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Liang MH, Lew ER, Fraser PA, Flower C, Hennis EH, Bae SC, Hennis A, Tikly M, Roberts WN. Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2024; 76:823-835. [PMID: 38229482 DOI: 10.1002/art.42797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Abstract
Systemic lupus erythematosus (SLE) is three times more common and its manifestations are more severe in African American women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care, or a combination of these factors. Health disparities in patients with SLE between African American patients and persons of other races have been reported since the 1960s and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated, but whether their mitigation improves outcomes for African American patients has not been tested except in self-efficacy. In 2002, the first true US population-based study of patients with SLE with death certificate records was conducted, which demonstrated a wide disparity between the number of African American women and White women dying from SLE. Five years ago, another study showed that SLE mortality rates in the United States had improved but that the African American patient mortality disparity persisted. Between 2014 and 2021, one study demonstrated racism's deleterious effects in patients with SLE. Racism may have been the unmeasured confounder, the proverbial "elephant in the room"-unnamed and unstudied. The etymology of "risk factor" has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the United States has a centuries-long existence and is deeply ingrained in US society, making its detection and resolution difficult. However, racism being man made means Man can choose to change the it. Health disparities in patients with SLE should be addressed by viewing health care as a basic human right. We offer a conceptual framework and goals for both individual and national actions.
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Affiliation(s)
- Matthew H Liang
- Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Cindy Flower
- University of the West Indies, Cave Hill campus, Barbados
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang Institute of Bioscience and Biotechnology, Seoul, Korea
| | - Anselm Hennis
- University of the West Indies, Cave Hill campus, Barbados
| | - Mohammed Tikly
- The Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, and Life Roseacres Hospital, Primrose, Germiston, South Africa
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White AA, Ba A, Faith TD, Ramakrishnan V, Dismuke-Greer CL, Oates JC, Williams EM. The Care-coordination Approach to Learning Lupus Self-Management: a patient navigator intervention for systemic lupus inpatients. Lupus Sci Med 2021; 8:e000482. [PMID: 33975925 PMCID: PMC8118035 DOI: 10.1136/lupus-2021-000482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The Care-coordination Approach to Learning Lupus Self-Management (CALLS) study was designed to improve SLE disease self-management. This study aims to assess the benefits of the intervention compared with existing lupus care. METHODS Participants were randomly assigned to participate in 12-weekly phone sessions with the patient navigator that included structured educational content, care coordination and patient-centred support services, or a usual care control condition. Validated measures of health literacy, self-efficacy, patient activation and disease activity were collected. We used least squares means and linear mixed-effects regression models for each outcome variable to assess the changes in outcome, from baseline to postintervention and to estimate the difference in these changes between the intervention and control group. RESULTS Thirty participants were enrolled and 14 were randomised to the treatment group. For perceived lupus self-efficacy, there was a significant increase in mean score for the intervention group, but not for the control group. With regard to disease activity, the experimental group experienced a slight decrease in mean flare score in the previous 3 months, whereas the control group experienced a slight increase, but this finding did not reach statistical significance. Trends were similar in self-reported global disease activity, but none of the findings were significant. Health literacy and patient activation measure scores remained largely unchanged throughout the study for the two groups. CONCLUSION These findings suggest that the CALLS intervention may work to improve aspects of SLE disease self-management. Future research will be needed to validate these findings long-term. TRIAL REGISTRATION NUMBER NCT04400240.
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Affiliation(s)
- Ashley A White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Aissatou Ba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Trevor Daniel Faith
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Jim C Oates
- Medicine, Medical University of South Carolina, Charleston, SC, USA
- Medical Service, Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Edith Marie Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Azizoddin DR, Jolly M, Arora S, Yelin E, Katz P. Longitudinal Study of Fatigue, Stress, and Depression: Role of Reduction in Stress Toward Improvement in Fatigue. Arthritis Care Res (Hoboken) 2020; 72:1440-1448. [PMID: 31421030 PMCID: PMC7024647 DOI: 10.1002/acr.24052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/13/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Fatigue is common among individuals with systemic lupus erythematosus (SLE), but the causes are not well understood. Our objective was to examine perceived stress and depressive symptoms as predictors of fatigue in SLE. METHODS Data from 2 years of the Lupus Outcomes Study (n = 650 patients), obtained through annual structured interviews, were used. Fatigue was measured with the Short Form 36 (SF-36) vitality scale along with a variety of self-report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of time 1 (T1) depression with time 2 (T2) fatigue; model 2 added T1 perceived stress to model 1, and final models added T1-to-T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self-report of fibromyalgia, pain, and SLE duration, activity, and damage. RESULTS Mean ± SD age was 51 ± 12 years, 92% of participants were women, and 68% were white. The mean ± SD SF-36 fatigue score was 55 ± 24. T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (β = 1.7 [95% confidence interval (95% CI) 1.1, 2.2]; P < 0.0001) significantly predicted T2 fatigue, but depression was no longer significant. The addition of T1-to-T2 decrease in stress was associated with a clinically meaningful decline in fatigue (β = -11.8 [95% CI -15.6, -8.9]; P < 0.0001). CONCLUSION While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.
