Opioids for Osteoarthritis: Cross-Sectional Survey of Patient Perspectives and Satisfaction.

Patients often take opioids to relieve osteoarthritis (OA) pain despite limited benefits and potential harms. This study aimed to compare cross-sectional perspectives of patients that were taking prescription opioid (N = 471) or nonopioid medications (N = 185) for OA in terms of satisfaction, expectations of effectiveness, and concerns. Patients prescribed opioids (>7 days) reported more prior treatments (2.47 vs. 1.74), greater mean pain intensity (5.47 vs. 4.11), and worse quality of life (EQ-5D-5L index value mean 0.45 vs. 0.71) than patients prescribed nonopioid medications (all p < 0.0001). Based on linear regression models adjusting for demographics and pain intensity, patients prescribed opioids were less satisfied with overall regimen (3.40 vs. 3.67, p = 0.0322), had less belief that medications were meeting effectiveness expectations (2.72 vs. 3.13, p < 0.0001), and had more concerns about treatments being "not very good" (3.66 vs. 3.22, p = 0.0026) and addiction (3.30 vs. 2.65, p < 0.0001) than patients prescribed nonopioid regimens. When the models were replicated for subgroups with ≥30 days' medication regimen duration, the findings were consistent with the main analyses. Patients have concerns about the risk of opioid addiction, but those with greater disease burden and more prior treatments continue taking opioid regimens.

Real-World Analysis of Clinical Characteristics, Treatment Patterns, and Patient-Reported Outcomes of Insufficient Responders and Responders to Prescribed Acute Migraine Treatment in China.

INTRODUCTION: Migraine is a common disabling primary headache disorder characterized by attacks of severe pain, sometimes accompanied by symptoms including nausea and photo-/phono-phobia. Real-world data of patients with migraine who sufficiently (responders) and insufficiently (insufficient responders) respond to acute treatment (AT) are limited in China. This analysis explored whether responders to AT differ from insufficient responders in terms of clinical characteristics, treatment patterns, and patient-reported outcomes in China. METHODS: Data were drawn from the Adelphi Migraine Disease Specific Programme™, a point-in-time survey of internists/neurologists and their consulting patients with migraine, conducted in a real-world setting in China, January-June 2014. Responders and insufficient responders to prescribed AT were patients who typically achieved headache pain freedom within 2 h of AT in ≥ 4 and ≤ 3 of five migraine attacks, respectively. Responders were compared with insufficient responders; logistic regression was used to identify factors associated with insufficient response. RESULTS: Of 777 patients currently receiving AT, 44.0% were insufficient responders. Significantly fewer responders than insufficient responders had migraine with aura (13.1 vs. 23.8%; p = 0.0001). Responders reported a significantly lower mean Migraine Disability Assessment (MIDAS) total score (5.5 vs. 6.6; p = 0.0325). Responders reported a lower mean impairment while working (50.0 vs. 63.9%; p < 0.0001), overall work impairment (52.6 vs. 66.0%; p < 0.0001), and activity impairment (48.9 vs. 59.0%; p < 0.0001). Statistically significant factors associated with insufficient response to AT included diabetes, unilateral pain, vomiting, sensitivity to smell, visual aura/sight disturbance, and an increase in MIDAS total score. However, there were no statistically significant differences in ATs received by responders and insufficient responders at any regimen of therapy. CONCLUSIONS: Many patients with migraine in China are insufficient responders to AT, experiencing worse symptoms that lead to overall poorer quality of life than responders. This unmet need suggests that new effective treatment options are required for migraine.

Opioid Prescribing for Osteoarthritis: Cross-Sectional Survey among Primary Care Physicians, Rheumatologists, and Orthopaedic Surgeons.

Opioids are often prescribed for osteoarthritis (OA) pain, despite recommendations to limit use due to minimal benefits and associated harms. This study aimed to assess physicians' practice patterns and perceptions regarding opioids by specialty one year following the Centers for Disease Control and Prevention (CDC) published guidance on opioid prescribing. The 139/153 (90.8%) physicians who reported prescribing opioids in the previous year reported decreased prescribing for mild OA (51.3%, 26.5% and 33.3% of primary care physicians, rheumatologists, and orthopaedic surgeons, respectively), moderate OA (50.0%, 47.1% and 48.1%) and severe OA (43.6%, 41.2% and 44.4%). Prescribing changes were attributed to the CDC guidelines for 58.9% of primary care physicians, 59.1% of rheumatologists, and 73.3% of orthopaedic surgeons. Strong opioids were mostly reserved as third-line treatment. Although treatment effectiveness post-CDC guidelines was not assessed, perceptions of efficacy and quality of life with opioids significantly differed across specialties, whereas perceptions of safety, convenience/acceptability and costs did not. Physicians generally agreed on the barriers to opioid prescribing, with fear of addiction and drug abuse being the most important. Across specialties, physicians reported decreased opioid prescribing for OA, irrespective of OA severity, and in most cases attributed changes in prescribing to the CDC guideline.

