Health Care Approach Research Articles

Integrated Health and Personality Adaptation Model (IHPAM) for Men Amidst Russia-Ukraine Conflict: Navigating Psychosomatic Health

In the midst of the Russia-Ukraine war and the ongoing challenges of the post-COVID era, this study presents the Integrated Health and Personality Adaptation Model (IHPAM), focusing on the critical examination of psychosomatic health determinants in Ukrainian men. Materials and methods. Conducted on a sample of 708 men from the Kyiv region, the research applies a comprehensive set of assessment tools to probe the complex interactions between physical health, psychological stress, personality dynamics, and adaptive coping mechanisms. We used the I-structural test of Ammon, Lifestyle Index (LSI), Short Form-36 (SF-36), Assessment of the level of health by the main functional systems, Clinical questionnaire for the identification and assessment of neurotic conditions and rigorous factor analysis with SPSS-28. Results. The study identifies five key factors within the IHPAM: Physical Functioning Nexus, Destructive Functions of the Personality, The Psychological Stress Nexus, The Constructive Personality Matrix, and The Adaptive Defense Mechanisms. The IHPAM model underscores the multifaceted impact of the Russia-Ukraine war and the COVID-19 pandemic on men’s health, revealing significant psychosomatic disturbances. The study highlights the necessity for healthcare systems to adopt a holistic view, recognizing the pivotal role of psychological support, alongside physical health care, in mitigating the adverse effects of such unprecedented global and local stressors. Conclusions. IHPAM advocates for an integrated healthcare approach to the complex interdependencies between physical health, psychological wellbeing, and the socio-political environment, urging for targeted interventions that address the comprehensive health needs of men during times of crisis.

Disaster management - preparation and planning for acute care facilities.

Both human-derived and naturally-occurring disasters stress the surge capacity of health systems and acute care facilities. In this article, we review recent literature related to having a disaster plan, facility planning principles, institutional and team preparedness, the concept of surge capacity, simulation exercises and advantages and disadvantages of each. Evidence suggests that every institution should have a disaster plan and a dedicated team responsible for updating this plan. The disaster plan must be people-oriented and incorporate different perspectives and opinions so that all stakeholders feel included and can contribute to a joint response. Simulation exercises are fundamental for preparation so that the team functions seamlessly in uncommon times when disaster management transitions from a theoretical plan to one that is executed in real time. Notably, however, there are significantly different realities related to disaster management between countries and even within the same country or region. Unfortunately, key stakeholders such as hospital administration, board of directors and investors often do not believe they have any responsibility related to disaster management planning or response. Additionally, while a disaster plan often exists within an institution, it is frequently not well known or understood by many stakeholders. Communication, simple plans and well defined roles are some of the most important characteristics of a successful response. In extreme circumstances, adapting civilian facilities to manage high-volume warfare-related injuries may be adopted, but the consequences of this approach for routine healthcare within a system can be devastating. Disaster management requires careful planning with input from multiple stakeholders and a plan that is frequently updated with repeated preparation to ensure the team is ready when a disaster occurs. Close communication as well as clearly defined roles are critical to success when transitioning from preparation to activation and execution of a disaster response.

Whole person healthcare as social and environmental justice: new research directions toward a paradigmatic integration of an ecological whole system medicine framework

With increasing recognition of the interdependencies of human and planetary health, calls for a socially and environmentally just framework of health have centered on whole person healthcare (WPHC) approaches. This perspective piece proposes an argument for broadening the definition of human health from WPHC to one that is guided by the philosophical orientation of traditional whole system medicine (WSM) approaches, undergirded by the values of social and environmental justice, and supported by the practices of an allopathic-integrative medicine-based WPHC framework. This piece presents opportunities for praxis offered by a WSM–WPHC framework to address global inequity, environmental disparities, and sustainability challenges. An ecological WSM–WPHC framework envisages social and environmental justice in material and discursive ways by foregrounding environmental planetary ecological consciousness as constitutive of human consciousness and biopsychosocial composition. It argues for structural support through formalized programmatic pathways targeting funding opportunities and mechanisms that invite investigations addressing epistemic challenges of expanding definitions of evidence constituting basic science knowledge domains beyond mechanistic, causal, and formative paradigms. Furthermore, it calls for innovative research directions examining the integration and validation of evidence-based approaches incorporating the ontologically diverse and epistemically distinct ontological orientation of WSM and clinical approaches. A WSM–WPHC framework that positions human health within the parameters of social and environmental justice principles envisions the material enactment of the practice of health and medicine as a universal planetary value.

