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Gordon KS, Buta E, Pratt-Chapman ML, Brandt CA, Gueorguieva R, Warren AR, Workman TE, Zeng-Treitler Q, Goulet JL. Relationship Between Pain and LGBT Status Among Veterans in Care in a Retrospective Cross-Sectional Cohort. J Pain Res 2023; 16:4037-4047. [PMID: 38054108 PMCID: PMC10695019 DOI: 10.2147/jpr.s432967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
Background Pain assessment is performed in many healthcare systems, such as the Veterans Health Administration, but prior studies have not assessed whether pain screening varies in sexual and gender minority populations that include individuals who identify as lesbian, gay, bisexual, and/or transgender (LGBT). Objective The purpose of this study was to evaluate pain screening and reported pain of LGBT Veterans compared to non-LGBT Veterans. Methods Using a retrospective cross-sectional cohort, data from the Corporate Data Warehouse, a national repository with clinical/administrative data, were analyzed. Veterans were classified as LGBT using natural language processing. We used a robust Poisson model to examine the association between LGBT status and binary outcomes of pain screening, any pain, and persistent pain within one year of entry in the cohort. All models were adjusted for demographics, mental health, substance use, musculoskeletal disorder(s), and number of clinic visits. Results There were 1,149,486 Veterans (218,154 (19%) classified as LGBT) in our study. Among LGBT Veterans, 94% were screened for pain compared to 89% among those not classified as LGBT (non-LGBT) Veterans. In adjusted models, LGBT Veterans' probability of being screened for pain compared to non-LGBT Veterans was 2.5% higher (95% CI 2.3%, 2.6%); risk of any pain was 2.1% lower (95% CI 1.6%, 2.6%); and there was no significant difference between LGBT and non-LGBT Veterans in persistent pain (RR = 1.00, 95% CI (0.99, 1.01), p = 0.88). Conclusions In a nationwide sample, LGBT Veterans were more likely to be screened for pain but had lower self-reported pain scores, though adjusted differences were small. It was notable that transgender and Black Veterans reported the greatest pain. Reasons for these findings require further investigation.
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Affiliation(s)
- Kirsha S Gordon
- Research, VA Connecticut Healthcare System, West Haven, CT, USA
- General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eugenia Buta
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Mandi L Pratt-Chapman
- Department of Medicine and The George Washington Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Cynthia A Brandt
- Research, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Allison R Warren
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - T Elizabeth Workman
- Biomedical Informatics Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
- Research, Washington VA Medical Center, Washington, DC, USA
| | - Qing Zeng-Treitler
- Biomedical Informatics Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
- Research, Washington VA Medical Center, Washington, DC, USA
| | - Joseph L Goulet
- Research, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Workman TE, Goulet JL, Brandt CA, Warren AR, Eleazer J, Skanderson M, Lindemann L, Blosnich JR, O'Leary J, Zeng‐Treitler Q. Identifying suicide documentation in clinical notes through zero-shot learning. Health Sci Rep 2023; 6:e1526. [PMID: 37706016 PMCID: PMC10495736 DOI: 10.1002/hsr2.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
Background and Aims In deep learning, a major difficulty in identifying suicidality and its risk factors in clinical notes is the lack of training samples given the small number of true positive instances among the number of patients screened. This paper describes a novel methodology that identifies suicidality in clinical notes by addressing this data sparsity issue through zero-shot learning. Our general aim was to develop a tool that leveraged zero-shot learning to effectively identify suicidality documentation in all types of clinical notes. Methods US Veterans Affairs clinical notes served as data. The training data set label was determined using diagnostic codes of suicide attempt and self-harm. We used a base string associated with the target label of suicidality to provide auxiliary information by narrowing the positive training cases to those containing the base string. We trained a deep neural network by mapping the training documents' contents to a semantic space. For comparison, we trained another deep neural network using the identical training data set labels, and bag-of-words features. Results The zero-shot learning model outperformed the baseline model in terms of area under the curve, sensitivity, specificity, and positive predictive value at multiple probability thresholds. In applying a 0.90 probability threshold, the methodology identified notes documenting suicidality but not associated with a relevant ICD-10-CM code, with 94% accuracy. Conclusion This method can effectively identify suicidality without manual annotation.
