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

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

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

Possible selves as roadmaps

Possible selves, expectations, and concerns about the coming year, can promote feeling good (‘‘I may not be doing well in school this year, but I will next year.’’) or can promote regulating for oneself (‘‘I may not be doing well in school this year, but to make sure I do better next year, I have signed up for summer tutoring.’’). We hypothesized that improved academic outcomes were likely only when a possible self could plausibly be a self-regulator. Hierarchical regression analyses supported this conclusion, with more support for the influence of self-regulation on change in behavior and academic outcomes than on affect regulation. N ¼ 160 low-income eighth graders improved grades, spent more time doing homework, participated in class more, and were referred less to summer school (controlling for fall grades and the dependent variable of interest) when academic possible selves were plausibly self-regulatory.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64253/1/Possible_selves_as_roadmaps.pd

When mothers have serious mental health problems: Parenting as a proximal mediator

Maternal mental health (MMH) problems are associated with lack of confidence in one’s parenting, overly lax or too harsh discipline, and child academic underperformance. We asked if parenting mediates the effect of MMH problems on academic outcomes even among mothers with serious mental illness (n ¼ 164). Structural equation analyses show a significant association between MMH problems and permissive (lack of parenting confidence, lack of follow through) parenting and verbal hostility as well as worse academic outcomes (school recorded grades, teacher reported behaviour). Permissive parenting completely mediated the direct effect of MMH on academic outcomes. Further analyses showed that the mediation effect was attributed to a single component of permissive parenting—lack of parenting confidence.http://deepblue.lib.umich.edu/bitstream/2027.42/64256/1/When_mothers_have_serious_mental_health_problems.pd

Diversity of outcomes among adolescent children of mothers with mental illness

Children of parents with mental illness are an at-risk population according to research on psychiatric outcomes using white, middle-class samples of depressed parents and infants and preschool children. The current study expands this evidence by exploring within-group heterogeneity across psychosocial outcomes, in a racially diverse, low-income sample of adolescent children of mothers with mental illness (N = 166). Using measures of mental health, academics, behavior problems, and social relationships--and employing cluster analysis methodology--we identified five meaningful subgroups of these youth. Two of five identified clusters evidenced mental health symptoms (15%) or possible behavioral problems (27%). The largest cluster (30%) appeared quite socially and academically competent; another cluster (22%) presented as average in their functioning but adult-oriented. A final small cluster (4.8%) was distinguished by members' social isolation. Cluster membership related to maternal substance abuse history, father's relationship to youth, and social support available to mothers. Implication for planning preventative intervention are discussed.http://deepblue.lib.umich.edu/bitstream/2027.42/64262/1/Diversity_of_outcomes_among_children_of_mothers_with_mental_illness.pd

Pregnancy Outcomes: A Study Testing a Model for Predicting Health Outcomes in Pregnancy

There is a persistent relationship between socioeconomic status and physical health outcomes found in the literature; however the variables mediating this relationship are many, and ways that they interact with each other are complex. The goal of understanding this relationship is to decrease the disparity in health by socioeconomic status. This study tested a biopsychosocial model proposed by David Williams (1990) to explain the relationship between socioeconomic status and physical health outcomes. The model included the following latent factors: demographics, socioeconomic status, biomedical risk, medical care, psychosocial variables, and health outcomes. The model was tested through a secondary data analysis. The 1937 women who participated entered one of six Portland area clinics over a three year period for prenatal care. Data was collected over three time points; two interviewsdone during the pregnancy and birth outcome data, taken from medical records. There were 1134 women with complete data for the purpose of this analysis. Confirmatory factor analysis was used to verify that the measurement tools fit the measurement model for the latent factors. After dropping four of the 28 measures, the fit was adequate and covariance structure modelling was used to test the structural model proposed by Williams. The fit of the model was adequate, however, only 3.8% of the variance in the outcomes measures was explained by the model, and three of the five paths leading to outcomes were insignificant. An alternative model with psychosocial variables broken into the two factors of psychosocial resources and behaviors was also tested with similar results. The variance explained in outcomes was 4.3% and the only factors with paths significantly related to outcomes were demographics and biomedical risk. It is of note in both models that SES was a very powerful predictor of the medical care variable, predicting over 50% of its variance. The psychosocial variable also had 20.7% and 18.8% of its variance explained by the preceding factors in Williams\u27 model and the alternative model respectively. Since the model did fit the data, it is believed improvements in utility of the model could be seen if a study was designed specifically for testing this model

Adopting otitis media practice guidelines increases adherence within a large primary care network

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168468/1/jpc15389.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168468/2/jpc15389_am.pd

Considerations for using race and ethnicity as quantitative variables in medical education research

Abstract Throughout history, race and ethnicity have been used as key descriptors to categorize and label individuals. The use of these concepts as variables can impact resources, policy, and perceptions in medical education. Despite the pervasive use of race and ethnicity as quantitative variables, it is unclear whether researchers use them in their proper context. In this Eye Opener, we present the following seven considerations with corresponding recommendations, for using race and ethnicity as variables in medical education research: 1) Ensure race and ethnicity variables are used to address questions directly related to these concepts. 2) Use race and ethnicity to represent social experiences, not biological facts, to explain the phenomenon under study. 3) Allow study participants to define their preferred racial and ethnic identity. 4) Collect complete and accurate race and ethnicity data that maximizes data richness and minimizes opportunities for researchers’ assumptions about participants’ identity. 5) Follow evidence-based practices to describe and collapse individual-level race and ethnicity data into broader categories. 6) Align statistical analyses with the study’s conceptualization and operationalization of race and ethnicity. 7) Provide thorough interpretation of results beyond simple reporting of statistical significance. By following these recommendations, medical education researchers can avoid major pitfalls associated with the use of race and ethnicity and make informed decisions around some of the most challenging race and ethnicity topics in medical education.http://deepblue.lib.umich.edu/bitstream/2027.42/173951/1/40037_2020_Article_602.pd