Racial discrimination and depressive symptoms mediated by conversations about race among students of color.

Racial discrimination is associated with adverse mental health outcomes among Students of Color. In order to address racial tensions, it is important to consider students' dialogues about race. The current study tested whether having positive and negative conversations about one's ethnic-racial group mediated the relation between racial discrimination at T1 and depressive symptoms 5 months later at T2 among 94 college Students of Color. Findings indicated that greater racial discrimination at T1 was associated with more frequent negative conversations about race at T2 (b = .38, p = .00), which was, in turn, associated with greater depressive symptoms at T2 (b = 2.73, p = .04); this pathway demonstrated significant mediation. However, positive conversations about race was not a significant mediator in this association. The current study highlights the importance of focusing on racial conversations after racial discrimination in order to minimize adverse effects on mental health among Students of Color.

Sex differences in how ethnic-racial identity informs first coital affect and virginity beliefs among Black college students.

Objective: The present study examined whether ethnic-racial identity (ERI) exploration, resolution, and affirmation informed individuals' beliefs about virginity (ie, virginity as a gift, stigma, process) and first coital affective reactions (FCAR; ie, positive and negative), and whether these relations varied by biological sex. Participants and method: The sample consisted of 184 Black college students (Mage = 19.79, SD = 2.08) enrolled in a large Southern university. Participants completed a virginity beliefs measure, first coital affective reaction measure, and an ethnic-racial identity measure. Results: Findings indicated that for Black females, greater ERI exploration was associated with decreased virginity as a gift beliefs; and ERI resolution was associated with increased virginity as a gift beliefs. Additionally, for Black males and females, ERI affirmation resulted in more positive FCAR, less negative FCAR, and less views of virginity as a stigma. Conclusion: Finding implications are presented in the context of future research.

Cultural Socialization and Ethnic-Racial Identity Mediated by Positive and Negative Conversations about Race: Exploring Differences among Asian American, African American, Latinx, Multiracial, and White Students.

The current study examined associations between cultural socialization and ethnic-racial identity via positive and negative conversations about one's ethnicity/race. Ethnic-racial differences between Asian American, African American, Latinx, Multiracial, and White students were explored. College students 18-22 (M age = 18.46) participating in a university-wide study provided self-reports of childhood cultural socialization, engagement in conversations about ethnicity/race during college, and ethnic-racial identity. Cultural socialization was associated with more positive conversations about race, and, in turn, greater ethnic-racial identity exploration, resolution, and affirmation among all students. Additionally, among Multiracial and African American students, cultural socialization was associated with greater negative conversations about race and, in turn, less ethnic-racial identity affirmation. Although cultural socialization was not associated with negative conversations about race for Asian American, Latinx, or White students, the relation between greater negative conversations about race and less ethnic-racial identity affirmation was significant. Negative conversations about race also informed greater ethnic-racial identity exploration among all students, but was not associated with ethnic-racial identity resolution. The current study highlights the nuanced ways that childhood cultural socialization and conversations about one's ethnicity/race influence college students' ethnic-racial identity, both similarly and differently among Asian American, African American, Latinx, Multiracial, and White students. Two items created for the current study were used to assess positive and negative conversations about one's ethnicity/race in the past month. Response options for the positive conversation item ("In the past month, I had conversations with someone about something positive about my ethnic-racial group.") and negative conversation item ("In the past month, I had conversations with someone about something negative about my ethnic-racial group.") were scored using a 5-point Likert scale ranging from (1) Not at all to (5) Extremely or almost always. Higher scores indicated more frequent positive conversations and more frequent negative conversations, respectively. Initial support for the validity of the two items for positive and negative conversations about race has been provided by research with emerging adults (Delaney et al., in press).

Factors associated with physician-reported treatment status of patients with osteoarthritis pain.