Traditional healing for physical and mental problems in the Arab region: past and current practices.

Exploring traditional healing practices in the Arab world unveils a diverse range of methods deeply rooted in ancient beliefs. Traditional healing practices encompass natural remedies, spiritual rituals and physical treatments. These historical practices persist today, reflecting their enduring relevance in Arab culture and their influence on healthcare approaches. Factors such as accessibility to traditional healing services, a lack of affordable medical treatment, cultural familiarity and a strong belief in the efficacy of traditional healing methods in treating mental problems contribute to their continued use. However, potential challenges arise when an exclusive reliance on traditional methods might hinder access to critical medical interventions. Thus, the need for further documentation and research into these deeply ingrained healing traditions is emphasised. Some research has focused on integrating these traditional approaches with the modern medical system, recognising their combined value in healthcare. This balanced approach holds the potential to bridge the gap between culturally informed traditional practices and contemporary medical treatments.

The Health History of First-Degree Relatives' Dyslipidemia Can Affect Preferences and Intentions following the Return of Genomic Results for Monogenic Familial Hypercholesterolemia.

Genetic testing is key in modern healthcare, particularly for monogenic disorders such as familial hypercholesterolemia. This Tohoku Medical Megabank Project study explored the impact of first-degree relatives' dyslipidemia history on individual responses to familial hypercholesterolemia genomic results. Involving 214 participants and using Japan's 3.5KJPN genome reference panel, the study assessed preferences and intentions regarding familial hypercholesterolemia genetic testing results. The data revealed a significant inclination among participants with a family history of dyslipidemia to share their genetic test results, with more than 80% of participants intending to share positive results with their partners and children and 98.1% acknowledging the usefulness of positive results for personal health management. The study underscores the importance of family health history in genetic-testing perceptions, highlighting the need for family-centered approaches in genetic counseling and healthcare. Notable study limitations include the regional scope and reliance on questionnaire data. The study results emphasize the association between family health history and genetic-testing attitudes and decisions.

The association of adverse childhood experiences with household income, educational attainment and partnered status among adults aged 30-39

BackgroundThe association of adverse childhood experiences (ACEs) with young adult social outcomes is poorly understood. ObjectiveTo examine the relationship between ACEs and young adult household income, education, and partnered status. Participants13,767 respondents (population-weighted estimate N = 13,191,291) aged 30–39 completed the optional ACES module in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) from 17 states. MethodsThe 2019 BRFSS was used to analyze the significance of ACE scores for the likelihood of reporting household income greater than $75,000, a college or postgraduate degree, and living with a partner among respondents aged 30–39. Poisson regression analyses controlled for sociodemographic, health status, and behavioral risk characteristics. ResultsAs compared to those with zero ACEs, respondents reporting four or more ACE exposures (20.2% of respondents) were marginally less likely to report high income (IRR: 0.87, 95% CI: 0.79–0.97) and one-third less likely to report a college degree (IRR: 0.68, 95% CI: 0.61–0.76), with no significant difference in partnered status. ConclusionsYoung adult social status may be shaped by social-emotional effects of ACEs that go beyond demographic and health status differences. Enhancing resilience to childhood adversity can benefit from a trauma-informed approach in health care, education, and employment.

