CONTEXT: Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites.

OBJECTIVES: To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided.

EVIDENCE: A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication.

CONCLUSIONS: Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/73822/j.1526-4637.2003.03034.x.pdf?sequence=1&isAllowed=y

The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain

Gender differences in substance use disorders.

Our understanding of the relationship between physical activity and health is constantly evolving. Therefore, the British Association of Sport and Exercise Sciences convened a panel of experts to review the literature and produce guidelines that health professionals might use. In the ABC of Physical Activity for Health, A is for All healthy adults, B is for Beginners, and C is for Conditioned individuals. All healthy adults aged 18-65 years should aim to take part in at least 150 min of moderate-intensity aerobic activity each week, or at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities. Moderate-intensity activities are those in which heart rate and breathing are raised, but it is possible to speak comfortably. Vigorous-intensity activities are those in which heart rate is higher, breathing is heavier, and conversation is harder. Aerobic activities should be undertaken in bouts of at least 10 min and, ideally, should be performed on five or more days a week. All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence. Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults. Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends. Conditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, or 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities. Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals. Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5-16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.

http://www.lsmarconi.it/documenti/edfisica/abc_attivita_fisica.pdf

The ABC of physical activity for health: A consensus statement from the British Association of Sport and Exercise Sciences

Objective The goals of this study were to explore gender differences in demographic variables, psychiatric comorbidity, and personality disorders in individuals with substance use disorders. Method A total of 100 treatment-seeking substance users (50 men and 50 women) admitted to a university-based and a university-affiliated private chemical dependency hospital were compared with regard to demographic variables and comorbid psychiatric and personality diagnosis according to the Structured Clinical Interview for DSM-III-R after 14-21 days in treatment. Results Men were significantly more likely to have a higher household income and to be alcohol dependent. Women were significantly more likely to have another axis I disorder in addition to substance use disorder, particularly anxiety disorders, but these gender differences were not substantially different from the gender prevalence of these disorders in the general population. Men had more affective disorders relative to women than would be expected from the general population data. Female alcoholics had substantially more psychopathology than male alcoholics, and generally these differences were consistent with the ratios of these disorders in the general population. For cocaine users, female/male ratios of anxiety and affective disorders were inconsistent with general population ratios and indicated more psychopathology than would be expected in male cocaine users. There were no gender differences in axis II diagnoses. Conclusions Some of the gender differences in psychopathology in substance users are at odds with gender differences for psychopathology in the general population. Further exploration of these differences could have important theoretical and treatment implications.

Coping strategies and burnout among veteran child protection workers.

Mental Health Effects of Women's Multiple Roles.

The following research article adeptly highlights the considerations which influence the effects of multiple roles on women’s mental health. It ident$es factors viewed by researchers as providing clues to how women cope and why they encounter role strain as they adjust to changing roles in American society and seek to meet their own needs for career fulfillment and economic gain. “Role strain” is one of the factors identified as contributing to prescription drug use in female health professionals. It also plays a role in increased reliance on alcohol and other drugs for individuals at risk, as well as perpetuating use. The article provides interesting background for individuals working with recovering nurses and women with addiction problems.

Mental Health Effects of Women's Multiple Roles

The Parent Report of Psychosocial Care was developed to address the concerns, needs for care and satisfaction with care received of parents of children with new-onset seizures. Parents were interviewed three months and six months after their child's first seizures using the instrument. Mothers especially identified continued needs for information and support and were worried about unlikely events such as brain tumors and death. The results from this study indicate that parents' needs for information and support need to be assessed at every encounter with the health care system during the first 6 months after the child's first seizure.

Psychosocial care needs of parents of children with new-onset seizures. 3.

Nursing and the informatics revolution.

Parenteral attitudes and adjustment to epilepsy were assessed for 50 parents of children aged 6 to 14 with epilepsy. Fishbein's Expectancy-Value Model of Attitude was used to assess parental attitudes. Parental adjustment was measured both by a self-report instrument and by an independent psychosocial assessment conducted by a psychiatric social worker. The major finding was a strong positive relationship (R = .67, p less than .001) between parental attitude and adjustment for the mothers. The attitude-adjustment relationship was not significant for the fathers. In addition, parental attitudes and perception of seizure control accounted for 60% of the variance in the mothers' adjustment scores. Seizure control was significantly positively related (p less than .05) to parental adjustment.

Angela Barron McBride

Papers

Mental Health Effects of Women's Multiple Roles.

Mental Health Effects of Women's Multiple Roles

Psychosocial care needs of parents of children with new-onset seizures. 3.

Nursing and the informatics revolution.

Parental attitude and adjustment to childhood epilepsy.