Psychosocial headache measures in Caucasian and African American headache patients: Psychometric attributes and measurement invariance

Introduction: As research increasingly examines differences in headache characteristics between Caucasian and African American headache patients, it is requisite to determine the equivalence of existing headache measures for both racial groups. Methods: This study examined the psychometric properties and measurement invariance of four widely used psychosocial headache measures. Caucasians ( N = 173) and African Americans ( N = 114) receiving treatment in four headache subspecialty clinics throughout Ohio completed the Headache Disability Inventory (HDI), the Migraine-Specific Quality of Life (MSQL) measure, the Headache Management Self-Efficacy (HMSE) scale, and the Headache-Specific Locus of Control (HSLC) scale prior to initiating new preventive therapies. Conclusion: All measures demonstrated good internal consistency and measurement invariance. Despite adequate measurement invariance, the recommended factor structure of the HMSE scale yielded a poor fit for both African American and Caucasian patients. With perhaps the exception of the HMSE scale, the HDI, MSQL scale and HSLC scale are psychometrically sound and can be used with both Caucasian and African American headache patients.

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Effects of race on blood loss in spinal fusions for adolescent idiopathic scoliosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds2049 ◽

2020 ◽

pp. 1-5

Author(s):

Neil Kaushal ◽

Keith J. Orland ◽

Andrew M. Schwartz ◽

Jacob M. Wilson ◽

Nicholas D. Fletcher ◽

...

Keyword(s):

African American ◽

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Posterior Spinal Fusion ◽

Transfusion Rate ◽

Racial Groups ◽

Significant Difference ◽

History Of ◽

Caucasian Patients

OBJECTIVEPosterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associated with significant blood loss. It has been suggested that blood loss is greater in different racial groups. The purpose of this study was to evaluate differences in blood loss between African American and Caucasian patients undergoing PSF for AIS.METHODSA retrospective review was performed of patients aged 10–18 years with AIS who were treated with PSF from 2014 to 2017 at a single children’s healthcare system. Patient demographic, radiographic, and operative data were obtained from medical records. Intraoperative blood loss was calculated using the formula described by Waters et al. Patients who declined reporting their race or had prior spinal surgery, neuromuscular or syndromic diagnoses, a history of cardiac or thoracic surgery, or a bleeding disorder were excluded. Blood loss variables were log-transformed for normality and modeled using multivariable linear regression.RESULTSA total of 433 PSFs for AIS qualified for the analysis. The average age was 14.1 years, and 73.7% of the patients were female. With respect to race, 44.6% identified themselves as African American. There was no significant difference in blood loss (p = 0.31) or blood loss per level fused (p = 0.36) in African American patients. African American patients, however, did have significantly lower preoperative hemoglobin and hematocrit levels and greater operating room time than Caucasian patients (p < 0.001). There was no difference between race and transfusion rate.CONCLUSIONSThere appears to be no relationship between race and blood loss during PSF for AIS. Standardized protocols for minimizing perioperative blood loss can be applied to both Caucasian and African American patients.

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Conceptualizing Protective Family Context and Its effect on Substance Use: Comparisons Across Diverse Ethnic-Racial Youth

10.31234/osf.io/abfs3 ◽

2019 ◽

Author(s):

Kevin Constante ◽

Edward Huntley ◽

Emma Schillinger ◽

Christine Wagner ◽

Daniel Keating

Keyword(s):

Substance Use ◽

Measurement Invariance ◽

Latent Variables ◽

Latent Variable ◽

Path Model ◽

Family Context ◽

Partial Metric ◽

Racial Groups ◽

Protective Methods ◽

Family Variables

Background: Although family behaviors are known to be important for buffering youth against substance use, research in this area often evaluates a particular type of family interaction and how it shapes adolescents’ behaviors, when it is likely that youth experience the co-occurrence of multiple types of family behaviors that may be protective. Methods: The current study (N = 1716, 10th and 12th graders, 55% female) examined associations between protective family context, a latent variable comprised of five different measures of family behaviors, and past 12 months substance use: alcohol, cigarettes, marijuana, and e-cigarettes. Results: A multi-group measurement invariance assessment supported protective family context as a coherent latent construct with partial (metric) measurement invariance among Black, Latinx, and White youth. A multi-group path model indicated that protective family context was significantly associated with less substance use for all youth, but of varying magnitudes across ethnic-racial groups. Conclusion: These results emphasize the importance of evaluating psychometric properties of family-relevant latent variables on the basis of group membership in order to draw appropriate inferences on how such family variables relate to substance use among diverse samples.