Abstract P109: HDL Cholesterol Confers Exceptionally Strong Cardioprotective and Metabolic Effects in Native Hawaiian and Pacific Islander Populations

Relative to the general population, Native Hawaiian and Pacific Islander (NHPI) communities are significantly more prone to obesity, diabetes, and heart disease. Our population-based longitudinal study focuses on HDL cholesterol levels and cardiovascular risk among NHPI and other (comparison) populations. Given the importance of health disparities in cardiovascular disease among the people of Hawai'i, this study holds considerable importance for establishing more diverse, equitable, and inclusive healthcare and precision medicine approaches. Specifically, we communicate a novel data-driven finding, revealed from a statistical and machine learning analysis of epidemiological data from the NIH All of Us Research Program, showing that the cardioprotective effect of high-density lipoprotein (HDL) cholesterol is significantly stronger in NHPI populations relative to other racial/ethnic demographics (including White, Black, and Hispanic/Latinx communities). Our results indicate that: 1) the cardioprotective effect of HDL against coronary artery disease (CAD), acute myocardial infarction (MI), and major adverse cardiovascular events (MACE), is much more powerful in NHPI populations compared to any other racial/ethnic groups currently represented in All of Us . 2) HDL has an exceptionally strong negative relationship with Type II diabetes (T2D) incidence in NHPI populations, which is also significantly stronger than in other ethnicities. In NHPI populations, these results suggest that an additional emphasis ought to be placed on the cardiac and metabolic-protective effect of HDL level as a key biomarker/risk factor in physicians’ assessment of cardiometabolic disease risk. These cardiovascular health equity findings highlight the importance of more and improved diversity, equity, and inclusion efforts to adequately serve growing subpopulations of historically underrepresented groups such as NHPIs within the US healthcare system.

Identifying implant abutments and fixtures by application of deep learning concept through artificial intelligence – A review

Artificial intelligence (AI) is an evolving and assuring approach in healthcare and has begun to improve the dental science ever since. A subgroup of AI called deep learning (DL) related convolutional neural network algorithm have showed significant applications in computer based tasks and have been shown to be fairly applicable for dental image recognition and treatment planning analysis. This article aims to review the adaptation of artificial intelligence in identifying implant systems and abutments using deep learning concept.

Artificial intelligence and multimodal data fusion for smart healthcare: topic modeling and bibliometrics

Advancements in artificial intelligence (AI) have driven extensive research into developing diverse multimodal data analysis approaches for smart healthcare. There is a scarcity of large-scale analysis of literature in this field based on quantitative approaches. This study performed a bibliometric and topic modeling examination on 683 articles from 2002 to 2022, focusing on research topics and trends, journals, countries/regions, institutions, authors, and scientific collaborations. Results showed that, firstly, the number of articles has grown from 1 in 2002 to 220 in 2022, with a majority being published in interdisciplinary journals that link healthcare and medical research and information technology and AI. Secondly, the significant rise in the quantity of research articles can be attributed to the increasing contribution of scholars from non-English speaking countries/regions and the noteworthy contributions made by authors in the USA and India. Thirdly, researchers show a high interest in diverse research issues, especially, cross-modality magnetic resonance imaging (MRI) for brain tumor analysis, cancer prognosis through multi-dimensional data analysis, and AI-assisted diagnostics and personalization in healthcare, with each topic experiencing a significant increase in research interest. There is an emerging trend towards issues such as applying generative adversarial networks and contrastive learning for multimodal medical image fusion and synthesis and utilizing the combined spatiotemporal resolution of functional MRI and electroencephalogram in a data-centric manner. This study is valuable in enhancing researchers’ and practitioners’ understanding of the present focal points and upcoming trajectories in AI-powered smart healthcare based on multimodal data analysis.

