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1.
JAMA Netw Open ; 4(7): e2118801, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34323984

RESUMO

Importance: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. Objective: To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients' treatment preferences and risk of opioid misuse. Design, Setting, and Participants: This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. Interventions: The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient's analgesic treatment preference and risk of opioid misuse. Main Outcomes and Measures: Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. Results: Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients' treatment preferences and risk of opioid misuse. Conclusions and Relevance: In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. Trial Registration: ClinicalTrials.gov Identifier: NCT03134092.

2.
JMIR Res Protoc ; 9(9): e19496, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32969832

RESUMO

BACKGROUND: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative-enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain. OBJECTIVE: Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported outcomes, including knowledge, opioid use, and patient preferences, for patients who present to emergency departments with back pain and kidney stone pain. METHODS: This is a multisite randomized controlled trial. Patients presenting to the acute care facilities of four geographically and ethnically diverse US hospital centers with acute renal colic pain or musculoskeletal back and/or neck pain are eligible for this randomized controlled trial. A control group of patients receiving general risk information is compared to two intervention groups: one receiving the risk information sheet plus an individualized, visual probabilistic Opioid Risk Tool (ORT) and another receiving the risk information sheet plus a video narrative-enhanced probabilistic ORT. We will study the effect of probabilistic and narrative-enhanced opioid risk communication on the following: risk awareness and recall at 14 days postenrollment, reduced use or preferences for opioids after the emergency department episode, and alignment with patient preference and provider prescription. To assess these outcomes, we administer baseline patient surveys during acute care admission and follow-up surveys at predetermined times during the 3 months after discharge. RESULTS: A total of 1302 patients were enrolled over 24 months. The mean age of the participants was 40 years (SD 14), 692 out of 1302 (53.15%) were female, 556 out of 1302 (42.70%) were White, 498 out of 1302 (38.25%) were Black, 1002 out of 1302 (76.96%) had back pain, and 334 out of 1302 (25.65%) were at medium or high risk. Demographics and ORT scores were equally distributed across arms. CONCLUSIONS: This study seeks to assess the potential clinical role of narrative-enhanced, risk-informed communication for acute pain management in acute care settings. This paper outlines the protocol used to implement the study and highlights crucial methodological, statistical, and stakeholder involvement as well as dissemination considerations. TRIAL REGISTRATION: ClinicalTrials.gov NCT03134092; https://clinicaltrials.gov/ct2/show/NCT03134092. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19496.

3.
Psychol Methods ; 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32673040

RESUMO

Selective reporting of results based on their statistical significance threatens the validity of meta-analytic findings. A variety of techniques for detecting selective reporting, publication bias, or small-study effects are available and are routinely used in research syntheses. Most such techniques are univariate, in that they assume that each study contributes a single, independent effect size estimate to the meta-analysis. In practice, however, studies often contribute multiple, statistically dependent effect size estimates, such as for multiple measures of a common outcome construct. Many methods are available for meta-analyzing dependent effect sizes, but methods for investigating selective reporting while also handling effect size dependencies require further investigation. Using Monte Carlo simulations, we evaluate three available univariate tests for small-study effects or selective reporting, including the trim and fill test, Egger's regression test, and a likelihood ratio test from a three-parameter selection model (3PSM), when dependence is ignored or handled using ad hoc techniques. We also examine two variants of Egger's regression test that incorporate robust variance estimation (RVE) or multilevel meta-analysis (MLMA) to handle dependence. Simulation results demonstrate that ignoring dependence inflates Type I error rates for all univariate tests. Variants of Egger's regression maintain Type I error rates when dependent effect sizes are sampled or handled using RVE or MLMA. The 3PSM likelihood ratio test does not fully control Type I error rates. With the exception of the 3PSM, all methods have limited power to detect selection bias except under strong selection for statistically significant effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

