associated with a risk of MI that is at least as much as that from diabetes mellitus. Among veterans, CKD appears to be a coronary disease equivalent. ©2011 by the American Society of Nephrology.

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