Cancer Pain: An Age-Based Analysis

Although cancer pain (consistent and breakthrough pain [BTP; pain flares interrupting well-controlled baseline pain]) is common among cancer patients, its characteristics, etiology, and impact on health-related quality of life (HRQOL) across the lifespan are poorly understood.This longitudinal study examines age-based differences and pain-related interference in young and old patients with cancer-related pain over 6 months. Patients in the community with stage III or IV breast, prostate, colorectal, or lung cancer, or stage II–IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL using previously validated measures.Respondents (N = 96) were 70% white and 66% female, with a mean age of 57 ± 10 years. There were no significant differences in pain severity based upon age. However, the younger group experienced more pain flares with greater frequency ( P  = 0.05). The oldest group had better emotional functioning at baseline but worse physical functioning at 6 months. Younger groups also had worse cognitive functioning at 6 months ( P  = 0.03). Pain interference was independent of age.These data provide evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike but demonstrate an increased toll for younger adults (especially financially). Beyond race and gender disparities, further health care disparities in the cancer and cancer pain were identified by age, illustrating the need for additional research across the lifespan in diverse cancer survivors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79337/1/j.1526-4637.2010.00957.x.pd

Physical and Psychosocial Health in Older Women with Chronic Pain: Comparing Clusters of Clinical and Nonclinical Samples

This investigation examined why some elderly women with severe pain symptoms and impairment in health status were not seen in a tertiary care pain center.Three groups of older (≥60 years) women were included in the study: women seeking chronic pain treatment at a multidisciplinary pain center (N = 49), and research volunteers from the same institution with (N = 28) and without (N = 27) chronic pain. A clustering classification technique was used to identify clusters of older women with similar physical and mental health status.We found three clusters: 1) a healthy cluster (cluster 1: mostly nonclinical women); 2) a cluster with very poor physical and mental health status (cluster 3); and 3) a cluster with low physical health but average mental health (cluster 2). Although only cluster 1 had significantly higher physical health ( P  < 0.001), all three clusters had different mental health ( P  < 0.001). Within cluster 2, clinical women had more pain than nonclinical women, but within cluster 3, this was not so, indicating that mental health issues may create an obstacle to women having their pain appropriately assessed and treated.Our findings support that while disability and pain severity contribute to specialized pain services usage among older women, there is a subgroup of people not receiving pain care for whom these pain symptoms are similar. Further studies are needed to assess the role of health-seeking behavior, coping preferences, referral patterns, and patient–physician communication on access to tertiary pain care for older women.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79094/1/j.1526-4637.2010.00803.x.pd

Cancer and Breakthrough Pain's Impact on a Diverse Population

Background.  Although breakthrough pain (BTP; pain flares interrupting well-controlled baseline pain) is common among patients with cancer, its prevalence, characteristics, and impact on health-related quality of life (HRQOL) are poorly understood in ethnic minorities. Methods.  This comparative study examines ethnic and gender differences in BTP characteristics and impact on HRQOL. Patients with stage III or IV cancer of the breast, prostate, colorectal, or lung, or stage II–IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 months, and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL. Results.  Respondents (N = 96) were 75% white, 66% female with a mean age of 56 ± 10 years. All subjects experienced significant psychological distress, but there were no racial differences in depression prevalence. Minorities reported significantly greater severity for consistent pain at its worst ( P  = 0.009), least ( P  ≤ 0.001), on average ( P  = 0.004), and upon initial assessment ( P  = 0.04) as well as greater severity for BTP at its worst ( P  = 0.03), least ( P  = 0.02), and at initial assessment ( P  = 0.008). Although minorities reported more flare types (3.0 vs 1.8, P  = 0.001), there were no significant ethnic differences in the duration, quality, or location of pain flares. Minorities consistently reported poorer outcomes on each HRQOL subscale (physical, role, emotional, cognitive, and social functioning) measured, although not statistically significant, as well as poorer QOL symptom control ( P  = 0.08) including lower dyspnea control ( P  = 0.002). Conclusions.  Overall, minorities experienced greater consistent and breakthrough pain as well as poorer HRQOL. These data suggest further health care disparities in the cancer and pain experience for minorities.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72924/1/j.1526-4637.2009.00564.x.pd

The Impact of Sexual or Physical Abuse History on Pain‐Related Outcomes Among Blacks and Whites with Chronic Pain: Gender Influence

