Background: The usefulness of laboratory tests in the decision-making process with regard to early identification of dengue virus infection has not been widely reported, particularly the aspartate aminotransferase (AST)/platelet count ratio index during a patient's days of illness. The aim of this study was to examine the pattern of the ratio index over the course of illness and identify whether it is a marker of dengue virus infection in dengue patients, as well as to assess the role of other laboratory tests. Methods: A chart review of 205 dengue patients was analyzed using available records of 845 laboratory results within different time intervals or exam dates during the course of illness. We used repeated measures mixed binary logistic regression analyses to model the dengue virus infection, defined as giving at least one positive antibody test (yes/no). Results: The high risk of dengue virus infection in dengue patients was found in the male gender (adjusted OR = 4.316, 95% CI: 1.285-14.498, P = 0.018), in patients with a high AST/platelet count ratio index (adjusted OR = 1.438, 95% CI: 1.057-1.957, P = 0.021), in patients with a low MCV level (adjusted OR = 0.815, 95% CI: 0.679-0.978, P = 0.028), and in patients with a low ALT level (adjusted OR = 0.996, 95% CI: 0.993-0.999, P=0.010). Conclusion: Laboratory markers, in particular the AST/platelet count ratio index, can be useful for clinicians to strengthen the decision-making process in primary care settings. Furthermore, our model revealed that low MCV and low ALT are predictors of the dengue virus infection, while being a male increases the risk of dengue virus infection. More studies are needed to evaluate the impact of the AST/platelet count ratio index on the severity of dengue fever infection during the onset of symptoms and course of treatment. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Hydroxyurea (HU) therapy in sickle cell anemia (SCA) improves health care utilization, slows organ failure, and prolongs life. Implementation of evidence-based, comprehensive care has been shown to improve health-related quality of life (HRQOL). Case management by community health workers (CHWs) is an evidence-based health management strategy. We therefore hypothesized that HU-eligible SCA adults exposed to patient navigators (PN), CHWs specially trained as case managers for SCA, would have improved HRQOL compared with controls. Methods: We enrolled 224 patients eligible for HU into the Start Healing in Patients with Hydroxyurea (SHIP-HU) Randomized Controlled Trial. All patients received care from trained physicians who implemented use of a standardized HU prescribing protocol using NIH guidelines. Pateints were randomized to either PN intervention (which included case management and education through home, telephone, and/or other visits from PNs) plus standard care by their treating physician (Experimental, E), or standard care by their physician alone (Control, C). Study physicians were blinded to study arm. At baseline, 6 and 12 months we assessed 4 psychosocial HRQOL variables-- ASCQ-Me emotional impact (EMOT), social impact (SOCI), PROMIS global mental (GMENT) and satisfaction with social roles (ROLE); 6 Physical HRQOL variables-- ASCQ-Me Sleep impact (SLEP) and Stiffness (STIFF), PROMIS global physical (GPHYS), Physical health (PHYS), Fatigue (FATG), and sleep/Wake disturbance (WAKE), and 4 pain HRQOL variables-- PROMIS pain behavior (PAINB), and ASCQ-ME-Pain crisis frequency (PAINF), Pain crisis severity (PAINS), and Pain impact (PAIN). Main analyses consisted of mixed model analysis of variance of follow-up visits, controlling for site and baseline value of outcome variable. Any missing baseline values for subjects were imputed. Results: 181 of 224 randomized patients had at least one HRQOL measure at follow-up. Patients had mean age 30.3, 45.3% were male, 81.2% were on HU at baseline. No HRQOL measures were different between groups E and C in any domain (Table, variables grouped by domain). Conclusions: In our sample, there were no differences in HRQOL among patients who were exposed to PNs vs those who weren't. These findings require further analyes before firm conclusions can be made about the isolated effect of PNs on HRQOL. PN dose of intervention was likely variable. HU use and adherence has been associated with higher HRQOL, and we did not predict high baseline HU uptake and adherence which may have led to minimal improvement despite adequate PN intervention. PNs were not allowed to work with MDs, nor did they work with the remainder of the health care team to improve HRQOL. Analyses are underway to examine these and other possible influences on HRQOL. Table. Disclosures Smith: Novartis: Consultancy, Honoraria. Villella:Emmaus: Membership on an entity's Board of Directors or advisory committees; Pfizer: Other: Site PI for the Rivipansel Clinical Trial. Liles:Novartis: Other: PI on clinical trial Sickle cell ; Shire: Other: PI on clinical trial Sickle cell ; Imara: Other: PI on Clinical trial- Sickle cell .

