Youjeong Kang

African Americans With Cancer Pain Are More Likely to Receive an Analgesic With Toxic Metabolite Despite Clinical Risks: A Mediation Analysis Study

PURPOSE Renal impairment is highly prevalent among patients with cancer, and many patients have undiagnosed chronic kidney disease (CKD) from underlying disease, treatment, or both. African American individuals have disproportionate risk factors (diabetes, hypertension) predisposing them to CKD. We investigated whether African American patients are more likely than white patients to receive morphine with 3- and 6-glucuronide metabolites, which are known to be neurotoxic and accumulate in CKD; whether insurance type mediates the relationship between race and the prescribers opioid selection; and whether the chosen opioid has a resultant negative effect according to race. PATIENTS AND METHODS Patients (N = 182) were recruited from oncology clinics within the University of Pennsylvania Health System. Inclusion was based on self-identified African American or white race, age older than 18 years, and the presence of cancer-related pain plus a prescription for morphine or oxycodone. Kidney function was estimated using the abbreviated Modification of Diet in Renal Disease formula. RESULTS Patients with CKD who received morphine reported a greater severity of analgesic-related adverse effects than patients with CKD who received oxycodone (P = .010). Controlling for health insurance type, African American patients had 71% lower odds of receiving a prescription of oxycodone than white patients (P < .001). Limiting analysis to those with CKD, the effect of private insurance became insignificant. However, race still remained a significant predictor of the prescribed opioid selection. Race was a strong predictor of adverse effect severity in the presence of CKD, and the type of opioid selection partially mediated this relationship. CONCLUSION Reducing racial disparities in the type of opioid prescription and understanding mechanisms of disproportionate opioid-related adverse effects in African American patients might decrease the clinical disparities in cancer pain outcomes.

Gender Disparity in Structured Physical Activity and Overall Activity Level in Adolescence: Evaluation of Youth Risk Behavior Surveillance Data

Background. Adolescent girls are less likely to meet physical activity recommendations than boys. This study examined the relative contribution of structured physical activity opportunities including physical education (PE) class and sports teams to overall activity levels for girls and boys. Methods. Data from 591 9th–12th grade students who completed the 2009 Philadelphia Youth Risk Behavior Survey were examined. Logistic regression was used to estimate the relationship between PE and sports teams and physical activity levels. Models were stratified by gender to estimate gender differences. Results. Girls were less likely to be active than boys: 27.9% of girls were sedentary as compared to 10.6% of boys. PE class was not related to activity levels among boys, while highly active girls were seven times more likely to participate in daily PE than were sedentary girls. Playing on one or more sports teams was associated with low-moderate and high activity in girls; among boys, sports team participation was only associated with high activity. Conclusions. The structured physical activity opportunities of PE and sports teams may contribute more to overall activity levels in girls than boys. A more rigorous assessment of this hypothesis is warranted to inform efforts to promote activity levels in girls.

Utilizing Home Healthcare Electronic Health Records for Telehomecare Patients With Heart Failure: A Decision Tree Approach to Detect Associations With Rehospitalizations.

Heart failure is a complex condition with a significant impact on patients’ lives. A few studies have identified risk factors associated with rehospitalization among telehomecare patients with heart failure using logistic regression or survival analysis models. To date, there are no published studies that have used data mining techniques to detect associations with rehospitalizations among telehomecare patients with heart failure. This study is a secondary analysis of the home healthcare electronic medical record called the Outcome and Assessment Information Set-C for 552 telemonitored heart failure patients. Bivariate analyses using SAS and a decision tree technique using Waikato Environment for Knowledge Analysis were used. From the decision tree technique, the presence of skin issues was identified as the top predictor of rehospitalization that could be identified during the start of care assessment, followed by patient’s living situation, patient’s overall health status, severe pain experiences, frequency of activity-limiting pain, and total number of anticipated therapy visits combined. Examining risk factors for rehospitalization from the Outcome and Assessment Information Set-C database using a decision tree approach among a cohort of telehomecare patients provided a broad understanding of the characteristics of patients who are appropriate for the use of telehomecare or who need additional supports.

Clinical Outcomes in Critically Ill Patients Associated With the Use of Complex vs Weight-Only Predictive Energy Equations

BACKGROUND The energy intake goal is important to achieving energy intake in critically ill patients, yet clinical outcomes associated with energy goals have not been reported. METHODS This secondary analysis used the Improving Nutrition Practices in the Critically III International Nutrition Surveys database from 2007-2009 to evaluate whether mortality or time to discharge alive is related to use of complex energy prediction equations vs weight only. The sample size was 5672 patients in the intensive care unit (ICU) ≥ 4 days and a subset of 3356 in the ICU ≥ 12 days. Mortality and time to discharge alive were compared between groups by regression, controlling for age, sex, admission type, Acute Physiology and Chronic Health Evaluation II score, ICU geographic region, actual energy intake, and obesity. RESULTS There was no difference in mortality between the use of complex and weight-only equations (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.86-1.15), but obesity (OR, 0.83; 95% CI, 0.71-0.96) and higher energy intake (OR, 0.65; 95% CI, 0.56-0.76) had lower odds of mortality. Time to discharge alive was shorter in patients fed using weight-only equations (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) in patients staying ≥ 4 days and with greater energy intake (HR, 1.19; 95% CI, 1.06-1.34) in patients in the ICU ≥ 12 days. CONCLUSION These data suggest that higher energy intake is important to survival and time to discharge alive. However, the analysis was limited by actual energy intake <70% of goal. Delivery of full goal intake will be needed to determine the relationship between the method of determining energy goal and clinical outcomes.