Objectives.  Physical and sexual abuses commonly co‐occur with chronic pain. We hypothesized that: 1) abuse history questions would form distinct factors that relate differently to pain perceptions and pain outcomes; 2) abuse history consequences on physical and mental health differ by gender; and 3) different abuse types and age of occurrence (childhood vs adolescent/adulthood) predict different negative outcomes. Methods.  Chronic pain patients at a tertiary care pain center provided data (64% women, 50% black) through a confidential survey. Factors were formed for abuse type and age. Linear regression, controlling for socio‐demographic information, was used to examine the relationship between abuse and abuse by sex interactions with pain‐related outcomes. Results.  Six 3‐item abuse factors (α = 0.77–0.91)—sexual molestation, sexual penetration, and physical abuse—were identified in both childhood and adulthood. Lifetime prevalence of abuse was 70% for men and 65% for women. Women experienced lower physical abuse ( P  = 0.01) in childhood, and higher penetration ( P  = 0.02) in adulthood. Decreased general health was associated with all abuse types ( P  < 0.05) in childhood. Affective pain was associated with all childhood abuse scales and adulthood molestation, though childhood molestation only for men ( P  = 0.04). Disability was associated with childhood ( P  = 0.02) and adulthood rape ( P  = 0.04). Men with childhood or adulthood molestation ( P  = 0.02; P  = 0.02) reported higher post‐traumatic stress disorder. Conclusions.  Our study confirms physical and mental health, and pain‐related outcomes are affected by abuse history for men and women. These results support screening all patients for abuse to improve the survivor's overall health and well‐being.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90270/1/j.1526-4637.2011.01312.x.pd

Doñana wetlands

The Doñana wetlands in SW Spain constitute what remains of the original 180,000 ha of marshland in the Guadalquivir delta. The natural wetlands are protected in the National Park and World Heritage Site (54,252 ha), and include more than 3,000 temporary dune ponds fed mainly from groundwater and 30,000 ha of seasonal marshes dependent on surface flows. They are particularly famous for their avifauna, and hold more wintering waterfowl than any other European wetland. Wading birds exploit surrounding ricefields and fishfarms, and their breeding numbers are increasing. Doñana holds a high diversity of herpetofauna, mammals, invertebrates and plants, with several endemic species. The wetlands have high value for ecotourism and are the setting for the El Rocío pilgrimage. Alien fish and crayfish have had a significant impact. The quantity and quality of water entering the wetlands is under threat from groundwater extraction and other effects of agricultural and urban development.Peer reviewe

MicroRNA Molecular Profiling from Matched Tumor and Bio-Fluids in Bladder Cancer

MicroRNAs have been identified as potential cancer biomarkers due to their presence and stability in many body fluids including urine and plasma, but the relationship of the pattern of expression of these messengers across various biological media has not been addressed and could provide important information in order to translate these biomarkers for epidemiologic or clinical use. We analyzed microRNA of matched FFPE-tumor tissue, plasma, urine exosomes (n = 16) and WBCs (n = 11) from patients with bladder cancer, using Nanostring miRNA assays and droplet digital PCR for validation. Pearson correlations were used to compare expression between media

Predictors of Complementary and Alternative Medicine Use in Chronic Pain Patients

We used Andersen's behavioral model of healthcare utilization to assess the relationship between sociodemographic, physical and psychosocial factors, and Complementary and Alternative Medicine (CAM) use among chronic pain patients. Three practitioner-based alternative therapies were considered: acupuncture, biofeedback/relaxation training, and manipulation services.A retrospective analysis of self-reported clinical data with 5,750 black and white adults presenting for initial assessment between 1994 and 2000 at the University of Michigan Multidisciplinary Pain Center was performed.CAM therapies were used in high frequencies, with 34.7% users. Specifically 8.3% used acupuncture, 13.0% used biofeedback/relaxation, and 24.9% used manipulation techniques. Race and age were predisposing factors associated with CAM use. Blacks used less biofeedback/relaxation and manipulation services than whites. Aging was related to more acupuncture, but less biofeedback/relaxation use. Women marginally used more biofeedback/relaxation services than men, and education was positively associated with all three CAM use. Perceived pain control was a consistent enabling factor positively correlated with the use of all three CAM services. Among need factors, pain characteristics and physical health were positively associated with at least one of the modalities. Depressive symptoms were not related to CAM services use.This study identifies variable patterns of CAM usage based on sociodemographic and health factors in chronic pain patients. Overall, who uses CAM depends on the modality; however, education, pain severity, and pain duration are persistent correlates of CAM usage regardless of the therapy considered. We found that mental health, as measured by depressive symptoms, had no noticeable impact on CAM usage among chronic pain patients. The clinical, policy, and research implications of CAM use are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78625/1/j.1526-4637.2009.00767.x.pd

A Baker\u27s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2017

With an increasing number of antimicrobial stewardship-related articles published each year, attempting to stay current is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an actionable intervention for 2017. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for training and teaching and identify potential intervention opportunities within their institutions

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training and to identify potential intervention opportunities within one’s institution

A Baker’s dozen of top antimicrobial stewardship intervention publications in 2019

© The Author(s) 2020. Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training and to identify potential intervention opportunities within one’s institution