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Affiliation(s)
| | | | | | - Edward Yelin
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
| | - Patricia Katz
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
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Twumasi AA, Shao A, Dunlop-Thomas C, Drenkard C, Cooper HL. Exploring the Perceived Impact of the Chronic Disease Self-Management Program on Self-Management Behaviors among African American Women with Lupus: A Qualitative Study. ACR Open Rheumatol 2020; 2:147-157. [PMID: 32037683 PMCID: PMC7077773 DOI: 10.1002/acr2.11117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/20/2019] [Indexed: 01/11/2023] Open
Abstract
Objective To qualitatively explore the processes through which the Chronic Disease Self‐Management Program (CDSMP)—a peer‐led, group‐based educational intervention for people with chronic conditions—affects self‐management behaviors among African American women with systemic lupus erythematosus (SLE). Methods Using a longitudinal pre‐ and postintervention design, we conducted two waves of one‐on‐one, semistructured interviews with 24 purposefully sampled participants. Wave 1 interviews explored self‐management behaviors at baseline; wave 2 interviews focused on changes in these behaviors postintervention. Transcripts were analyzed using thematic analysis methods. Results Study participants perceived the CDSMP to be a valuable resource that helped them improve fundamental self‐management behaviors, including exercise, relaxation, diet, and medication adherence. We found, with few exceptions, that in this sample, women's reported changes in self‐management behaviors did not vary by participant age, education, SLE disease severity, or depression status. Our analysis suggests that the CDSMP had the most widespread perceived effects on relaxation and exercise. Strategies that generated improvements in relaxation and exercise included goal setting, action planning, encouragement to pursue low‐impact physical activity, and introduction of mindfulness techniques to better manage SLE symptoms. Conclusion Our findings suggest that African American women with SLE perceived the CDSMP as an effective educational self‐management intervention. The program can potentially catalyze improvements in self‐management behaviors in this population, regardless of demographic or disease characteristics.
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Affiliation(s)
- Abena A Twumasi
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anna Shao
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | | | - Hannah L Cooper
- Emory University Rollins School of Public Health, Atlanta, Georgia
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Williams EM, Dismuke CL, Faith TD, Smalls BL, Brown E, Oates JC, Egede LE. Cost-effectiveness of a peer mentoring intervention to improve disease self-management practices and self-efficacy among African American women with systemic lupus erythematosus: analysis of the Peer Approaches to Lupus Self-management (PALS) pilot study. Lupus 2019; 28:937-944. [PMID: 31166867 PMCID: PMC6597273 DOI: 10.1177/0961203319851559] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Peer Approaches to Lupus Self-management (PALS) program was developed as a peer mentoring tool to improve health behaviors, beliefs, and outcomes in African American women with systemic lupus erythematosus (SLE). This study aims to assess the cost of the PALS intervention and determine its effectiveness when compared to existing treatments. METHODS Peer mentors and mentees were paired on shared criteria such as life stage, marital status, or whether they were mothers. This 12-week program consisted of a weekly peer mentoring session by telephone. Cost of healthcare utilization was evaluated by assessing the healthcare costs pre- and post-intervention. Validated measures of quality of life, self-management, disease activity, depression, and anxiety were collected. Total direct program costs per participant were totaled and used to determine average per unit improvement in outcome measures. The benefit-cost ratio and pre- versus post-intervention hospital charges were examined. RESULTS A total of 20 mentees and 7 mentors were enrolled in the PALS program. All PALS pairs completed 12 sessions lasting an average of 54 minutes. Mentees reported statistically significant decreases in patient-reported disease activity, depression, and anxiety, with improved trends in patient activation or patient engagement in their disease and management. The total cost per patient was $1291.50, which was $107.62 per patient per week. There was a savings of $23,417 per individual receiving the intervention with a benefit-cost ratio of 18.13 per patient. CONCLUSION These findings suggest that the PALS intervention was effective in improving patient-level factors and was cost-effective. Future research will need to validate these findings in a larger sample.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Clara L. Dismuke
- Veterans Health Administration, Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC 29401, USA