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Affiliation(s)
- Terri Elizabeth Workman
- Biomedical Informatics CenterThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
- VA Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Joseph L. Goulet
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Cynthia A. Brandt
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Allison R. Warren
- PRIME Center, VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Jacob Eleazer
- PRIME Center, VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | | | - Luke Lindemann
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - John R. Blosnich
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John O'Leary
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineWest HavenConnecticutUSA
| | - Qing Zeng‐Treitler
- Biomedical Informatics CenterThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
- VA Medical CenterWashingtonDistrict of ColumbiaUSA
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Warren AR, Relyea MR, Gross GM, Eleazer JR, Goulet JL, Brandt CA, Haskell SG, Portnoy GA. Intimate partner violence among lesbian, gay, and bisexual veterans. Psychol Serv 2023:2024-00281-001. [PMID: 37602982 PMCID: PMC10879444 DOI: 10.1037/ser0000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
The present study describes intimate partner violence (IPV) perpetration and victimization alongside theoretically associated variables in a sample of lesbian, gay, and bisexual veterans. We conducted bivariate analyses (chi-square tests and independent t test) to examine whether the frequencies of IPV perpetration and victimization varied by demographic characteristics, military sexual trauma, alcohol use, and mental health symptoms. Out of the 69 lesbian, gay, and bisexual (LGB) veterans who answered the questions on IPV, 16 (23.2%) reported some form of IPV victimization in the past year, and 38 (55.1%) reported past-year perpetration. Among the 43 veterans who reported psychological IPV, roughly half (48.9%) reported bidirectional psychological IPV, 39.5% reported perpetration only, and 11.6% reported victimization only. LGB veterans who reported bidirectional psychological IPV in their relationships were younger and reported greater symptoms of posttraumatic stress disorder symptoms and depression. The results presented here call for universal screening of IPV perpetration and victimization to both accurately assess and ultimately intervene among all veterans. Inclusive interventions are needed for all genders and sexual orientations, specifically interventions that do not adhere to gendered assumptions of perpetrators and victims. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Jacob R Eleazer
- Department of Psychiatry and Psychology, Mayo Clinic Florida
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Workman TE, Goulet JL, Brandt CA, Lindemann L, Skanderson M, Warren AR, Eleazer JR, Kronk C, Gordon KS, Pratt-Chapman M, Zeng-Treitler Q. Temporal and Geographic Patterns of Documentation of Sexual Orientation and Gender Identity Keywords in Clinical Notes. Med Care 2023; 61:130-136. [PMID: 36511399 PMCID: PMC9931630 DOI: 10.1097/mlr.0000000000001803] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Disclosure of sexual orientation and gender identity correlates with better outcomes, yet data may not be available in structured fields in electronic health record data. To gain greater insight into the care of sexual and gender-diverse patients in the Veterans Health Administration (VHA), we examined the documentation patterns of sexual orientation and gender identity through extraction and analyses of data contained in unstructured electronic health record clinical notes. METHODS Salient terms were identified through authoritative vocabularies, the research team's expertise, and frequencies, and the use of consistency in VHA clinical notes. Term frequencies were extracted from VHA clinical notes recorded from 2000 to 2018. Temporal analyses assessed usage changes in normalized frequencies as compared with nonclinical use, relative growth rates, and geographic variations. RESULTS Over time most terms increased in use, similar to Google ngram data, especially after the repeal of the "Don't Ask Don't Tell" military policy in 2010. For most terms, the usage adoption consistency also increased by the study's end. Aggregated use of all terms increased throughout the United States. CONCLUSION Term usage trends may provide a view of evolving care in a temporal continuum of changing policy. These findings may be useful for policies and interventions geared toward sexual and gender-diverse individuals. Despite the lack of structured data, the documentation of sexual orientation and gender identity terms is increasing in clinical notes.