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Social determinants of health affecting treatment of pediatric brain tumors

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.4.peds18594 ◽

2019 ◽

Vol 24 (2) ◽

pp. 159-165

Author(s):

Jillian M. Berkman ◽

Jonathan Dallas ◽

Jaims Lim ◽

Ritwik Bhatia ◽

Amber Gaulden ◽

...

Keyword(s):

African American ◽

Health Disparities ◽

Brain Tumors ◽

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health ◽

Cns Tumor ◽

Initial Symptoms ◽

Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

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Longitudinal and Gender Measurement Invariance of the Gratitude Questionnaire in Chinese Adolescents

Psychological Reports ◽

10.1177/00332941211036015 ◽

2021 ◽

pp. 003329412110360

Author(s):

Qingsong Tan ◽

Jilin Zou ◽

Feng Kong

Keyword(s):

Measurement Invariance ◽

Time Interval ◽

Longitudinal Measurement Invariance ◽

Multiple Group ◽

Longitudinal Measurement ◽

Confirmatory Factor ◽

Adolescent Sample ◽

Good Internal Consistency ◽

And Gender ◽

Mean Differences

The 5-item Gratitude Questionnaire (GQ-5) is one of the most commonly used instruments to measure dispositional gratitude in adolescents. The purpose of this study was to verify the longitudinal measurement invariance (LMI) and gender measurement invariance (GMI) of the GQ-5 that was administered to an adolescent sample twice over the course of 18 months ( N = 669). Single-group confirmatory factor analysis (CFA) was adopted to examine the LMI and multiple-group CFA was conducted to assess the GMI. The results showed that the GQ-5 had strong invariance (i.e., equality of factor patterns, loadings, and intercepts) across time and gender. Validation of latent factor mean differences showed that females had higher gratitude scores than males. In addition, the GQ-5 exhibited good internal consistency indices across time and a moderate stability coefficient was also found across an 18-month time interval in adolescents. In summary, our study showed that LMI and GMI of the GQ-5 are satisfactory and the GQ-5 is a reliable instrument for measuring gratitude in adolescents.

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223 Racial differences in outcomes for metastatic renal cell carcinoma (mRCC) patients managed on immune-checkpoint inhibitor (ICI) therapy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0223 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A242-A242

Author(s):