ALLOPECIA AREATA AND PERIODONTITIS: A CASE REPORT

This case report examines the interrelationship between periodontitis and Alopecia areata (AA), an autoimmune condition, within the broader context of the impact of oral health on systemic diseases. The concept of "oral primary foci," encompassing various oral pathologies such as periodontitis, dentoalveolar abscesses, and pulpal necrosis, is highlighted as a key factor in systemic diseases and complications. The report details the case of a 50-year-old female patient with AA who exhibited significant improvement in her condition following periodontal treatment. This improvement underscores the potential systemic influence of oral health conditions, particularly periodontitis, which is characterized by a dynamic interplay between bacterial infection and the host's immune response. The presence of autoantibodies in periodontitis suggests an autoimmune component, potentially linking it to autoimmune diseases like AA. The patient's case also aligns with the epidemiological data on AA, emphasizing its complex etiology and association with various systemic conditions. The report concludes that effective management of oral health, especially periodontal diseases, is crucial in the systemic health and management of conditions such as AA. It advocates for a holistic approach in healthcare, integrating oral health as a fundamental aspect of managing systemic diseases, and calls for continued research into the mechanisms connecting oral and systemic autoimmune responses. This research is vital for developing comprehensive treatment strategies that address both oral and systemic health, thereby enhancing overall patient outcomes.

Using simulation modelling to transform hospital planning and management to address health inequalities

Health inequalities are a perennial concern for policymakers and in service delivery to ensure fair and equitable access and outcomes. As health inequalities are socially influenced by employment, income, and education, this impacts healthcare services among socio-economically disadvantaged groups, making it a pertinent area for investigation in seeking to promote equitable access. Researchers widely acknowledge that health equity is a multi-faceted problem requiring approaches to understand the complexity and interconnections in hospital planning as a precursor to healthcare delivery. Operations research offers the potential to develop analytical models and frameworks to aid in complex decision-making that has both a strategic and operational function in problem-solving. This paper develops a simulation-based modelling framework (SimulEQUITY) to model the complexities in addressing health inequalities at a hospital level. The model encompasses an entire hospital operation (including inpatient, outpatient, and emergency department services) using the discrete-event simulation method to simulate the behaviour and performance of real-world systems, processes, or organisations. The paper makes a sustained contribution to knowledge by challenging the existing population-level planning approaches in healthcare that often overlook individual patient needs, especially within disadvantaged groups. By holistically modelling an entire hospital, socio-economic variations in patients' pathways are developed by incorporating individual patient attributes and variables. This innovative framework facilitates the exploration of diverse scenarios, from processes to resources and environmental factors, enabling key decision-makers to evaluate what intervention strategies to adopt as well as the likely scenarios for future patterns of healthcare inequality. The paper outlines the decision-support toolkit developed and the practical application of the SimulEQUITY model through to implementation within a hospital in the UK. This moves hospital management and strategic planning to a more dynamic position where a software-based approach, incorporating complexity, is implicit in the modelling rather than simplification and generalisation arising from the use of population-based models.

Accessing care for Long Covid from the perspectives of patients and healthcare practitioners: A qualitative study.

Long Covid is an emerging long-term condition, with those affected raising concerns about lack of healthcare support. We conducted a qualitative study to identify facilitators and barriers to healthcare access for people with Long Covid, aiming to enhance our understanding of the specific nature of these barriers and how patient experiences may vary. In the context of the Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVIDto Address and Transform Existing Integrated Care Pathways (STIMULATE-ICP) Delphi study, a nationally distributed online survey was conducted. Eight patients and eight healthcare practitioners (HCP) were interviewed via telephone or video call. Framework analysis, sensitised by the candidacy theory, was used to identify barriers and facilitators over four levels of access to care. Three themes were identified: (i) patients' efforts to navigate emerging pathways for Long Covid, (ii) the patient-HCP interaction and (iii) service resources and structural constraints. Barriers to specialist care included long waiting times, communication gaps across services and a lack of continuity in care. Facilitators included collaborative, patient-centred approaches, patients' active role in their healthcare and blended approaches for appointments. The perspectives of both patients and HCPs largely aligned. The candidacy framework was valuable in understanding the experiences of people with Long Covid seeking access to healthcare. Individuals perceived themselves as eligible for care, but they often encountered obstacles in obtaining the expected level of care or, in some cases, did not receive it at all. Our findings are discussed in the context of the candidacy model through multiple processes of identification, negotiation, permeability and appearances at health services. These themes seem to be especially important for the emerging new pathway model and are relevant to both primary and secondary care. This study highlights that despite these interviews being conducted two years after the start of the COVID-19 pandemic, people with Long Covid still struggle to access healthcare, emphasising the ongoing need to provide equitable timely healthcare access for people with Long Covid. People with Long Covid advised on all stages of this research.