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Affiliation(s)
- Terri Elizabeth Workman
- Biomedical Informatics Center, The George Washington University, Washington, DC
- Washington DC VA Medical Center, Washington, DC
| | - Joseph L. Goulet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Cynthia A. Brandt
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Luke Lindemann
- VA Connecticut Healthcare System, West Haven, CT
- Department of Psychology, Yale University, New Haven, CT
| | | | | | - Jacob R. Eleazer
- VA Connecticut Healthcare System PRIME Center, West Haven, CT
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Kirsha S. Gordon
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | - Qing Zeng-Treitler
- Biomedical Informatics Center, The George Washington University, Washington, DC
- Washington DC VA Medical Center, Washington, DC
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Goulet JL, Warren AR, Workman TE, Skanderson M, Farmer MM, Gordon KS, Abel EA, Akgün KM, Bean-Mayberry B, Zeng-Treitler Q, Haderlein TP, Haskell SG, Bastian LA, Womack JA, Post LA, Hwang U, Brandt CA. Variation in firearm screening and access by LGBT status. Acad Emerg Med 2023; 30:420-423. [PMID: 36661348 DOI: 10.1111/acem.14664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Joseph L Goulet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Allison R Warren
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - T Elizabeth Workman
- Biomedical Informatics Center, The George Washington University, Washington, DC, USA
| | | | - Melissa M Farmer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica A Abel
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathleen M Akgün
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, UCLA-David Geffen School of Medicine, Los Angeles, California, USA
| | - Qing Zeng-Treitler
- Biomedical Informatics Center, The George Washington University, Washington, DC, USA.,Washington DC VA Medical Center, Washington, DC, USA
| | - Taona P Haderlein
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Veterans Affairs, Veterans Emergency Management Evaluation Center (VEMEC), North Hills, California, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julie A Womack
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Yale School of Nursing, VA Connecticut, West Haven, Connecticut, USA
| | - Lori A Post
- Northwestern University, Chicago, Illinois, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
| | - Cynthia A Brandt
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
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Warren AR, Steffen AM. Reactions and Preferences for Training Among Area Agency on Aging Providers Working With Transgender and Gender Nonconforming Older Adults. J Appl Gerontol 2019; 39:545-554. [PMID: 31382804 DOI: 10.1177/0733464819868057] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Transgender and gender nonconforming (TGNC) older adults face numerous barriers to healthy aging. These older adults may be less likely to seek out aging-focused services due to fear of discrimination and a lack of culturally competent services. There is a dearth of trainings for aging-focused professionals that would contribute to the development of affirming service environments for TGNC older adults. The current study explores providers' responses to a professional development training made available nationwide to staff and volunteers of area agencies on aging. Participants' (N = 155) reflections on what would be most helpful in their future work with TGNC older adults included requests for role-plays, instructions on creating more inclusive agency documents, increased contact with TGNC older adults, and managing discriminatory language in the workplace. Future directions include creating professional development opportunities that incorporate experiences with and exposure to both other aging-focused providers and TGNC elders.
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Warren AR, Steffen AM. Development of a Transgender and Gender Nonconforming Language Self-Efficacy Scale for Social Service Providers Working With Older Adults. J Appl Gerontol 2018. [PMID: 29514542 DOI: 10.1177/0733464818759754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is consensus that providers who work with transgender and gender nonconforming (TGNC) older adults should use the language preferred by the older adult; however, assessment tools to document professional training efforts are lacking. This study presents data on a new TGNC Language Self-Efficacy Scale, using responses collected from employees and volunteers of area agencies on aging (AAA) across the United States (N = 155). Exploratory factor analysis supports a two-factor model: Interactions and Information subscales significantly correlated with knowledge of TGNC terminology, genderism and transphobia, gender role beliefs, beliefs about gender and gender identity, and attitudes toward lesbians and gay men. Future directions include additional measurement development work and replication of these findings outside of AAAs.
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Abstract
This study utilized the theory of planned behavior to examine individual intentions to engage in gay affirmative practice among aging-focused professionals (N = 83) in the Midwestern United States. Participants completed self-report measures of perceived agency norms and individual attitudes related to the treatment of gay men and lesbians, intentions to provide gay affirmative care, and perceived behavioral control. Attitudes, norms and perceived behavioral control were examined as predictors of intentions; attitudes of individual aging-service professionals emerged as the strongest predictor. Results indicated that affirmative attitudes within the agency may be important in predicting intentions to provide this type of care.
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Affiliation(s)
- Allison R Warren
- a Department of Psychological Sciences , University of Missouri-St. Louis , St. Louis , Missouri , USA
| | - Ann M Steffen
- a Department of Psychological Sciences , University of Missouri-St. Louis , St. Louis , Missouri , USA
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Boley SJ, Agrawal GP, Warren AR, Veith FJ, Levowitz BS, Treiber W, Dougherty J, Schwartz SS, Gliedman ML. Pathophysiologic effects of bowel distention on intestinal blood flow. Am J Surg 1969; 117:228-34. [PMID: 5773936 DOI: 10.1016/0002-9610(69)90308-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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