- College of Medicine, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Suite 280, Charleston, SC 29425, USA
| | - Trevor D. Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Brittany L. Smalls
- Center for Health Services Research, College of Medicine, University of Kentucky, 740 S. Limestone Street, Suite J530, Lexington, KY 40536, USA
| | - Elizabeth Brown
- Division of Healthcare Studies, Department of Health Professions, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, Charleston, SC 29425, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leonard E. Egede
- Division of General Internal Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Faith TD, Flournoy-Floyd M, Ortiz K, Egede LE, Oates JC, Williams EM. My life with lupus: contextual responses of African-American women with systemic lupus participating in a peer mentoring intervention to improve disease self-management. BMJ Open 2018; 8:e022701. [PMID: 30413505 PMCID: PMC6231552 DOI: 10.1136/bmjopen-2018-022701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The current article seeks to examine the ways in which African-American women with systemic lupus erythematosus (SLE) describe their disease experience and how they cope with their disease. This qualitative study provides deeper insight into whether experiences of African-American women with SLE differ from previous qualitative study findings. METHODS Qualitative data were gathered using interviews and a focus group, from participants in the Peer Approaches to Lupus Self-management (PALS) programme. Data were analysed for themes related to disease experience and how participants cope with their disease. Twenty-seven African-American women with SLE were recruited into the peer mentoring programme, of which 7 served as mentors and 20 served as mentees. A 12-week peer mentoring intervention delivered by phone and based on the Chronic Disease Self-Management and Arthritis Self-Management Programs. RESULTS Three categories encompassing a total of 10 subcategories emerged from analyses: (A) interpersonal, familialandromantic relationships; (B) individual experiences of living with SLE; and (C) physician-patient relationships. CONCLUSION We gained insight on several issues related to patient perspectives of African-American women with SLE, and the context surrounding their thoughts and feelings related to lupus, including their providers, families and other social support networks. Additional research efforts could explore and address the thematic domains and respective subthemes identified here. Although limited due to the preliminary nature of the study, this information can be used to create future evidence-based interventions to decrease the impact of SLE on African-American patients.
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Affiliation(s)
- Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Minnjuan Flournoy-Floyd
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland, USA
| | - Kasim Ortiz
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Leonard E Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
- Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Flournoy-Floyd M, Ortiz K, Egede L, Oates JC, Faith TD, Williams EM. "We Would Still Find Things to Talk About": Assessment of Mentor Perspectives in a Systemic Lupus Erythematosus Intervention to Improve Disease Self-Management, Empowering SLE Patients. J Natl Med Assoc 2018; 110:182-189. [PMID: 29580453 PMCID: PMC6931279 DOI: 10.1016/j.jnma.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with significant disparate impact on African American women. The current study sought to highlight how the Peer Approaches to Lupus Self-management (PALS) intervention worked bi-directionally wherein both women with SLE leading the disease self-management program (mentors), and those participants who served as mentees, were empowered toward greater disease self-efficacy. METHODS Data was captured for this study in two formats from the seven mentors participating in the pilot study: 1) mentor logs and 2) mentor interviews with the principle investigator. This information was then analyzed for themes relating to their experience within the study. RESULTS We found that empowerment was facilitated by mentors taking their mentorship responsibilities seriously and seeking several avenues for collaboratively developing success with their mentees. Mentors reported that although challenges arose, their desire for success resulted in multiple approaches to be flexible and responsive to the needs of their mentees. Additionally, reciprocity was found to be a vital element of the program. CONCLUSIONS Key thematic areas supported our ability to demonstrate the usefulness of a peer mentoring program for SLE disease self-management on evoking empowerment through reciprocal relationships among mentors and mentees within our study population. Furthermore the feedback from PALS participants yielded very rich and contextual information that can be used as a thematic guide for developing and refining evidence-based interventions that seek to incorporate empowerment into disease self-management efforts for women suffering from SLE.