Cost and burden of diagnostic testing may be reduced if fewer tests can be applied. Sequential testing involves selecting a sequence of tests, but only administering subsequent tests dependent on results of previous tests. This research provides guidance to choosing between single tests or the believe the positive (BP) and believe the negative (BN) sequential testing strategies, using accuracy (as measured by the Youden Index) as the primary determinant. Approximately 75% of the parameter combinations examined resulted in either BP or BN being recommended based on a higher accuracy at the optimal point. In about half of the scenarios BP was preferred, and the other half, BN, with the choice often a function of the value of the ratio of standard deviations of those without and with disease (b). Large values of b for the first test of the sequence tended to be associated with preference for BN as opposed to BP, while small values of b appear to favor BP. When there was no preference between sequences and/or single tests based on the Youden Index, cost of the sequence was considered. In this case, disease prevalence plays a large role in the selection of strategies, with lower values favoring BN and sometimes higher values favoring BP. The cost threshold for the sequential strategy to be preferred over a single, more accurate test, was often quite high. It appears that while sequential strategies most often increase diagnostic accuracy over a single test, sequential strategies are not always preferred.

Objective: To develop a survey instrument to identify adult sickle cell disease (SCD) patients on chronic opioid therapy who are at-risk for opioid abuse. Design: Prospective survey and interview.Setting: Adult SCD clinic in a large urban teaching facility.Patients/participants: Convenience sampling of adult patients presenting to the sickle cell clinic.Interventions: None.Main outcome: Primary outcome was “at-risk for opioid misuse,” defined as at least 3/8 “yes” answers (a positive composite score) on the Prescription Opioid Misuse Index (POMI) questionnaire. Secondary outcome was DSM-IV criteria for substance abuse using the DSM IV Diagnostic Interview Schedule.Results: Of the 99 patients who completed the POMI, the mean age was 36 years; 58.6 percent were female, 48 percent were hemoglobin SS (47/99), and 26 percent were SC (26/99). Twenty-four percent (24/99) were identified as at-risk for opioid misuse using the POMI. There were no differences in demographic, SCD genotype, or socioeconomic variables for at-risk versus not-at-risk patients.Conclusion: Twenty-four percent of unselected adult SCD patients on opioids were identified as at-risk for opioid misuse using a quick survey. This may represent as much as 2.5-7 times the national misuse rate. This group of patients may benefit from additional diagnostic and therapeutic interventions to help understand and manage their opioid usage.

Background:Pain diary assessment in sickle cell disease (SCD) may be expensive and impose a high respondent burden.Objective:To report whether intermittent assessment could substitute for continuous daily pain assessment in SCD.Design:Prospective cohort study.Setting:Academic and community practices in Virginia. Patients. A total of 125 SCD patients age 16 years or older in the Pain in Sickle Cell Epidemiology Study. Measurements. Using pain measures that summarized all diaries as the gold standard, we tested the statistical equivalence of four alternative strategies that summarized diaries only from the week prior or the month prior to study completion; one week per month; or one day per week (random day). Summary measures included percent pain days, percent crisis days (self-defined), mean pain (0-9 Likert scale) on all days, and mean pain on pain days. Equivalence tests included comparisons of means, regression intercepts, and slopes, as well as measurement of R2.Results:Compared with the gold standard, the one-day-per-week and one-week-per-month strategies yielded statistically equivalent means of six summary pain measures, and the week prior and month prior yielded equivalent means as some of the measures. Regression showed statistically equivalent slopes and intercepts to the gold standard using one-day-per-week and one-week-per-month strategies for percent pain days and percent crisis days, but almost no other equivalence. R2 values ranged from 0.64 to 0.989.Conclusions:It is possible to simulate five- to six-month daily assessment of pain in SCD. Either one-day-per-week or one-week-per-month assessment yields an equivalent mean and fair regression equivalence.