BACKGROUND: Osteoarthritis (OA) is typically associated with pain, but many patients are not treated. METHODS: This point in time study explored factors associated with treatment status, using logistic regression of data from the Adelphi OA Disease Specific Programme conducted in the United States. Patients' treatment status was based on physician-reported, current: 1) prescription medication for OA vs. none; and 2) physician treatment (prescription medication and/or recommendation for specified nonpharmacologic treatment for OA [physical or occupational therapy, acupuncture, transcutaneous electrical nerve stimulation, or cognitive behavior therapy/psychotherapy]) vs. self-management (no prescription medication or specified nonpharmacologic treatment). RESULTS: The 841 patients (including 57.0% knee OA, 31.9% hip OA) reported mild (45.4%) or moderate or severe (54.6%) average pain intensity over the last week. The majority were prescribed medication and/or recommended specified nonpharmacologic treatment; 218 were not prescription-medicated and 122 were self-managed. Bivariate analyses showed less severe patient-reported pain intensity and physician-rated OA severity, fewer joints affected by OA, lower proportion of joints affected by knee OA, better health status, lower body mass index, and lower ratings for cardiovascular and gastrointestinal risks, for those not prescribed medication (vs. prescription-medicated). Multivariate analyses confirmed factors significantly (p < 0.05) associated with prescription medication included (odds ratio): physician-rated current moderate OA severity (vs. mild, 2.03), patient-reported moderate OA severity 6 months ago (vs. mild, 1.71), knee OA (vs. not, 1.81), physician-recommended (0.28) and patient-reported (0.43) over-the-counter medication use (vs. not), prior surgery for OA (vs. not, 0.37); uncertain income was also significant. Factors significantly (p < 0.05) associated with physician treatment included (odds ratio): physician-recommended nonpharmacologic therapy requiring no/minimal medical supervision (vs. not, 2.21), physician-rated current moderate OA severity (vs. mild, 2.04), patient-reported over-the-counter medication use (vs. not, 0.26); uncertain time since diagnosis was also significant. Patient-reported pain intensity and most demographic factors were not significant in either model. CONCLUSIONS: Approximately 1 in 4 patients were not prescribed medication and 1 in 7 were self-managed, although many were using over-the-counter medications or nonpharmacologic therapies requiring no/minimal medical supervision. Multiple factors were significantly associated with treatment status, including OA severity and over-the-counter medication, but not pain intensity or most demographics.

Predictors of QOL in Patients with Alopecia Areata.

Although alopecia areata (AA) severity is often defined by the degree of scalp hair loss, its impact on QOL can also be a defining measure of severity. In this cross-sectional study (AA Disease Specific Program), 259 patients were surveyed for demographics, AA illness characteristics, QOL (Skindex-16 AA), and daily impairment (Work Productivity and Activity Impairment). The association between patient demographics and illness variables, the Skindex-16 AA scores, and the Work Productivity and Activity Impairment scores were analyzed using regression analyses. The mean age of patients was 39 years (51% female). Self-reported severity of current AA was rated as mild (21%), moderate (54%), and severe (25%). The highest impairment was observed for the Skindex-16 AA emotions and the Work Productivity and Activity Impairment daily activity performance scores. Although the degree of scalp hair loss (physician Severity of Alopecia Tool score) was not predictive of QOL, patients' self-report of moderate or severe disease, sex (females more impacted), and eyebrow and eyelash involvement were predictors of diminished QOL, consistently and incrementally. The present results suggest patients' perception of severity as well as the presence of eyelash and eyebrow hair loss are also impactful and should be considered in defining the severity of disease.

Healthcare resource utilization and quality of life by cognitive impairment in patients with schizophrenia.

OBJECTIVE: The objective was to investigate the association between cognitive impairment and healthcare resource utilization (HCRU) and quality of life (QoL) among patients with schizophrenia. METHODS: Data from the Adelphi Schizophrenia Disease Specific Programme™, a point-in-time survey of physicians and their patients, were collected in the United States between July-October 2019. Psychiatrists reported on patient cognitive function, HCRU, housing circumstances and employment status for their next 10 consulting adult patients with schizophrenia. Patients were classified as having no/mild or moderate/severe cognitive impairment and asked to complete a QoL questionnaire voluntarily. Multiple regression analysis estimated the association between severity of cognitive impairment and patient outcomes adjusting for patient demographics and clinical characteristics. RESULTS: Psychiatrists (n=124) reported on 651 and 484 patients with no/mild and moderate/severe cognitive impairment, respectively. Moderate/severe vs. no/mild cognitive impairment was associated with greater odds of hospitalization related to schizophrenia relapse within the last 12 months (adjusted odds ratio [aOR] [95% CI] = 2.23 [1.53-3.24]) and being unemployed due to disability (aOR = 2.39 [1.65-3.45]). Patients with moderate/severe vs. no/mild cognitive impairment had worse average QoL (EuroQoL 5-dimension [EQ-5D] Health Index: difference = -0.09 [-0.13 to -0.04]; EQ-5D Visual Analogue Scale: difference = -7.0 [-13.0 to -1.0]) and overall life satisfaction (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form: difference = -8.4 [-14.1 to -2.8]). CONCLUSIONS: Moderate/severe cognitive impairment among patients with schizophrenia was associated with worse patient outcomes including greater risk of hospitalizations related to schizophrenia relapse. Treatment to improve cognitive function could benefit the large proportion of patients with schizophrenia who suffer from cognitive impairment.