Consistency and Accuracy of Multiple Pain Scales Measured in Cancer Patients From Multiple Ethnic Groups.

Background: Standardized pain-intensity measurement across different tools would enable practitioners to have confidence in clinical decision making for pain management. Objectives: The purpose was to examine the degree of agreement among unidimensional pain scales and to determine the accuracy of the multidimensional pain scales in the diagnosis of severe pain. Methods: A secondary analysis was performed. The sample included a convenience sample of 480 cancer patients recruited from both the Internet and community settings. Cancer pain was measured using the Verbal Descriptor Scale (VDS), the visual analog scale (VAS), the Faces Pain Scale (FPS), the McGill Pain Questionnaire–Short Form (MPQ-SF), and the Brief Pain Inventory–Short Form (BPI-SF). Data were analyzed using a multivariate analysis of variance and a receiver operating characteristic curve. Results: The agreement between the VDS and VAS was 77.25%, whereas the agreement was 71.88% and 71.60% between the VDS and FPS, and VAS and FPS, respectively. The MPQ-SF and BPI-SF yielded high accuracy in the diagnosis of severe pain. Cutoff points for severe pain were more than 8 for the MPQ-SF and more than 14 for the BPI-SF, which exhibited high sensitivity and relatively low specificity. Conclusion: The study found substantial agreement between the unidimensional pain scales and high accuracy of the MPQ-SF and the BPI-SF in the diagnosis of severe pain. Implications for Practice: Use of 1 or more pain screening tools that have validated diagnostic accuracy and consistency will help classify pain effectively and subsequently promote optimal pain control in multiethnic groups of cancer patients.

The Psychometric Properties of the Midlife Women’s Symptom Index

OBJECTIVE To evaluate the psychometric properties of the Midlife Womens Symptom Index (MSI) among four racial/ethnic groups of midlife women in the United States. DESIGN A secondary data analysis. SETTING Internet communities/groups. PARTICIPANTS A total of 494 midlife women with symptoms of menopause who self-reported using an Internet survey and completed all sections of the MSI questionnaire. METHODS Data were collected from January 1, 2008 to December 31, 2010. The psychometric properties of the MSI were evaluated using measures of internal consistency, item-total correlation coefficients, and discriminant validity. RESULTS There were statistically significant differences in marital status, employment, income, religion, country of birth, level of education, diagnosed disease, and self-reported health status across the four racial/ethnic groups. The Kuder-Richardson Formula 20 (KR-20) coefficients for the three subscales of the MSI prevalence section (i.e., physical, psychological, and psychosomatic) ranged from 0.58 (psychosomatic symptoms in Whites) to 0.91 (psychological symptoms in Asian Americans). The Cronbachs alpha coefficients for the three subscale scores ranged from 0.60 (psychosomatic symptoms in Whites) to 0.93 (psychological symptoms in Asian Americans). The mean scores of the MSI differed significantly by race/ethnicity among midlife women of each menopausal status, except for the prevalence section of the psychosocial symptoms. CONCLUSION The MSI has demonstrated an acceptable reliability and appropriate discriminant validity across the four racial/ethnic groups, except in the domain of psychosomatic symptoms. Health care providers as well as researchers could use the MSI to assess the symptoms of menopause of midlife women from diverse racial/ethnic backgrounds.

Physical activities and sleep-related symptoms in 4 major racial/ethnic groups of midlife women.

The purpose of this study was to determine racial/ethnic differences in midlife womens sleep-related symptoms, relationships between their physical activity and sleep-related symptoms, and specific factors associated with their sleep-related symptoms in each racial/ethnic group. This was a secondary analysis of the data from 542 midlife women in the United States. The data were analyzed using descriptive statistics, &khgr;2 tests, analysis of variance, hierarchical multiple linear regression analyses, and logistic regression analyses. The findings indicated that physical activities could improve midlife womens sleep-related symptoms, but the types of physical activities and racially/ethnically different factors associated with sleep-related symptoms need to be considered.

Visualization approaches to support healthy aging: A systematic review

Background Informatics tools have the potential to support the growing number of older adults who are aging in place. Many tools include visualizations (data visualizations and visualizations of physical representations). However, the role of visualizations in supporting aging in place remains largely unexplored. Objective To synthesize and identify gaps in the literature evaluating visualizations (data visualizations and visualizations of physical representations) for informatics tools to support healthy aging. Methods We conducted a search in CINAHL, Embase, Engineering Village, PsycINFO, PubMed, and Web of Science using a priori defined terms for publications in English describing community-based studies evaluating visualizations used by adults aged ≥ 65 years. Results Six out of the identified 251 publications were eligible. Most studies described in the publications were user studies and all varied methodological quality. Three publications described visualizations of virtual representations supported performing at-home exercises. Participants found visual representations either (1) helpful, motivational, and supported their understanding of their health behaviours or (2) not an improvement over alternatives. Three publications described data visualizations that aimed to support understanding of one’s health. Participants were able to interpret data visualizations that used precise data and encodings that were more concrete better than those that did not provide precision or were abstract. Participants found data visualizations helpful in understanding their overall health and granular data. Conclusions Few studies were identified that used and evaluated visualizations for older adults to promote engagement in exercises or understanding of their health. While visualizations demonstrated some promise to support older adult users in these activities, the studies had various methodological limitations. More research is needed, including research that overcomes methodological limitations of studies we identified, to develop visualizations that older adults could use with ease and accuracy to support their health behaviours and decision making.