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Affiliation(s)
- Minnjuan Flournoy-Floyd
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Kasim Ortiz
- University of New Mexico, Department of Sociology, MSC05 3080 1915 Roma NE Ste. 1103, Albuquerque NM 87131-0001, USA
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Clinical Cancer Center Building, 5th Floor, Suite C5400, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA; Rheumatology Section, Ralph H. Johnson VA Medical Center 109 Bee Street, Charleston, SC 29401, USA
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
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Faith TD, Egede L, Williams EM. Research Ethics in Behavioral Interventions Among Special Populations: Lessons From the Peer Approaches to Lupus Self-Management Study. Am J Med Sci 2018; 355:104-112. [PMID: 29406037 PMCID: PMC5896319 DOI: 10.1016/j.amjms.2017.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Research involving a homogenous cohort of participants belonging to a special population must make considerations to recruit and protect the subjects. This study analyses the ethical considerations made in the peer approaches to lupus self-management project which pilot tested a peer mentoring intervention for African American women with systemic lupus erythematosus. METHODS Considerations made at the outset of the project are described and their justifications and reasoning are given. Through analysis of feedback from a postintervention focus group and mentors' logs, implications on program outcomes and participant satisfaction are discussed. RESULTS Feedback indicated the importance of recruiting and training capable mentors, consistent contact from study staff to avert adverse events and avert fear or mistrust and careful consideration that must go into the pairing of mentors and mentees. Participant feedback also indicated that sensitive topics must be addressed carefully to prevent distress and dissatisfaction. CONCLUSIONS Applying the lessons learned from this work as well as the considerations that proved successful may improve the contextualization and ethical conduct of behavioral interventions in special populations resulting in improved tailoring and acceptability toward historically underserved individuals.
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Affiliation(s)
- Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Williams EM, Hyer JM, Viswanathan R, Faith TD, Egede L, Oates JC, Marshall GD. Cytokine balance and behavioral intervention; findings from the Peer Approaches to Lupus Self-Management (PALS) project. Hum Immunol 2017; 78:574-581. [PMID: 28716698 PMCID: PMC6013837 DOI: 10.1016/j.humimm.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022]
Abstract
The Peer Approaches to Lupus Self-Management program sought to address the disparate impact of systemic lupus erythematosus (SLE) on African American women through a peer mentoring intervention with aims of reducing stress, anxiety, and depression. Given the association between psychological health and immune function this study examines the relationship between patient reported outcomes (PROs) in these domains and immunologic indicators of disease activity. Twenty-three African American women with SLE served as mentees in the intervention from whom PRO measures were collected at the outset, midpoint, and end of the 12week pilot study. Blood samples were collected pre- and post-intervention. Plasma was collected from the samples and cryopreserved for subsequent analyses. The strongest correlations were between the Generalized Anxiety Disorder measure and Th1/Th2 cytokine balance. Weaker correlations existed between depression and the Th1/Th2 cytokine balance. Assessment of fresh versus cryopreserved samples revealed that changes in Th1/Th2 cytokine balance within the intervention were generally equivalent, regardless of sample type. The PALS intervention resulted in significant improvements to anxiety and depression levels which were significantly associated with positive changes in Th1/Th2 cytokine balance indicating a possible underlying mechanism of action. The nature of this relationship warrants further study.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - J Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Ramakrishnan Viswanathan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Clinical Cancer Center Building, 5th Floor, Suite C5400, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 8, Charleston, SC 29425, USA; Rheumatology Section, Medial Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
| | - Gailen D Marshall
- Division of Clinical Immunology and Allergy, University of Mississippi Medical Center, 2500 North State Street, N416, Jackson, MS 39216, USA.