T Anders Olsen ◽

Dylan Martini ◽

Subir Goyal ◽

Yuan Liu ◽

Sean Evans ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

African American ◽

Retrospective Study ◽

Cell Carcinoma ◽

Clinical Outcomes ◽

Immune Checkpoint ◽

Renal Cell ◽

Clear Cell ◽

Emory University ◽

Caucasian Patients

BackgroundImmune checkpoint inhibitors (ICIs) have increased in prevalence for the treatment of metastatic clear-cell renal cell carcinoma (mccRCC) in recent years given their efficacy and favorable toxicity profile. However, there has been insufficient investigation in the literature of how clinical outcomes differ on the basis of race. In this paper, we investigated differences in clinical outcomes between African American (AA) and Caucasian mRCC patients treated with ICI therapy.MethodsWe performed a retrospective study of 198 patients with mRCC who received ICI at the Emory Winship Cancer Institute from 2015–2020. Clinical outcomes were measured by overall survival (OS), progression-free survival (PFS), and clinical benefit (CB). OS and PFS were calculated from ICI-initiation to date of death and radiographic or clinical progression, respectively. CB was defined as a best radiographic response of complete response, partial response, or stable disease maintained for at least 6 months per response evaluation criteria in solid tumors version 1.1. The association of self-identified race with OS and PFS was generally modeled by Cox proportional hazards model. Univariable and multivariable logistic regression models were used for binary outcomes of CB. The univariate association of immune-related adverse events (irAEs) and non-clear-cell RCC (nccRCC) with race was assessed using Chi-square test.ResultsOur cohort was made up of 38 AA (19%) and 160 Caucasian (81%) patients. Most of the patients were diagnosed with ccRCC (78%) and more than half received PD-1 monotherapy (57%). Most patients were international mRCC database consortium (IMDC) intermediate (57%) or poor-risk (25%) groups. AA patients displayed significantly shorter PFS (HR=1.52, 95% CI: 1.01–2.3, p=0.045) and trended towards decreased CB (OR=0.51, 95% CI: 0.22–1.17, p=0.111) in MVA (table 1). There was no difference in OS (HR=1.09, 95% CI: 0.61–1.95, p=0.778) between the two racial groups in MVA (table 1). On Kaplan-Meier method, AA patients had shorter median OS (17 vs 25 months, p=0.3676) and median PFS (3.1 vs 4.4 months, p=0.0676) relative to Caucasian patients (figure 1). Additionally, AA patients more commonly had nccRCC compared to Caucasian patients (41.7% vs 17.5% nccRCC, p-0.002). AA patients also trended towards a lower incidence of irAEs compared to Caucasian patients in UVA (23.7% vs 35.8%, p=0.153).Abstract 223 Table 1*MVA controlled for age, race, gender, IMDC risk group, number of prior lines of therapy, PD-1 monotherapy, and ccRCC**statistical significance at alpha < 0.05Abstract 223 Figure 1African-American (black) and Caucasian (white) for OS (left panel) and PFS (right panel)ConclusionsIn this group of mRCC patients treated with ICI, African American patients had significantly shorter PFS compared to Caucasian patients. These findings suggest race could play a role in the management of late-stage mRCC. Larger, prospective studies are needed to validate these findings.AcknowledgementsResearch reported in this publication was supported in part by the Breen Foundation and the Biostatistics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Trial RegistrationNot applicable.Ethics ApprovalThis retrospective study was approved by the Emory University Institutional Review Board.ConsentNot applicable.ReferencesNot applicable

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The Differential Diagnosis in Nonlymphoproliferative Malignant Pleural Effusion Cytopathology and Its Correlation with Patients’ Demographics

Acta Cytologica ◽

10.1159/000493336 ◽

2018 ◽

Vol 62 (5-6) ◽

pp. 436-442 ◽

Cited By ~ 3

Author(s):

Erika F. Rodriguez ◽

Sayanan Chowsilpa ◽

Zahra Maleki

Keyword(s):

Differential Diagnosis ◽

African American ◽

Pleural Effusion ◽

Malignant Pleural Effusion ◽

Primary Site ◽

Gi Tract ◽

Asian Patients ◽

Caucasian Patients ◽

The Impact ◽

Upper Gastrointestinal

Background: We report our experience with malignant pleural effusion (MPE) and the impact of patients’ demographics on the differential diagnosis at the primary site. Methods: After IRB approval, we searched our pathology database from January 2013 to January 2017 for patients with positive pleural effusions (PEs). Patients’ demographics and clinical histories were noted. Results: 474 patients were identified (288 females [61%] and 186 males [39%]), ranging in age from 19 to 64 years old. Ethnicity was distributed as follows: Caucasian (n = 330, 70%), African American (n = 114, 24%) and Asian (n = 30, 6%). The most common primary sites were the lung (n = 180, 37%), followed by the breast (n = 81, 17%), and the gynecologic system (67, 13%). The lung was the most common primary for all ethnicities (n = 190, 40%). The second-most common primary site was the breast in African Americans and Caucasians and upper gastrointestinal (GI) tract in Asians. In 5 cases (1%), the primary tumor could not be determined. Conclusion: Cytology examination is a useful method to diagnose primary sites of PE. Pulmonary primary is the most common cause of effusion in all ethnicities. In African American and Caucasian patients, the breast was the second-most common site of MPE, while in Asian patients it was the upper GI tract.

