Chronic pain is a significant problem in the U.S. pediatric population, conservatively estimated to affect 15% to 20% of children. Few studies have focused on coping strategies African American children use to manage chronic pain. The purpose of this study was to examine coping strategies used by African American children and adolescents ages 11 to 18 years suffering from chronic pain and to examine gender and age differences in this population. The gate control theory provided the framework for the study. The Pain Coping Questionnaire was used to measure coping strategies in a convenience sample of 44 children and adolescents recruited from pain clinics and online pain support groups. Descriptive statistics indicated that active coping was used most often, and emotion-focused coping was used least often. Analyses of variance indicated that age was positively related with cognitive distraction, that male participants used problem-solving more often than female participants, and that female participants sought out social support and used internalizing/catastrophizing more often that male participants. Findings may be used to improve assessment and management of chronic pain by providing mental health professionals and doctors with a better understanding of African American children and adolescents' coping strategies.

archives@tulane.edu / Background Ankle brachial index (ABI) is a noninvasive measure of subclinical cardiovascular disease (CVD) and atherosclerosis of the lower extremities. Low and high levels of ABI are associated with cardiovascular mortality and vascular calcification in dialysis chronic kidney disease (CKD) patients. However, the association of the spectrum of vascular calcification with low and high ABI is not well studied in pre-dialysis CKD patients. The purpose of this study is to investigate the association of both low and high ABI with the risk of vascular calcification in CKD patients. Methods We recruited 243 patients with pre-dialysis CKD from the great New Orleans area between 2010 and 2012. Our study used a cross-sectional design with ABI and CAC measured at the same visit. Continuous ABI measurements were taken and further classified into four categories : <=0.9 (low ABI) >0.9-<1.0 (borderline), 1.0-<1.4 (normal), >=1.4 (high). Level of vascular calcification were considered as the outcome and calculated by agatston score. Three categories of CAC is defined as: CAC agaston score=0, 0-100, >100. Three cumulative logit models were applied to the data. The first is an unadjusted univariate model, the second adjusts for baseline demographics, and the third adjusts for baseline demographics and covariates that are associated with CAC. Logistic regression methods were used to calculate the odds ratio of having a higher CAC score for CKD patients. Results We found a significant association between ABI and vascular calcification. All three models returned consistently significant result (p=0.0005, 0.0005, 0.0037, respectively) for the association between ABI and CAC. In addition, low ABI (ABI≤0.9) is also associated with an increased risk of CAC and severe CAC (OR=6.183, 95%CI(1.085, 35.228)). High ABI (>1.4) is also associated with an increase in CAC and severe CAC (OR=5.064, 95%CI (1.696, 15.122)). Borderline ABI (0.9<ABI<1.0) is not associated with an increase in CAC or severe CAC (OR=2.704, 95% CI (0.702, 10.418). Conclusion Compared to normal ABI level, low and high ABIs are both significantly associated with an increased risk of coronary artery calcification and severe coronary artery calcification in CKD patients. / 1 / Shuo Bai

The purpose of this study was to determine the service needs being met and the needs not being met as perceived by the chronically homeless who call the park their home. The authors thought this an important study to examine to better understand the service needs of the homeless. The study used a qualitative design for collecting data which involved face-to-face interviews with ten of the homeless people at the park. Four primary themes, three of which had two subthemes each, were identified through a thematic analysis. The primary theme of mistrust of services had subthemes of safety and restrictions and ineffective services. The primary theme of services needed was subdivided into problem identified and potential solutions. The families theme contained subthemes fractured families and park community as family. The theme of hopelessness did not have any subthemes. It was concluded that research should continue in this field and funding should be used to focus on providing services as specified through these themes.

Introducción: Perú tiene una gran población carcelaria de aproximadamente setenta y seis mil ciento ochenta internos (76 180). Las principales morbilidades de esta población son una alta prevalencia de enfermedades crónicas como el cáncer, la diabetes, la hipertensión, la enfermedad pulmonar crónica, la ansiedad y la depresión. La falta de actividad física durante el encarcelamiento es uno de los principales factores de riesgo que aumentan el riesgo de desarrollar o empeorar los síntomas de estas enfermedades crónicas. Objetivo: Comparar la prevalencia de práctica deportiva según el autorreporte de enfermedades crónicas de la población penitenciaria del Perú. Materiales y método: Estudio de tipo trasversal , diseño analítico con base secundaria del primer Censo Nacional Penitenciario realizado por el Instituto Nacional de Estadística e Informática (INEI) 2016. Resultado: Las enfermedades crónicas como pulmonares, la diabetes, la ansiedad, el cáncer, la hipertensión arterial (HTA) y la depresión se asociaron estadísticamente con la actividad física (p <0,001). El modelo de Poisson ajustado mostró que los reclusos que se autorreportan enfermedades pulmonares crónicas, diabetes, HTA y cáncer se asociaron con una menor probabilidad de practicar deportes. Sin embargo, los reclusos que se auto-reportaron depresión se asociaron con una mayor probabilidad de practicar deportes. Conclusiones: Las enfermedades crónicas autorreportadas se asociaron con la falta de práctica deportiva. Es muy importante implementar programas de salud que promuevan actividades deportivas de acuerdo con la situación de salud de los internos. / Introduction: Peru has a large prison population of roughly seventy-six thousand and one hundred eighty inmates (76 180). The mains morbidities of this population is a high prevalence of chronic diseases such as cancer, diabetes, hypertension, chronic pulmonary disease, anxiety, and depression. The lack of physical activity during imprisonment is one of the main risk factors that increase the risk of developing or worsening the symptoms of these chronic diseases. Objective: To compare sports practicing prevalence and the self-reporting of chronic diseases among the prison population in Peru. Materials and Method: We did a cross-sectional study using the first National Prison Census database (2016) of the National Institute of Statistics and Information, and we performed a Poisson regression model to determine the factors associated with sports practice. Results: Chronic diseases such as pulmonary failures, diabetes, anxiety, cancer, high blood pressure (HBP) and depression were statistically associated with physical activity (p< 0,001). The adjusted Poisson model showed that inmates that self-report with depression who self-report chronic pulmonary diseases, diabetes, HBP and cancer were associated with less probability of practicing sports. However, inmates who self-report depression were associated with more probability of practicing sports. Conclusion: Self-reporting chronic diseases were associated with lack of practice sports. It is very important to implement health programs that promote sports activities according to inmates health situation. / Tesis

