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Bazargan M, Comini J, Kibe LW, Assari S, Cobb S. Association between Migraine and Quality of Life, Mental Health, Sleeping Disorders, and Health Care Utilization Among Older African American Adults. J Racial Ethn Health Disparities 2024; 11:1530-1540. [PMID: 37227684 PMCID: PMC11101580 DOI: 10.1007/s40615-023-01629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE This study examines the associations between migraine headaches, well-being, and health care use among a sample of underserved older African American adults. Controlling for relevant variables, the association between migraine headaches and (1) health care utilization, (2) health-related quality of life (HRQoL), and (3) physical and mental health outcomes was examined. METHODS Our sample included 760 older African American adults from South Los Angeles recruited through convenience and snowball sampling. In addition to demographic variables, our survey included validated instruments, such as the SF-12 QoL, Short-Form McGill Pain Questionnaire, and the Geriatric Depression Scale. Data analysis included 12 independent multivariate models using multiple linear regression, log transferred linear regression, binary and multinomial logistic regression, and generalized linear regression with Poisson distribution. RESULTS Having migraine was associated with three categories of outcomes: (1) higher level of health care utilization measured by (i) emergency department admissions and (ii) number of medication use; (2) lower level of HRQoL and health status measured by (i) lower self-rated health (ii) physical QoL, and (iii) mental QoL; and (3) worse physical and mental health outcomes measured by (i) higher number of depressive symptoms, (ii) higher level of pain, (iii) sleep disorder, and (iv) being disabled. CONCLUSIONS Migraine headache significantly was associated with quality of life, health care utilization, and many health outcomes of underserved African American middle-aged and older adults. Diagnoses and treatments of migraine among underserved older African American adults require multi-faceted and culturally sensitive interventional studies.
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Affiliation(s)
- M Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA.
- Department of Family Medicine, David Geffen School of Medicine UCLA, Los Angeles, CA, USA.
- Department of Urban Public Health, CDU, Los Angeles, CA, USA.
- Physician Assistant Program, CDU, Los Angeles, CA, USA.
| | - J Comini
- Physician Assistant Program, CDU, Los Angeles, CA, USA
| | - L W Kibe
- Physician Assistant Program, CDU, Los Angeles, CA, USA
| | - S Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine UCLA, Los Angeles, CA, USA
| | - S Cobb
- Mervyn M. Dymally College of Nursing, CDU, Los Angeles, CA, USA
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Fan L, Xue H, Wang Q, Yan Y, Du W. Development and Validation of a Nomogram for Predicting Risk of Emergency Department Revisits in Chinese Older Patients. Healthc Policy 2022; 15:2283-2295. [PMID: 36510569 PMCID: PMC9738955 DOI: 10.2147/rmhp.s391731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Objective The identification of older patients at risk of repeated emergency department (ED) visits is crucial for managing preventable adverse outcomes. This study aims to identify risk factors associated with ED revisits and to develop and validate a nomogram for predicting risk of geriatric ED revisits. Methods This was a cohort study comprising 553 older patients, who attended the two tertiary hospitals EDs in China from August 2018 to February 2019 and were prospectively followed for any unplanned revisit within 1 year after discharge. Patients were randomly assigned to a training or validation set at a ratio of 2:1. Stepwise selection procedure was applied to select factors associated with ED revisits for inclusion in a multivariable logistic model from which a nomogram was elaborated. Discrimination, calibration and clinical utility of the nomogram were assessed using C-statistic, calibration plot, Hosmer-Lemeshow test, and decision curve analysis (DCA). Results The final nomogram included four predictors for ED revisits: age, BMI, frailty and polypharmacy. Older patients having revisits were more likely to be frail (OR = 1.17, p = 0.031), have polypharmacy (OR = 1.69, p = 0.049) or BMI <18.5 kg/m2 (OR = 2.45, p = 0.025), and were less likely to be older than 90 years (OR = 0.21, p = 0.002). The nomogram demonstrated acceptable discrimination ability in the training (C-index = 0.661) and validation sets (C-index = 0.651), satisfactory calibration (p > 0.05), and good clinical applicability. Conclusion A nomogram incorporating four obtainable variables was constructed to individualize ED readmission risk in older patients. These patients may benefit from early triage and better-targeted care if considering the nomogram as a clinical decision aid.
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Affiliation(s)
- Lijun Fan
- School of Public Health, Southeast University, Nanjing, People’s Republic of China,School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Hui Xue
- School of Public Health, Southeast University, Nanjing, People’s Republic of China
| | - Qian Wang
- Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Yuhan Yan
- General Hospital of Eastern Theater Command, Nanjing, People’s Republic of China,Yuhan Yan, General Hospital of Eastern Theater Command, Nanjing, 210009, People’s Republic of China, Email
| | - Wei Du
- School of Public Health, Southeast University, Nanjing, People’s Republic of China,Correspondence: Wei Du, School of Public Health, Southeast University, Nanjing, 210009, People’s Republic of China, Email
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Morris MC, Bruehl S, Stone AL, Garber J, Smith C, Palermo TM, Walker LS. Place and Pain: Association Between Neighborhood SES and Quantitative Sensory Testing Responses in Youth With Functional Abdominal Pain. J Pediatr Psychol 2021; 47:446-455. [PMID: 34757421 DOI: 10.1093/jpepsy/jsab113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Neighborhood socioeconomic status (SES) is linked to self-reported pain severity and disability but its association with evoked pain responsiveness in individuals with chronic pain remains unclear. The present study examined relations between neighborhood SES, assessed through the area deprivation index (ADI), and static and dynamic pain response indices. It was hypothesized that youth with functional abdominal pain (FAP) living in lower SES neighborhoods would exhibit lower pain threshold, lower pain tolerance, and reduced conditioned pain modulation (CPM) compared to youth living in higher SES neighborhoods. METHODS Participants were 183 youth with FAP and their parents. Youth completed a quantitative sensory testing protocol. Family addresses were used to compute ADI scores. Thermal stimuli for pain threshold and tolerance were delivered to participants' forearms using thermodes. CPM, an index of descending pain inhibition, was determined using a thermode as test stimulus and a hot water bath as conditioning stimulus. RESULTS As hypothesized, youth with FAP living in lower SES neighborhoods exhibited weaker CPM. Contrary to hypotheses, lower neighborhood SES was associated with neither pain thresholds nor with pain tolerance. CONCLUSIONS These findings demonstrated the independent contribution of place of residence-an often neglected component of the biopsychosocial model-to efficiency of descending pain inhibition. Understanding the mechanisms that account for such associations between place and pain could guide the development of public health and policy initiatives designed to mitigate chronic pain risk in underserved and economically marginalized communities.
