Abstract
Introduction
Disparities in pain experience and treatment amongst people of different races and ethnicities have been described for several conditions. However, the relationship between ...race, ethnicity, socioeconomic status (SES) and pain reported by people with burn injury is not well understood. This study compares pain intensity and interference with daily activities among burn-injured adults of various sociodemographic backgrounds. We hypothesized that minority and low-income populations will report greater pain intensity and interference, necessitating additional strategies to address pain disparity.
Methods
Adult multicenter national database participants with complete PROMIS® pain intensity and pain interference measures at 6 and 12 months after injury were analyzed. Linear regression models examined associations between sex, race, ethnicity, education, income, burn size and pain interference and intensity scores. Regression model diagnostics were tested, and final models used robust standard errors to account for heteroskedasticity.
Results
Data from 656 participants were analyzed, with a mean age of 47.1 ± 16.2. Racial representation was 84.0% White, 8.8% African American/Black, 2.5% Asian/Native Hawaiian/Pacific Islander, 1.9% American India laskan Native, and 2.8% other/more than one race; 80.4% were non-Hispanic and 19.6% Hispanic. Weighted regression models revealed that pain intensity at 6 mo (Ⓡ=1.25, p=0.029) and interference at 12 mo (β=6.71, p=0.013) among Black participants were markedly higher than White participants. Hispanic participants reported lower pain intensity (β=-0.86, p=0.036) and interference (β=-4.06, p=0.007) compared to non-Hispanic participants at 6 mo. Average pain intensity at 6 mo varied significantly by income (p=0.01), with the highest pain intensity (mean 3.8, SD 3.0) reported by those making < $25,000/year. Females reported greater pain intensity at 6 mo than males (β=0.63, p=0.029).
Conclusions
Greater pain intensity and interference were reported by Black participants compared to White participants, while Hispanic participants reported lower pain outcomes. Lower income was also associated with worse pain outcomes. Targeted study of pre-injury pain experiences, pain management, psychosocial health, and financial toxicity are required to identify opportunities for intervention on the many dimensions and causal factors of unsatisfactory pain experiences.
Applicability of Research to Practice
Systematic screening for pain intensity and interference after burn injury may find sociodemographic groups with high pain levels and a need for interdisciplinary pain and psychosocial health management. Comprehensive pain treatment following burn injury should account for social determinants of health and impact of bias to further improve quality care for all people.
Abstract Introduction Burn survivors experience lower levels of health-related quality of life (HRQOL) compared to U.S. population norms even one year post-injury. Research suggests that social ...support predicts functional outcomes, and while studies comparing life satisfaction pre-burn and at follow-up can begin to elucidate HRQOL following burn injury, there is a paucity of research focusing on the role of social participation in HRQOL. The current study sought to examine the roles of social participation and satisfaction with life pre-injury on HRQOL at two years post-injury. Methods Analyses were completed using data from a large national multi-center database. A total of 139 participants enrolled from October 2018 to May 2022 were included (34% female, mean age ± SD = 46.3 ± 16.9, mean TBSA burned ± SD = 19.4% ± 19.7). Measures of social participation included: LIBRE (Life Impact Burn Recovery Evaluation) Social Activities (SA) and Social Interaction (SI) subscales collected at 24-months post-injury. Measure of HRQOL included: VR-12 mental component summary score (MCS) and physical component summary score (PCS) collected at 24-months post-injury. Additional measures included: Satisfaction with Life Scale (SWLS) and Community Integration Questionnaire (CIQ) collected at discharge for pre-injury recall. Four regression models with an interaction term were run to analyze how SWLS pre-injury impacts the relationships amongst LIBRE-SA, LIBRE-SI, VR-12 MCS, and VR-12 PCS while controlling for pre-injury community participation (CIQ). Results After adjusting for preinjury CIQ, LIBRE-SI and LIBRE-SA were both positively associated with MCS (p < 0.001). While LIBRE-SA was positively associated with PCS (p < 0.001), LIBRE-SI was not significant. There was no evidence to support an interaction/moderation effect of the relationship between LIBRE-SA or LIBRE-SI and VR-12 MCS or VR-12 PCS by SWLS pre-injury. Conclusions Findings suggest higher levels of social participation are associated with increased mental HRQOL. However, only higher levels of social activities were related to increased physical HRQOL. The impact of increased social participation on improvements in both mental and physical HRQOL should be further investigated to inform program development and education for burn survivors on avenues to improve overall HRQOL. Further investigation is warranted to confirm the impact of life satisfaction pre-injury on these results. Applicability of Research to Practice These results reinforce the importance of social participation during recovery from burn injury, particularly as it relates to mental health.
Mitochondrial toxicity resulting in myopathy and lactic acidosis has been described in antiretroviral (ARV)-exposed patients. We hypothesized that myopathy in HIV-infected, ARV-treated children would ...be associated with metabolic (acylcarnitines) and genetic (variants in metabolic genes) markers of dysfunctional fatty acid oxidation (FAO).
Acylcarnitine profiles (ACP) were analyzed for 74 HIV-infected children on nucleoside reverse transcriptase inhibitor (NRTI)-containing ARV. Thirty-seven participants with ≥2 creatine kinase measurements >500 IU (n = 18) or evidence of echocardiographic cardiomyopathy (n = 19) were matched with 37 participants without myopathy. Single nucleotide polymorphisms (SNPs) in FAO genes were also evaluated.
Abnormal ACP was 73% (95% CI: 56%-86%) and 62% (95% CI: 45%-78%) in the myopathic and nonmyopathic groups, respectively. No significant association was found between myopathy and having an abnormal ACP (OR = 2.10, P = 0.22). In univariate analysis, a 1-year increase in NRTI use was associated with a 20% increase in odds of at least 1 ACP abnormality OR (95% CI) = 1.20 (1.03-1.41); P = 0.02), and a 1-year increase in protease inhibitor use was associated with 28% increase in the odds of having at least 1 ACP abnormality OR (95% CI) = 1.28 (1.07-1.52); P = 0.006). Three SNPs, all in the gene for the carnitine transporter ( SLC22A5 ), were associated with the cardiomyopathy phenotype.
FAO appears to be altered in HIV-infected children with and without myopathy, but abnormal FAO does not fully explain myopathy in ARV-exposed children. Further study of SLC22A5 variation in ARV-exposed people is warranted carnitine transporter dysfunction-related cardiomyopathy may be treatable.
Greater access to college education, owed in part to technology and globalization, increases opportunities for students to prepare and thrive professionally. Undergraduate education must offer ...pedagogies of engagement to meet needs of the competitive global workforce and post-baccalaureate programs requiring advanced research and analytical skills. Many universities and colleges recognize the critical need for undergraduate engagement in research and participation in professional world experiences to cultivate aptitudes required in the 21st century. Using a triangulation inquiry methodology, this empirical study contributes to the research on undergraduate research mentorship pedagogy by assessing its merits operationalized across multiple disciplines at a public liberal arts university. Findings support the added value of the pedagogy in its capacity to optimize marketable aptitudes. The study presents participants' unique voices, as their perceptions are significant in identifying the value-added by this pedagogy.
The 19th annual Michigan Womyn's Music Festival is criticized for supporting sadomasochism while having a policy against violence against women. Sadomasochism within the lesbian community should not ...be promoted by increasing the number of sadomasochist vendors and increased visibility of sadomasochists and their paraphernalia.
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