Chronic pain and excessive alcohol consumption are individually problems in our society today. Alcohol Use Disorder (AUD) affects 15.1 million adult Americans each year. Chronic pain affects over 100 million people annually in the United States. However, there is growing evidence suggesting that these two conditions can often be interrelated with chronic pain increasing consumption of alcohol, and excessive alcohol consumption increasing pain that leaves a feedback cycle trapping millions of patients in an ever worsening spiral. Large population-based studies show an association between pain and alcohol abuse, suggesting a link between increased alcohol use and reduced pain. While rodent studies consistently demonstrate antinociception following acute ethanol administration in hot-plate and tail-flick tests. However, little is currently known about the effects of alcohol in chronic pain models. We hypothesize that acute ethanol administration will possess analgesic-like properties in models of chronic pain by engaging opioid receptors in addition to its more commonly studied action at the GABA receptor. The first aim of this study was to characterize the antinociceptive effects of alcohol in Complete Freund’s Adjuvant (CFA) and Chronic Constriction Injury (CCI) mouse models of chronic inflammatory and neuropathic pain models, respectively. The second aim of this study is to investigate the mechanisms behind ethanol's analgesic like effects including tolerance, receptor activation and correlates with blood alcohol content. Lastly, we investigated whether alcohol maintains its analgesic-like effects in non-reflexive assays in addition to effects in reflexive assays.

Researchers and practitioners have developed new treatment options for chronic pain management based on biopsychosocial models of pain known as interdisciplinary pain management programs (IPMP), which involve interdisciplinary care that integrates physical treatment with emotional, environmental, behavioral, and cognitive interventions. Despite literature documenting the effectiveness of IPMPs, patients find it difficult to obtain authorization for these programs from third party insurance payers. The purpose of this quantitative causal comparative study was to explore whether a patient's perceived quality of life after injury but prior to treatment will affect his or her success in an IPMP. This study was based in the theoretical foundations of the biopsychosocial model of pain as well as positive psychology. Regression analysis and a test of mean differences were used to analyze the data to determine if there was a statistically significant difference in the perceived success in an IPMP program between patients who were part of a workers' compensation program (n = 77) and those who were not (n = 60). None of the null hypotheses could be rejected. Quality of Life Index (QOLI) scores were not predictive of success in an IPMP. None of the QOLI 16 subscales were predictive of success in an IPMP. Additionally, there was no significant difference between patients who were on workers' compensation and those who were not. This study contributes to the knowledge gap regarding appropriate screening tools for admittance into an IPMP. The results of this study can be used by practitioners who are trying to get patients approved for an IPMP and by third party insurance payer when determining which patients would most benefit from attending an IPMP.

Illness. A secret. Feeling alone? Have you ever kept a secret? A life-changing secret that keeps you secluded, isolated, and contained in a bubble, lonely and empty? The daily struggle of coping with your own secret, yet feeling like everyone you come in contact with already knows, takes its toll in the lives of those who carry the burden of a chronic disease. While dealing with judgmental thoughts, and the scrutinizing gaze from others, do we think that the stigma of a medical diagnosis affects our ability to love someone? More specifically, how about being capable of allowing someone to love you knowing that you are HIV positive? In We Were Here, the choreographic research speaks directly to the topic of secrecy and isolation through song, dance, poetry, and videography of people living with life-threatening diseases in today’s society. This piece will take the audience on a short journey through the lives of seven individuals who seek to find peace and understanding in revealing their conditions to their family, friends and loved ones. In seven different journeys, through the highs and lows of coping with a chronic disease, the silver lining of WE WERE HERE, provides a friendly reminder that everyone needs somebody, sometimes.

