Migraine care among different ethnicities: do disparities exist?

Sociodemographic differences in diagnosis and treatment of pediatric headache

The authors investigated the sociodemographic differences in receiving a headache diagnosis for pediatric health care visits using 2 nationally representative databases--the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. For those visits involving a headache diagnosis, the authors explored 2 possible disparities in care--being diagnosed by a neurologist and being prescribed an evidence-based medication. A headache diagnosis was less common during visits for private insurance patients versus Medicaid patients. In addition, while a headache diagnosis was equally likely for visits by Caucasian American children versus African American children and children of other races, visits for the latter 2 groups were less likely to involve a headache diagnosis from a neurologist. Finally, only 37% of the headache visits involved a prescription of an evidence-based medication. The authors conclude that some sociodemographic disparities exist in pediatric headache care across the United States.

Racial and ethnic disparities in pain: causes and consequences of unequal care

The purpose of our review is to evaluate critically the recent literature on racial and ethnic disparities in pain and to determine how far we have come toward reducing and eliminating disparities in pain. We examined peer-reviewed research articles published between 1990 and early 2009 that focused on racial and ethnic disparities in pain in the United States. The databases used were PubMed, Medline, Scopus, CINAHL, and PsycInfo. The probable causes of minority group disparities in pain are discussed, along with suggested strategies for eliminating pain-related disparities. This review reveals the persistence of racial and ethnic disparities in acute, chronic, cancer, and palliative pain care across the lifespan and treatment settings, with minorities receiving lesser quality pain care than non-Hispanic whites. Although health and health care disparities attract local, state, and federal attention, disparities in pain care continue to be missing from publicized public health agendas and health care reform plans. Ensuring optimal pain care for all is critically important from a public health and policy perspective. A robust research program on disparities in pain is needed, and the results must be successfully translated into practices and policies specifically designed to reduce and eliminate disparities in care.

PERSPECTIVE

This review evaluates the recent literature on racial and ethnic disparities in pain and pain treatment. Racial and ethnic disparities in acute pain, chronic cancer pain, and palliative pain care continue to persist. Rigorous research is needed to develop interventions, practices, and policies for eliminating disparities in pain.

Chronic headache: the role of the psychologist

The role of the psychologist in chronic headache needs to be tailored to the patient's presentation. For some patients, psychological issues need to be directly addressed (eg, psychiatric comorbidity, difficulties coping with headache, significant problems with sleep and/or stress, medication overuse, and history of abuse). Other situations (eg, patients' beliefs about their readiness to change ability to actively manage headaches, medication adherence, and managing triggers) involve behavioral/psychological principles even when there is no direct contact with a psychologist. This article reviews the literature on the importance of psychological issues in headache management and provides suggestions for how to address behavioral and cognitive factors and their potential for improved headache care.

Racial differences in medical mistrust among men diagnosed with prostate cancer

BACKGROUND

Mistrust of healthcare providers and systems is a significant barrier to quality healthcare. However, limited empirical data are available on perceptions of medical mistrust among individuals who are diagnosed with cancer. The objective of this study was to identify sociodemographic, clinical, and cultural determinants of mistrust among men diagnosed with prostate cancer.

METHODS

The authors conducted an observational study among 196 African-American men (n = 71) and white men (n = 125) who were newly diagnosed with prostate cancer during 2003 through 2007.

RESULTS

Race, education, healthcare experiences, and cultural factors had significant effects on mistrust. African-American men (P = .01) and men who had fewer years of formal education (P = .001) reported significantly greater levels of mistrust compared with white men and men who had more education. Mistrust also was greater among men who had been seeing their healthcare provider for a longer period (P = .01) and among men with lower perceptions of interdependence (P = .01).

CONCLUSIONS

The current findings suggested that efforts to enhance trust among men who are diagnosed with prostate cancer should target African-American men, men with fewer socioeconomic resources, and men with lower perceptions of interdependence. Reasons for deterioration in trust associated with greater experience with specialty providers should be explored along with the effects of interventions that are designed to address the concerns of individuals who have greater mistrust.

Whites and African-Americans in Headache Specialty Clinics Respond Equally Well to Treatment

This study sought to determine if Whites and African-Americans respond similarly to headache treatment administered in ‘real-world’ headache specialty treatment clinics. Using a naturalistic, longitudinal design, 284 patients receiving treatment for headache disorders completed 30–day daily diaries that assessed headache frequency and severity at pretreatment and 6–month follow-up and also provided data on their headache disability and quality of life at pretreatment and 1–, 2– and 6–month follow-up. Controlling for socioeconomic status and psychiatric comorbidity, hierarchical linear models found that African-Americans and Whites reported significant reductions in headache frequency and disability and improvements in life quality over the 6–month treatment period. African-Americans, unlike Whites, also reported significant decreases in headache severity. Nevertheless, Africans-Americans had significantly more frequent and disabling headaches and lower quality of life after treatment relative to Whites. Although Whites and African Americans responded favourably to headache treatments, more efficacious treatments are needed given the elevated level of headache frequency that remained in both racial groups following treatment.

Underrepresentation of African Americans in online cancer support groups

The Internet is increasingly important for many cancer survivors because it provides access to the latest information on cancer treatments and also allows them to receive support by participating in online cancer support groups. Unfortunately, little is known about why African-American cancer survivors are underrepresented in online cancer support groups. This article reviews the relevant literature and discusses three possible explanations for why African Americans are underrepresented in online cancer support groups: the digital divide/digital inequality, preferences for face-to-face support or culture-specific online support, and trust concerns. We conclude that a health inequity exists with regard to the utilization of information that can be obtained from online cancer support groups. However, with regard to the potential benefits of the psychosocial and emotional support aspect of online cancer support groups, a health inequity may not exist, as African Americans have other preferred avenues for obtaining needed support, and there is no evidence that this is detrimental to their health.

Psychological risk factors in headache

Headache is a chronic disease that occurs with varying frequency and results in varying levels of disability. To date, the majority of research and clinical focus has been on the role of biological factors in headache and headache-related disability. However, reliance on a purely biomedical model of headache does not account for all aspects of headache and associated disability. Using a biopsychosocial framework, the current manuscript expands the view of what factors influence headache by considering the role psychological (i.e., cognitive and affective) factors have in the development, course, and consequences of headache. The manuscript initially reviews evidence showing that neural circuits responsible for cognitive-affective phenomena are highly interconnected with the circuitry responsible for headache pain. The manuscript then reviews the influence cognitions (locus of control and self-efficacy) and negative affect (depression, anxiety, and anger) have on the development of headache attacks, perception of headache pain, adherence to prescribed treatment, headache treatment outcome, and headache-related disability. The manuscript concludes with a discussion of the clinical implications of considering psychological factors when treating headache.