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Management of Primary Headache in the Emergency Department

10.30756/ahmj.2020.02.01 ◽

2020 ◽

Author(s):

Richard Pescatore

Keyword(s):

Emergency Department ◽

Symptom Relief ◽

Disease Process ◽

Primary Headache ◽

Overwhelming Majority ◽

Diagnostic Process ◽

Primary Headaches ◽

Emergency Setting ◽

Headache Management ◽

Headache Patients

Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.‎1 While the overwhelming majority of patients present with a primary headache disorder, particularly migraine, the emergency physician’s role calls for the simultaneous exclusion of severe or life-threatening pathology while providing judicious and effective symptom relief.‎2 Notably, recent investigations suggest that this dual mandate performs well, excluding more than 99% of conditions resulting in serious adverse neurologic sequelae, though at the cost of high-frequency and low-yield advanced imaging utilization.‎3‎, 4 While a comprehensive understanding of the diagnostic process and underlying pathophysiology associated with headache disorders is critical for the emergency clinician, this review is meant to chiefly describe the treatment of primary headache and the variety, efficacy, and indications of those interventions. While individual headache type classification can be helpful in targeting approach or therapy, diagnosis can be difficult in the emergency setting, and primary headaches of most types are often approached similarly in the ED. Interestingly, the overwhelming majority of patients who present to an emergency department with acute primary headache have migraine, but the majority of patients receive a less specific diagnosis and a treatment that is correspondingly nonspecific.‎5 Importantly, however, the dynamic, diverse, and unique nature of different headache presentations to the ED make an algorithmic or step-wise approach to headache management ill-advised. The emergency practitioner must have a working knowledge of the array of treatment options available and apply therapies in a considered and informed manner. Following effective analgesia, however, the most important intervention emergency physicians can deliver for their headache patients is to connect them with outpatient physicians savvy about headache management, who will then provide these headache patients with appropriate acute therapeutics, initiate preventive therapy and provide anticipatory guidance about their disease process.‎6

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Speaking Fundamental Frequency Characteristics of White, African American, and Hispanic Kindergartners

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3903.573 ◽

1996 ◽

Vol 39 (3) ◽

pp. 573-577 ◽

Cited By ~ 33

Author(s):

Shaheen N. Awan ◽

Peter B. Mueller

Keyword(s):

African American ◽

Fundamental Frequency ◽

Frequency Characteristics ◽

African American Children ◽

Racial Groups ◽

Hispanic Children ◽

Speech Language Pathologist ◽

American Children ◽

Speaking Fundamental Frequency

Speech samples from groups of White, African American, and Hispanic kindergarten-age children were compared on measures of mean speaking fundamental frequency (F o ), maximum and minimum speaking F o , pitch sigma, and speaking range (in semitones). Results indicate that there are significant differences between racial groups on measures of mean speaking F o and speaking range. In particular, the Hispanic children were observed to have increased mean speaking F O S in comparison with the African American children and reduced speaking ranges as compared to both African American and White racial groups. Results indicate that the speech-language pathologist must exercise discretion when assessing the speaking F o characteristics (particularly mean speaking F o and speaking range) of children from different racial groups.

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Abstract 15685: Multicenter Analysis of Advanced Heart Failure Referral Outcomes by Race

Circulation ◽

10.1161/circ.142.suppl_3.15685 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jared J Herr ◽

Farooq Sheikh ◽

Parin Patel ◽

Anuradha Lala ◽

Christopher Chien ◽

...

Keyword(s):