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Affiliation(s)
- Matthew C Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Craig Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
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Sheikh S, Fishe J, Norse A, Henson M, James D, Sher W, Lott M, Kalynych C, Hendry P. Comparing Pain Intensity Using the Numeric Rating Scale and Defense and Veterans Pain Rating Scale in Patients Revisiting the Emergency Department. Cureus 2021; 13:e17501. [PMID: 34603880 PMCID: PMC8476185 DOI: 10.7759/cureus.17501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the relationship between Numeric Rating Scale (NRS) and Defense and Veterans Pain Rating Scale (DVPRS) as pain intensity measures, we compared pain scores to sociodemographic and treatment data in patients revisiting the emergency department (ED). Methods After Institutional Review Board approval, 389 adults presenting within 30 days of an index visit were enrolled. Pain scores were classified as follows: 0-3 (mild), 4-7 (moderate), and 8-10 (high). Data were analyzed using descriptive analysis. Wilcoxon rank-sum test measured the association of pain score with gender. Pain scales were correlated using Spearman correlation coefficient. Pain scale association with opioid treatment was tested via ordinal logistic regression controlling for gender, home opioid use, and if ED revisit was for pain. Results Average patient age was 49. Most patients were African American (68.4%), male (51.2%), and returned for pain (67.0%). As continuous measures, both scales were positively correlated with each other (p<0.0001). Pain score severity categories were distributed differently between the two scales (p=0.0085), decreasing by 8% in patients reporting high pain severity when using DVPRS. For both scales, the proportion of patients (1) administered opioids (p=0.0009 and p≤0.0001, respectively) and (2) discharged with opioids (p=0.0103 and p=0.0417, respectively) increased with pain severity. Discharge NRS (p=0.0001) (OR=3.2, 1.780-5.988) and DVPRS pain score categories (p<0.0001) (OR=2.7, 95% CI=1.63-4.473) were associated with revisits for pain. Conclusions Our findings demonstrate a link between NRS and administration of opioid medications and suggest that DVPRS may better differentiate between moderate and high levels of pain in the ED setting.
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Affiliation(s)
- Sophia Sheikh
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jennifer Fishe
- Pediatric Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Ashley Norse
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Morgan Henson
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Divya James
- Emergency Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Warren Sher
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Michelle Lott
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Colleen Kalynych
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Phyllis Hendry
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Sheikh S, Booth-Norse A, Holden D, Henson M, Dodd C, Edgerton E, James D, Kalynych C, Smotherman C, Hendry P. Opioid Overdose Risk in Patients Returning to the Emergency Department for Pain. PAIN MEDICINE 2021; 22:2100-2105. [PMID: 33560418 DOI: 10.1093/pm/pnab047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Using the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) in patients returning to the emergency department (ED) for pain and discharged with an opioid prescription, we assessed overall opioid overdose risk and compared risk in opioid naive patients to those who are non-opioid naive. DESIGN This was a secondary analysis from a prospective observational study of patients ≥ 18 years old returning to the ED within 30 days. Data were collected from patient interviews and chart reviews. Patients were categorized as Group 1 (not using prescription opioids) or Group 2 (consuming prescription opioids). Statistical analyses were performed using Fisher's exact and Wilcoxon's rank sum tests. Risk class and probability of overdose was determined using Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD). RESULTS Of the 389 enrollees who returned to the ED due to pain within 30 days of an initial visit, 67 (17%) were prescribed opioids. The majority of these patients were in Group 1 (60%). Both Group 1 (n = 40) and Group 2 (n = 27) held an average CIP-RIOSORD risk class of 3. Race significantly differed between groups; the majority of Group 1 self-identified as African American (80%) (P = .0267). There were no differences in age, gender, or CIP-RIOSORD risk class between groups. However, Group 2 had nearly double the number of predictive factors (median = 1.93) as Group 1 (median = 1.18) (P = .0267). CONCLUSIONS A substantial proportion of patients (25%) were high risk for opioid overdose. CIP-RIOSORD may prove beneficial in risk stratification of patients discharged with prescription opioids from the ED.
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Affiliation(s)
- Sophia Sheikh
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Ashley Booth-Norse
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - David Holden
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Morgan Henson
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Caroline Dodd
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Eric Edgerton
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Divya James
- University of Florida College of Medicine, Gainesville, Florida
| | - Colleen Kalynych
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine-Jacksonville, Florida, USA
| | - Phyllis Hendry
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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