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Williams EM, Egede L, Faith T, Oates J. Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring. Am J Med Sci 2017; 353:580-592. [PMID: 28641721 PMCID: PMC6249683 DOI: 10.1016/j.amjms.2017.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/28/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Trevor Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - James Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Aqel SI, Hampton JM, Bruss M, Jones KT, Valiente GR, Wu LC, Young MC, Willis WL, Ardoin S, Agarwal S, Bolon B, Powell N, Sheridan J, Schlesinger N, Jarjour WN, Young NA. Daily Moderate Exercise Is Beneficial and Social Stress Is Detrimental to Disease Pathology in Murine Lupus Nephritis. Front Physiol 2017; 8:236. [PMID: 28491039 PMCID: PMC5405126 DOI: 10.3389/fphys.2017.00236] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/04/2017] [Indexed: 12/21/2022] Open
Abstract
Daily moderate exercise (DME) and stress management are underemphasized in the care of patients with lupus nephritis (LN) due to a poor comprehensive understanding of their potential roles in controlling the inflammatory response. To investigate these effects on murine LN, disease progression was monitored with either DME or social disruption stress (SDR) induction in NZM2410/J mice, which spontaneously develop severe, early-onset LN. SDR of previously established social hierarchies was performed daily for 6 days and DME consisted of treadmill walking (8.5 m/min for 45 min/day). SDR significantly enhanced kidney disease when compared to age-matched, randomly selected control counterparts, as measured by histopathological analysis of H&E staining and immunohistochemistry for complement component 3 (C3) and IgG complex deposition. Conversely, while 88% of non-exercised mice displayed significant renal damage by 43 weeks of age, this was reduced to 45% with exercise. DME also reduced histopathology in kidney tissue and significantly decreased deposits of C3 and IgG complexes. Further examination of renal infiltrates revealed a macrophage-mediated inflammatory response that was significantly induced with SDR and suppressed with DME, which also correlated with expression of inflammatory mediators. Specifically, SDR induced IL-6, TNF-α, IL-1β, and MCP-1, while DME suppressed IL-6, TNF-α, IL-10, CXCL1, and anti-dsDNA autoantibodies. These data demonstrate that psychological stressors and DME have significant, but opposing effects on the chronic inflammation associated with LN; thus identifying and characterizing stress reduction and a daily regimen of physical activity as potential adjunct therapies to complement pharmacological intervention in the management of autoimmune disorders, including LN.
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Affiliation(s)
- Saba I Aqel
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Jeffrey M Hampton
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Michael Bruss
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Kendra T Jones
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Giancarlo R Valiente
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Lai-Chu Wu
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | | | - William L Willis
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Stacy Ardoin
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Sudha Agarwal
- Ohio State University Wexner Medical CenterColumbus, OH, USA.,The Biomechanics and Tissue Engineering Laboratory, College of Dentistry, Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Brad Bolon
- Ohio State University Wexner Medical CenterColumbus, OH, USA.,Department of Veterinary Biosciences and the Comparative Pathology and Mouse Phenotyping Shared ResourceColumbus, OH, USA
| | - Nicole Powell
- Ohio State University Wexner Medical CenterColumbus, OH, USA.,Institute for Behavioral Medicine Research, Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - John Sheridan
- Ohio State University Wexner Medical CenterColumbus, OH, USA.,Institute for Behavioral Medicine Research, Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Naomi Schlesinger
- Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical SchoolNew Brunswick, NJ, USA
| | - Wael N Jarjour
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
| | - Nicholas A Young
- Department of Internal Medicine Division of Rheumatology and Immunology, Ohio State University Wexner Medical CenterColumbus, OH, USA.,Ohio State University Wexner Medical CenterColumbus, OH, USA
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Williams EM, Bruner L, Adkins A, Vrana C, Logan A, Kamen D, Oates JC. I too, am America: a review of research on systemic lupus erythematosus in African-Americans. Lupus Sci Med 2016; 3:e000144. [PMID: 27651918 PMCID: PMC5013381 DOI: 10.1136/lupus-2015-000144] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that can cause significant morbidity and mortality. A large body of evidence has shown that African-Americans experience the disease more severely than other racial-ethnic groups. Relevant literature for the years 2000 to August 2015 were obtained from systematic searches of PubMed, Scopus, and the EBSCOHost platform that includes MEDLINE, CINAHL, etc. to evaluate research focused on SLE in African-Americans. Thirty-six of the 1502 articles were classified according to their level of evidence. The systematic review of the literature reported a wide range of adverse outcomes in African-American SLE patients and risk factors observed in other mono and multi-ethnic investigations. Studies limited to African-Americans with SLE identified novel methods for more precise ascertainment of risk and observed novel findings that hadn't been previously reported in African-Americans with SLE. Both environmental and genetic studies included in this review have highlighted unique African-American populations in an attempt to isolate risk attributable to African ancestry and observed increased genetic influence on overall disease in this cohort. The review also revealed emerging research in areas of quality of life, race-tailored interventions, and self-management. This review reemphasizes the importance of additional studies to better elucidate the natural history of SLE in African-Americans and optimize therapeutic strategies for those who are identified as being at high risk.