Social participation, subjective well-being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults.

BackgroundAlthough tooth loss appears to be related to functional limitations, the mechanisms that underpin this relationship are unknown. We sought to address this knowledge gap by examining a multiple mediation hypothesis whereby tooth loss is predicted to indirectly affect functional limitations through social participation, subjective well-being, and cognitive function.MethodsThis study included 7,629 Chinese adults from the 2017/2018 Chinese Longitudinal Healthy Longevity Survey wave. The serial mediation effects were examined using Model 6 in the Hayes’ PROCESS macro for SPSS.ResultsTooth loss was significantly related to functional limitations. There was a direct (β = − 0.0308; 95% CI, − 0.0131 to − 0.0036) and indirect (β = − 0.0068; 95% CI, − 0.0096 to − 0.0041) association between tooth loss and instrumental activities of daily living (IADL) limitations, but only an indirect correlation with activities of daily living (ADL) limitations (β = − 0.0188; 95% CI, − 0.0259 to − 0.0121). Social participation, subjective well-being, and cognitive function serially mediated the relationship between tooth loss and ADL/IADL limitations.ConclusionThe association between tooth loss and functional limitations is serially mediated by social participation, subjective well-being, and cognitive function. Our findings underscore the necessity of considering psychological and social factors as integrated healthcare approaches for the functional health of older adults.

Evaluating tuberculosis treatment outcomes in Haiti from 2018 to 2019: A competing risk analysis

ObjectivesThis study assesses tuberculosis (TB) treatment outcomes in Haiti. MethodsData from drug-susceptible patients with TB (2018-2019) were analyzed using the Fine & Gray model with multiple imputation. ResultsOf the 16,545 patients, 14.7% had concurrent HIV coinfection, with a 66.2% success rate. The median treatment duration was 5 months, with patients averaging 30 years (with an interquartile range of 22-42 years). The estimated hazard of achieving a successful treatment outcome decreased by 2.5% and 8.1% for patients aged 45 and 60 years, respectively, compared with patients aged 30 years. Male patients had a 6.5% lower estimated hazard of success than their female counterparts. In addition, patients coinfected with HIV experienced a 35.3% reduction in the estimated hazard of achieving a successful treatment outcome compared with those with a negative HIV serologic status. ConclusionsIntegrated health care approaches should be implemented, incorporating innovative solutions, such as machine learning algorithms combined with geographic information systems and non-conventional data sources (including social media), to identify TB hotspots and high-burden households.

Introducing a value-based healthcare approach for women with premature ovarian insufficiency (POI): Recommendations for patient-centered outcomes in clinical practice

ObjectiveTo establish a set of clinician and patient-reported outcome measures (PROMs) and present the initial findings of a value-based healthcare (VBHC) program in patients with premature ovarian insufficiency (POI). MethodsEmploying a four-phase approach, we identified the most crucial domains for patients with POI and translated these into PROMs. Prior to each visit, patients completed questionnaires to evaluate: depression (BDI-II), menopausal symptoms (GCS), work ability (WAS) and infertility (FertiQoL). During the visits, cardiovascular health assessments and dual-energy X-ray absorptiometry (DEXA) scans to measure bone mineral density were performed. Data at intake is presented, and comparisons are drawn between women using and those not using hormone replacement therapy (HRT). Patient-reported experience measures (PREMs) were evaluated by a questionnaire. ResultsA total of 267 POI patients completed the PROM questionnaires, of whom 58.1 % were using HRT at intake. Over half of the patients (53.5 %), had a BDI-II score of 14 or higher, indicating mild to severe depression. The mean total GCS score was 20.9 (SD 11.3). The median work ability score was 7.5 (IQR 6.0–8.0) and the mean FertiQoL score 63.9 (SD 15.7). Additionally, 22.7 % of patients presented with hypertension, 6.2 % with hypercholesterolemia, and almost 50 % had low bone mass. Patients rated the VBHC program with a mean of 8.6 (SD 1.2). ConclusionsThese findings underscore the necessity of a multidisciplinary VBHC program incorporating standardized screening and psychological treatment. We advocate for the implementation of patient-centered outcomes for clinical practice, which have been found to be highly relevant by patients with POI.