The purpose of this study was to understand the cultural context in which Amish families manage the care of a child with a chronic illness and how it frames the interface with the larger health care delivery system outside their communities. The aims of this study were to describe Amish families' understanding of their children's chronic illnesses, and to describe Amish families' health management and health seeking behaviors for their children within the Amish community and with health services outside their community. Ethnographic research methods were used to paint a cultural portrait of individuals and families, using data sources such as formal and informal interviews with participants, participant observations in the Amish community and family homes, Amish newspapers, and direct observations in health care clinic settings. Informants in this study included Amish families, Amish community members, and health care providers to illustrate commonalities and differences in perspectives on the chronic illness management for children. The study made use of ethnographic analysis, guided by thematic and cultural narrative techniques, to describe Amish family management for children with chronic illnesses in a way that pulls forward how their cultural background is involved in their behaviors and experiences. The results of this study highlight several points: a) the Amish community influences how families understand and appraise concern for their children's illnesses, and families prioritize children's function as a measure of health/illness and see children as ultimately in the hands of God; b) minimal entanglement with the health care community allows for children to be as normalized as possible into the everyday life of the Amish community; c) families prefer to use home remedies to lower costs, potentially prevent the need for health services, and alleviate their child's symptoms in their own homes and community; d) when seeking health services, families prefer treatments they can manage in their homes, health care providers who are knowledgeable about the use of Amish home remedies for their children, and the ability to make health decisions in consideration of the impact to the greater Amish community. To provide culturally competent care for Amish children, this study describes provider competencies needed to understand and accommodate the child's family cultural orientation, values, beliefs, and health care practices into cooperative care planning. One of the most significant attributes for providers to understand when working with Amish families is their collectivist perspective. As collectivists, these families may place the ultimate Amish community goals of believing in God, separation from society, and traditional lifestyle choices over their own when caring for children with chronic illnesses. This is a difficult competency for health care providers who function within a larger medical legal system that requires the placement of individuals above other considerations. It is at the intersection of these two cultures that this study is situated.

This study sought to provide a description of the psychosocial profile of persons with complex regional pain syndrome (CRPS). CRPS is an excruciatingly painful and debilitating condition that is poorly understood by medical professionals. Its profound impact on an individual's quality of life prompts a closer examination of the psychosocial profile of individuals suffering from CRPS. The extant literature examining psychological variables associated with CRPS is inconclusive with regard to the role that these factors play in the course of the syndrome. It has been shown, however, that CRPS patients suffer tremendous physical discomfort and this is often reflected in increased emotional distress. The present study assesses level of pain, anxiety, depression, disability, intrusive thoughts, quality of life, and demographic variables utilizing a national sample obtained from an online survey distributed to members of an organization that provides resources to CRPS patients. Descriptive data are presented for all data gathered and specific correlates of quality of life were examined. Results of the study demonstrated that this sample endorsed high levels of anxiety and depression and reported low levels of both physical and mental quality of life. When compared to normative data, this sample endorsed more pain and anxiety than other pain populations and also endorsed lower mental and physical quality of life than other pain conditions. The psychosocial profile of individuals with CRPS type I did not vary significantly from individuals with type II. Intrusive thoughts were uniquely predictive of disability, physical quality of life, and mental quality of life after controlling for age, gender, and pain level. The role of intrusive thoughts in predicting disability and quality of life suggests a potential mechanism by which clinicians can target psychotherapeutic treatment. Understanding the psychosocial profile and psychological sequelae of this disorder will help both physicians and psychologists understand the impact of CRPS on patients and provide a pathway for improved comprehensive interdisciplinary treatments.

Increased risk for chronic disease is closely associated with individual nutrition, tobacco use, and physical inactivity. This thesis focuses on physical activity as a means of preventing select chronic diseases. A major barrier preventing engagement in physical activity is the built environment. Populations residing in rural environment are not afforded the abundance of opportunities for physical activity prevalent in most urban networks. Of the demographic living in rural environments, individuals with disability face additional barriers to physical activity than those without disability. This leads to a higher prevalence of chronic diseases associated with sedentary lifestyles among populations with disability. Few studies address the correlation between physical activity, chronic disease, and the built environment as they relate to individuals with disability. This thesis utilized independent samples t tests to evaluate variation among physical activity levels and the prevalence of chronic disease. In the first paper, four research objectives defined the parameters for comparison: (1) physical activity for individuals with disability in rural versus urban environments; (2) physical activity in rural environments for individuals with and without disability; (3) prevalence of chronic disease for individuals with disability in rural versus urban areas; and (4) prevalence of chronic disease in rural environments for individuals with and without disability. The four research objectives of the second paper are: (1) rural and urban physical activity comparison for the highest disability classification; (2) rural and urban physical activity comparison for individuals with disability using equipment; (3) rural and urban physical activity comparison for individuals with disability resulting from physical, mental, or emotional impairments; and (4) rural and urban physical activity comparison for individuals not reporting disability. The 2011 Behavioral Risk Factor Surveillance System (BRFSS) provided the data used to evaluate the correlation between these variables. The results of both studies indicate important statistical significance relating the rural built environment to lower levels of physical activity for individuals with disability. The varied statistical significance and small effect sizes, however, were contrary to the hypothesis and warrants further exploration of the complex relationship regarding the built environment, physical activity, and chronic disease.