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Affiliation(s)
- Edith M Williams
- Division of Rheumatology, Department of Public Health Sciences, Medicine,MUSC Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Larisa Bruner
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Alyssa Adkins
- University of South Carolina, Columbia, South Carolina, USA
| | - Caroline Vrana
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ayaba Logan
- The Department of Public Health and Programs in Nurse Anesthesia, Liaison for College of Nursing, Medical University of South Carolina Library, Charleston, South Carolina, USA
| | - Diane Kamen
- Department of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James C Oates
- Department of Medicine, Division of Rheumatology,Medical University of South Carolina, Charleston, South Carolina, USA
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13
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Williams EM, Ortiz K, Flournoy-Floyd M, Bruner L, Kamen D. Systemic lupus erythematosus observations of travel burden: A qualitative inquiry. Int J Rheum Dis 2015; 18:751-60. [PMID: 26176174 DOI: 10.1111/1756-185x.12614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Explorations of travel impediments among patients suffering from rheumatic diseases have been very limited. Research has consistently indicated a shortage of rheumatologists, resulting in patients potentially having to travel long distances for care. The purpose of our study was to explore how systemic lupus erythematosus (SLE) patients experience travel issues differentially by race and socio-economic status. METHODS We conducted semi-structured interviews and a brief demographic survey with 10 patients diagnosed with SLE. Interview transcripts were coded and analyzed using NVivo Analysis Software to facilitate the reporting of recurrent themes and supporting quotations, and an initial codebook was independently developed by two researchers on the study team and then verified together. RESULTS Patients described three major areas of concern with respect to travel burden in accessing their rheumatologists: reliance on caregivers; meeting financial priorities; and pain and physical limitations. CONCLUSIONS Our data suggest general traveling challenges interfering with medical appointment compliance for several participants and the importance of socio-economic issues when considering travel issues. This study highlights an important area with implications for adherence to medical appointments and participation in research among patients with SLE.
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Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kasim Ortiz
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Minnjuan Flournoy-Floyd
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Larisa Bruner
- Office of Public Health Practice, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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14
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Beckerman NL, Auerbach C, Kim SJ, Salmon J, Horton R. Lupus (SLE): Existence and Impact of Depressive Symptomatology. SOCIAL WORK IN HEALTH CARE 2015; 54:499-517. [PMID: 26186422 DOI: 10.1080/00981389.2015.1045575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this cross-sectional study (N = 84) is to: (1) further identify the unique psychosocial challenges facing those living with Systemic Lupus Erythematosus (SLE) and (2) discern the validity of the depression dimension of the System Lupus Erythematosus Needs Questionnaire (SLENQ) (by including the Beck Depression Inventory [BDI-II]). Utilizing the BDI-II, this study replicates and confirms the validity of studies that employed the SLENQ, establishing that those who have manifested signs of depression in the SLENQ, are equally likely to show signs of depression in the BDI-II. Authors identify and confirm that patients who experience SLE-related depression are significantly more likely to forget taking or stop taking their SLE medications. The authors review relevant research, discuss findings, and provide evidence-based recommendations for social workers providing mental health care to patients living with Lupus.
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Williams EM, Bruner L, Penfield M, Kamen D, Oates JC. Stress and Depression in Relation to Functional Health Behaviors in African American Patients with Systemic Lupus Erythematosus. RHEUMATOLOGY (SUNNYVALE, CALIF.) 2014; 2014:005. [PMID: 26618072 PMCID: PMC4662575 DOI: 10.4172/2161-1149.s4-005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE While increased psychological distress in SLE has been clinically and empirically reported, the relationship between emotional distress, treatment adherence, and disease activity are complex and even more unclear in African American lupus patients. In an effort to elucidate this phenomenon in these patients, this exploratory study aimed to investigate relationships between stress, depression, and various health behaviors in this group. METHODS Thirty patients invited to participate in this study were African American systemic lupus erythematosus (SLE) patients attending rheumatology clinics at the Medical University of South Carolina (MUSC). This study was part of a larger interventional pilot study, the Balancing Lupus Experiences with Stress Strategies (BLESS) study, that included a comprehensive battery of psychosocial, quality of life, and behavior change measures. RESULTS When looking at the association between anxiety/stress and functionality, levels of reported stress had strong effects upon functionality, especially between health distress and functionality. When looking at the association between depressive symptoms and functionality, depressive symptoms had moderate effects upon social/role limitations and nights spent in the hospital. CONCLUSION Not only did the larger pilot project demonstrate significant reductions in stress and depression as a result of workshop participation; this nested study also showed that those improvements were positively associated with improved health behaviors. These results could have implications for developing interventions to improve disease experience and quality of life in SLE patients with stress and depression.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina; Columbia, SC, USA
| | - Larisa Bruner
- Office of Public Health Practice, University of South Carolina; Columbia, SC, USA
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina; Columbia, SC, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
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