Prevalence and pattern of psychiatric morbidity in patients with first-episode acute coronary syndrome

BackgroundThe existing body of literature extensively highlights the impact of psychological determinants on the initiation of coronary heart disease. Globally, the incidence of psychiatric disorders is increasing, and India is no stranger to this trend. However, the connection between psychiatric co-morbidities and the onset of acute coronary syndrome has been relatively understudied in this region of the world.ResultsIndividuals experiencing acute coronary syndrome exhibited notably higher psychiatric morbidity compared to the control group, with an odds ratio of 4.14. Mood disorders, in particular, were the most prevalent among ACS patients, demonstrating an odds ratio of 5.023, followed by anxiety disorders with an odds ratio of 2.48.ConclusionThe findings revealed a substantial association underscoring the intricate interplay between mental and cardiovascular health emphasizing the importance of holistic healthcare approaches that consider both physical and psychological well-being, in the context of cardiovascular diseases. Further research in this area can contribute to a more comprehensive understanding of the links between mental health and cardiovascular outcomes, potentially informing targeted interventions and improving overall patient care.

Anxiety, Depression, and Quality of Life Among Infertile Women: A Case-Control Study.

Introduction Pregnancy holds significant cultural and social value for women. However, women facing challenges in conceiving often grapple with emotional distress, including depression and anxiety. The connection between psychological elements (stress, anxiety, and depression) and infertility is complex, influenced by multiple factors, and bidirectional. Infertile women are more likely to develop mental illnesses, marital dissatisfaction, and impaired quality of life compared to the individuals of the fertile group. Thus, the study aimed to assess levels of anxiety, depression, and quality of life among infertile women compared to fertile women. Methods This case-control study conducted at a tertiary care center recruited 100 nulliparous women between the age group of 20 and 38 years with primary or secondary infertility, while those with male factor infertility were excluded. The control group (N=100) comprised normal parous women who had at least one child. The primary objective of the study was to assess the impact of infertility on the mental health and quality of life of women seeking infertility treatment. Outcome measures included standardized tools such as the WHOQOL-BREF questionnaire to assess the quality of life across multiple domains (e.g., physical, psychological, social, and environmental) as well as the Depression Anxiety and Stress Scale (DASS-21) to measure levels of anxiety, depression, and stress. Cronbach's alpha was used to measure the tool's reliability. A P value of <0.05 was considered statistically significant. Results Baseline sociodemographic parameters were comparable between the two groups. The mean age of infertile women was 30.6±3.9 years compared to 31.5±3.2 years in fertile women (P=0.076). Using the WHOQOL-BREF scale, we found that the quality of life was better in the fertile group compared to the infertile group through all the physical, psychological, social, and environmental domains (P<0.001). The infertile group had a significantly higher number of women with anxiety, depression, and stress. The questionnaires showed high internal reliability. Conclusion Infertile women experienced a lower quality of life in various domains, higher levels of anxiety, and increased rates of depression compared to fertile counterparts. The study findings underscore the multidimensional impact of infertility, emphasizing the need for comprehensive healthcare approaches to address the psychosocial challenges faced by women undergoing infertility treatment.