Associations between ethnic-racial identity and alcohol problems among diverse emerging adults.

Excessive alcohol use and problems during college is a major public health concern, and there are health disparities in patterns of drinking and alcohol-related illnesses based on ethnicity and race. Given the prevalence and disparities in excessive alcohol use and problems and associated negative impacts, it is important to examine potential protective factors such as dimensions of ethnic-racial identity (ERI). Thus, the current study examined how multiple dimensions of ERI were associated with alcohol use and alcohol use disorder (AUD) symptoms, and how these relations varied by individuals' ethnic-racial group among 1850 diverse emerging adults (M = 18.46, SD = .38). Findings indicated that there were significant differences by race/ethnicity. ERI affirmation was negatively associated with AUD symptoms for Asian individuals and African American individuals, while ERI exploration was positively associated with AUD symptoms among African American individuals. ERI resolution was negatively associated with alcohol use for Latinx individuals and positively associated with alcohol use for Multiracial individuals. Among White individuals, ERI exploration was negatively associated with alcohol use and ERI affirmation was negatively associated with AUD symptoms. Overall, the current study builds on our understanding of nuanced ways in which ethnic-racial identity impacts alcohol problems among emerging adults and highlights areas for future research.

African American Children's Racial Discrimination Experiences and Mental Health.

The current study examined how African American children's experiences of perceived personal racial discrimination and perceived vicarious racial discrimination were linked with depressive and anxiety symptoms, and whether there were significant sex differences in these relations. The sample included 73 African American children (48% male), ranging from 7 to 12 years of age (M = 8.82, SD = 2.06). Models specified children's personal discrimination and vicarious discrimination as predictors of depressive and anxiety symptoms. Nested model comparisons were also used to examine whether associations varied as a function of children's sex. The current study hypothesized that both forms of discrimination would be associated with greater anxiety and depressive symptoms. Findings indicated that children's personal racial discrimination significantly predicted greater child anxiety symptoms for both boys and girls. No significant sex differences emerged. Neither personal nor vicarious discrimination significantly predicted depressive symptoms. Our findings highlight that racialized experiences occur early in childhood and have important implications for children's mental health.

Point-in-time survey of healthcare resource utilization, employment, quality of life and caregiver status by disease severity in patients with schizophrenia in the US.

OBJECTIVE: The objective of this survey was to assess patient outcomes and caregiver status by disease severity among patients with schizophrenia in the United States. METHODS: A point-in-time survey was conducted between July and October 2019 via the Adelphi Schizophrenia Disease Specific Programme. Psychiatrists reported on their next 10 eligible patients with schizophrenia including demographics, disease severity, treatment history and hospitalizations. Patients receiving treatment for schizophrenia were classified as mild, moderate or severe based on disease severity. Regression models adjusted for age, sex and race/ethnicity. RESULTS: Psychiatrists (n = 124) reported on 435 mild, 401 moderate and 247 severe patients. Greater severity of schizophrenia was associated with a greater number of hospitalizations related to schizophrenia relapse in the previous 12 months (moderate vs. mild: adjusted incidence rate ratio (aIRR) [95% CI] = 2.17 [1.60-2.94]; severe vs. mild: aIRR = 5.45 [3.59-8.27]), lower full-time employment (moderate vs. mild: adjusted odds ratio (aOR) = 0.15 [0.08-0.28]; severe vs. mild: aOR = 0.02 [0.002-0.12]) and greater unemployment due to disability (moderate vs. mild: aOR = 4.24 [3.02-5.97]; severe vs. mild: aOR = 10.85 [6.85-17.17]). Patients with severe vs. mild schizophrenia had lower average quality of life (QoL) measured by the EuroQoL 5-dimension Health Index (difference = -0.16 [-0.23-0.09]). Among patients requiring care, patients with severe vs. mild schizophrenia received more caregiver hours per week (aIRR = 1.89 [1.25-2.84]). CONCLUSIONS: Greater severity of schizophrenia was associated with a significantly greater number of hospitalizations and greater unemployment due to disability. Compared with mild schizophrenia, severe schizophrenia was associated with worse patient QoL and greater caregiver hours.