4.
J Adolesc ; 78: 33-42, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31812942

RESUMO

INTRODUCTION: The aim of the present study is to examine gender identity disparities in different kinds of weight-related health behaviors, including physical activity, participation in physical education at school, and healthy and unhealthy eating habits, and to investigate the relationship between school safety and such behaviors in a sample of transgender and non-transgender students. METHOD: We analyzed a statewide sample of 31,609 students (Mage = 14.04, SD = 1.70; 1.1% transgender). We used multilevel regression models to examine the interactive effects of gender identity and perceptions of school safety on the 4 different outcome variables (physical activity, physical education, healthy and unhealthy eating habits). All models included student- and school-level characteristics as controls. RESULTS: Findings indicated that transgender students, when compared to non-transgender students, reported (a) feeling less safe at school; (b) more physical activity, but less participation in physical education at school; and (c) both more healthy as well as unhealthy eating behaviors. Adjusted regression models showed a significant interaction between gender identity and perceived school safety on healthy eating behaviors; simple slopes indicated that transgender students have healthier eating behaviors when the school context is perceived as safe compared to those who perceived the school as less safe. CONCLUSIONS: School interventions are needed to improve school safety for transgender youth and to reduce gender identity-related disparities in healthy eating and physical activity. Research implications and limitations are discussed.


Assuntos
Exercício Físico , Comportamento Alimentar/psicologia , Comportamentos Relacionados com a Saúde , Pessoas Transgênero/psicologia , Adolescente , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Instituições Acadêmicas/normas , Inquéritos e Questionários
5.
Res Synth Methods ; 10(1): 57-71, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30506832

RESUMO

Publication bias and other forms of outcome reporting bias are critical threats to the validity of findings from research syntheses. A variety of methods have been proposed for detecting selective outcome reporting in a collection of effect size estimates, including several methods based on assessment of asymmetry of funnel plots, such as the Egger's regression test, the rank correlation test, and the Trim-and-Fill test. Previous research has demonstated that the Egger's regression test is miscalibrated when applied to log-odds ratio effect size estimates, because of artifactual correlation between the effect size estimate and its standard error. This study examines similar problems that occur in meta-analyses of the standardized mean difference, a ubiquitous effect size measure in educational and psychological research. In a simulation study of standardized mean difference effect sizes, we assess the Type I error rates of conventional tests of funnel plot asymmetry, as well as the likelihood ratio test from a three-parameter selection model. Results demonstrate that the conventional tests have inflated Type I error due to the correlation between the effect size estimate and its standard error, while tests based on either a simple modification to the conventional standard error formula or a variance-stabilizing transformation both maintain close-to-nominal Type I error.


Assuntos
Interpretação Estatística de Dados , Razão de Chances , Viés de Publicação , Projetos de Pesquisa , Animais , Simulação por Computador , Humanos , Funções Verossimilhança , Modelos Estatísticos , Método de Monte Carlo , Linguagens de Programação , Padrões de Referência , Análise de Regressão , Reprodutibilidade dos Testes , Tamanho da Amostra
6.
Violence Against Women ; 23(3): 287-308, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27075666

RESUMO

Community health workers (CHWs) provide peer support in diverse health care settings, but few studies have evaluated CHW interventions for intimate partner violence (IPV). We assessed the feasibility, acceptability, and safety of CHW outreach in four urban community health clinics and characterized the experiences and barriers to providing safe and effective services for women experiencing IPV. CHWs successfully enrolled and engaged IPV victims, who indicated satisfaction and increased safety with program participation. However, complex psychosocial barriers prevented many from achieving safety and security. More work is needed to assess the impact of well-integrated IPV-trained CHWs in primary care medical homes.

7.
J Health Care Poor Underserved ; 21(2 Suppl): 157-68, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20453383

RESUMO

UNLABELLED: As a preliminary investigation of the effectiveness of medical-legal partnership in pediatrics, we conducted a 36-month prospective cohort study of the impact of clinic- and hospital-based legal services. We hypothesized that integration of legal services into pediatric settings would increase families' awareness of and access to legal and social services, decrease barriers to health care for children, and improve child health. METHODS: Health care providers referred families with legal or social needs to the Peninsula Family Advocacy Program (FAP). RESULTS: Fifty four families completed both baseline and six-month follow-up assessments. Comparison of follow-up with baseline demonstrated significantly increased proportions of families who utilized food and income supports and significantly decreased proportions of families avoiding health care due to lack of health insurance or concerns about cost. Two-thirds of respondents reported improved child health and well-being. CONCLUSIONS: This study suggests that adding an attorney to the medical team increases awareness of and access to social and legal services.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Proteção da Criança/legislação & jurisprudência , Relações Interprofissionais , Pediatria , California , Criança , Defesa da Criança e do Adolescente/legislação & jurisprudência , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Seguro Saúde/estatística & dados numéricos , Advogados , Projetos Piloto , Estudos Prospectivos , Encaminhamento e Consulta , Apoio Social
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