Nurse-led family-based approach in primary health care for patients with type 2 diabetes mellitus: a qualitative study

ABSTRACT Purpose The prevalence of Type 2 diabetes is rapidly increasing, with 537 million people estimated to have diabetes in 2021. The literature suggests that nurses can deliver effective person-centred diabetes care and that families can be essential in supporting patients. Thus, a Nurse-led Family-based (NLFB) approach may be particularly effective. This study aims to explore the perceptions of nurses, adults with type 2 diabetes, and family members regarding the NLFB intervention. Methods Guided by the UK Medical Research Council Framework, this seminal study adopted a qualitative, descriptive approach with content analysis. Data were obtained through 16 semi-structured, in-depth interviews. Themes emerged based on an inductive process using constant comparison (Graneheim and Lundman 2004). The COREQ checklist was used in ensuring rigour. Results Three main themes emerged includes: (1) nurses’ experiences with current diabetes care practices, (2) stakeholders’ views on the development of a NLFB approach, and (3) merging the nurse-led family aspects into the diabetes care. The key challenges are the dominant medical model, lack of specialist nurses, and time. The key facilitators are knowledge and social support. Conclusion The study recommends stakeholders embrace nursing empowerment strategies and involve families to enhance the nurses’ advanced roles and family inclusion in healthcare.

Association between self-reported pain severity and characteristics of United States adults (age ≥50 years) who used opioids.

The aim of this study was to assess the associations between the characteristics of United States (US) adults (≥50 years) who used opioids and self-reported pain severity using a nationally representative dataset. This retrospective cross-sectional database study used 2019 Medical Expenditure Panel Survey data to identify US adults aged ≥50 years with self-reported pain within the past 4 weeks and ≥1 opioid prescription within the calendar year (n = 1,077). Weighted multivariable logistic regression analysis modeled associations between various characteristics and self-reported pain severity (quite a bit/extreme vs less/moderate pain). The adjusted logistic regression model indicated that greater odds of reporting quite a bit/extreme pain was associated with the following: age 50-64 vs ≥65 (adjusted odds ratio [AOR] = 1.76; 95% confidence interval [CI] = 1.22-2.54), non-Hispanic vs Hispanic (AOR = 2.0; CI = 1.18-3.39), unemployed vs employed (AOR = 2.01; CI = 1.33-3.05), no health insurance vs private insurance (AOR = 6.80; CI = 1.43-32.26), fair/poor vs excellent/very good/good health (AOR = 3.10; CI = 2.19-4.39), fair/poor vs excellent/very good/good mental health (AOR = 2.16; CI = 1.39-3.38), non-smoker vs smoker (AOR = 1.80; CI = 1.19-2.71), and instrumental activity of daily living, yes vs no (AOR = 2.27; CI = 1.30-3.96). Understanding the several characteristics associated with pain severity in US adults ≥50 years who used an opioid may help transform healthcare approaches to prevention, education, and management of pain severity in later life.

COMPOSITE SCORES FOR TRANSPLANT CENTER EVALUATION: A NEW INDIVIDUALIZED EMPIRICAL NULL METHOD.

Risk-adjusted quality measures are used to evaluate healthcare providers with respect to national norms while controlling for factors beyond their control. Existing healthcare provider profiling approaches typically assume that the between-provider variation in these measures is entirely due to meaningful differences in quality of care. However, in practice, much of the between-provider variation will be due to trivial fluctuations in healthcare quality, or unobservable confounding risk factors. If these additional sources of variation are not accounted for, conventional methods will disproportionately identify larger providers as outliers, even though their departures from the national norms may not be "extreme" or clinically meaningful. Motivated by efforts to evaluate the quality of care provided by transplant centers, we develop a composite evaluation score based on a novel individualized empirical null method, which robustly accounts for overdispersion due to unobserved risk factors, models the marginal variance of standardized scores as a function of the effective sample size, and only requires the use of publicly-available center-level statistics. The evaluations of United States kidney transplant centers based on the proposed composite score are substantially different from those based on conventional methods. Simulations show that the proposed empirical null approach more accurately classifies centers in terms of quality of care, compared to existing methods.