Heart Failure ◽

Racial Differences ◽

Patient Preference ◽

Univariate Analysis ◽

Advanced Heart Failure ◽

Racial Groups ◽

Physician Characteristics ◽

Multicenter Survey ◽

Multicenter Analysis ◽

Caucasian Patients

Background: Advanced heart failure (AHF) therapies can improve survival in Stage D HF patients. We sought to evaluate racial differences in AHF therapy referrals and decision-making across a multicenter survey. Methods/Results: We performed a retrospective analysis of patients referred for evaluation for AHF therapies at 9 centers (N=515) across the country. Data included: demographics, clinical/referring physician characteristics and evaluation outcomes. By identified racial/ethnic groups, referrals comprised of 55.7% Caucasian, 29.9% African American, 9.1% Hispanic, and 4.7% Asian. Univariate analysis was performed between Caucasian and a combined non-Caucasian group. Most patients were advanced in their disease state, with 47.7% of Caucasian and 55.7% of non-Caucasian patients having EF<20% with a high risk INTERMACS profiles (1-3), 77% and 71.1% respectively. Non-ischemic etiology was more common in non-Caucasians (66.6% vs. 47.4% p=0.001), ischemic etiology more common in Caucasians (41.1% vs. 23.2% p=0.001). The primary reasons for Caucasians to be referred were ventricular arrhythmias (7.6% vs. 3%, p=0.024) and pulmonary hypertension (3.4% vs 0.4% p=0.018), while non-Caucasians were referred most for worsening heart failure (35.9% vs. 25.4% p=0.009). Non-Caucasians were more likely to be declined/deferred for LVAD (45.9% vs. 39.7% p=0.014) or transplantation (48.2% vs. 66.9% p=0.002). Patient preference to not pursue LVAD therapy differed significantly between the groups (Non-Caucasians 17.6% vs. Caucasians 9.6% p=0.022). Conclusions: In this multicenter analysis of referrals for AHF therapies, significant differences exist in referral characteristics and evaluation outcomes between Caucasian and non-Caucasians. The driving factor for not offering LVAD therapy in non-Caucasians was patient preference, raising concerns for potential differences in patient education surrounding AHF therapies between racial groups. Further investigation is needed to explore these differences and why non-Caucasians were more likely to be declined or deferred for LVAD and transplantation.

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Abstract TP26: Endovascular Therapy and Outcomes in a Large Biracial Cohort of Patients with Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp26 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Leticia C Rebello ◽

Aaron Anderson ◽

Diogo C Haussen ◽

Samir R Belagaje ◽

Jonathan A Grossberg ◽

...

Keyword(s):

African American ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Ethnic Disparities ◽

Stroke Outcomes ◽

Good Outcome ◽

Caucasian Patients ◽

Baseline Characteristics ◽

The Impact

Background: The ethnic disparities in stroke outcomes have been well described. Stroke is twice more common and leads to higher mortality rates among blacks as compared to whites. We compared the outcomes of patients undergoing endovascular stroke therapy (ET) in a high-volume center according to their racial profile after age adjustment. Methods: Retrospective analysis of a prospectively collected ET database between September/2010-September/2015. The baseline characteristics of African-American vs. Caucasian patients were compared. Given the impact of age on stroke outcomes additional analyses were performed dichotomizing patients using the median age of the overall cohort. Primary and secondary efficacy outcomes included the rates of good outcome (90-day mRS 0-2) and successful reperfusion (mTICI 2b-3), respectively. Safety outcome was accessed by rates of any parenchymal hematoma (PH-1 and PH-2) and 90-day mortality. Results: 781 patients fit the inclusion criteria and were included in the analysis; 440 were included in the Caucasian group (56% overall cohort) and 341 in the African-American group (44%). Caucasian patients were significantly older (69±13 vs. 60±14 years-old, p<0.01) but the remaining baseline characteristics were otherwise well-balanced. This included similar baseline CT perfusion core volumes (rCBF<30%, 17.6 ± 20.8 vs. 17.9 ± 32.8; p=0.93). There were no differences in the rates successful reperfusion (mTICI 2b-3: 83% vs. 85%, p=0.37), any PH (8% vs. 5%, p=0.26), or final infarct volume (32 IQR 12-89 vs. 25 IQR 9-67; p=0.12) across the two groups. In the overall cohort, there was a lower proportion of 90-day good outcome (39% vs. 49%; p<0.01) and higher 90-day mortality (32% vs. 16%; p<0.01) among Caucasians presumably due to their older age. Subgroup analysis of patients 65 years-old or younger showed similar rates of 90-day good outcomes (59% vs. 53%; p=0.33) and mortality (17% vs. 12%; p=0.22) across Caucasian and African-American patients. Conclusion: Aggressive treatment of acute ischemic stroke with endovascular therapy leads to similar outcomes across African-American and Caucasian patients. Greater availability of ET may diminish the ethnic/racial disparities in stroke outcomes.

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