Acute pain episodes are the most common complication in patients with sickle cell disease (SCD). Classically attributed to vaso-occlusion, recent insights suggest that chronic pain may also contribute to the pathogenesis of acute pain episodes, which adds complexity to their diagnosis and management. A taxonomy, or classification system, for acute pain in patients with SCD would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including SCD. To accomplish this, a working group of experts in SCD and pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific to SCD. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of chronic pain, are proposed to define the types of acute pain observed in patients with SCD. Perspective: This article presents a taxonomy for acute pain in patients with SCD. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients with SCD. (C) 2018 by the American Pain Society

•Use secondary data to understand use and timing of outpatient palliative care among those who have access to it.•Consider ways to reduce inequities in the use of outpatient PC, for example among patients with commercial insurance, those who are older, or those with hematological malignancies. Academic cancer centers are increasingly offering clinic-based specialist palliative care services (OP-SPC) (Carlton, 2016), but little is known about which patients use those services. To understand how many patients use OP-SPC, and the characteristics associated with use of OP-SPC. Retrospective study using billing/administrative data from an NCI-designated cancer center and safety-net hospital. Data were extracted for cancer patients using VCU for ongoing care (2+ ambulatory visits in the year prior to death) who died between August 2013 and June 2016. 1,701 patients with solid tumors and 313 with hematological malignancies met criteria (total n=2,014). Potential predictor variables of OP-SPC use in final year of life included in the analysis were age, sex, race, marital status, socio-economic status (three variables), insurance status, cancer type, comorbidities, and utilization in the 12-24 months prior to death. 240 (13.7%) used OP-SPC. The number of OP-SPC visits ranged from 1 to 48, mean 4.52 (SD 5.56). The median time of first OP-SPC visit was 190 days (6 months) before death. In univariate analyses, 12 variables were significantly associated with OP-SPC use. In the stepwise logistic regression, 7 variables were significantly associated: solid tumor (OR 3.20), living in an area with higher percentage of people with bachelor’s degrees or higher (OR 1.13), number of outpatient visits 1-2 years prior to death (OR 1.11 for difference of 5 visits), number of hospital days 1-2 years before death (OR 1.02), fewer comorbidities (OR 0.81), not having commercial insurance (OR 0.68), and younger age (OR 0.63 for difference of 10 years). The area under the ROC curve was 0.71. Various patient characteristics including cancer type, utilization, insurance status, age, comorbidities, and SES were associated with OP-SPC use. No differences by sex or race were detected.

Background: Imaging tests used in our center are usually inadequate to confirm the high risk for pancreatic cancer. We aimed to use a combination of potential predictors including imaging tests to quantify the risk of pancreatic cancer and evaluate its utility. Methods: This was a retrospective cohort study of patients who were suspected as having pancreatic cancer and underwent biopsy examination of pancreatic mass at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 1, 2013, and December 31, 2016. We retrieved data on demographics, clinical history, imaging tests, and final pancreatic diagnosis from medical records. Results: Of the 206 who underwent pancreatic biopsies, the mean age was 63.6 years; 54.4% were male. Of all the biopsies, 57.8% were malignant and 42.2% were benign masses. Nine factors contributed significantly to the risk of pancreatic cancer and were noted: older age (adjusted odds ratio [aOR] =1.048; P=0.010), male gender (aOR =4.670; P=0.008), weight loss (aOR =14.810; P=0.001), abdominal pain (aOR =7.053; P=0.0.001), blood clots (aOR =20.787; P=0.014), pancreatitis (aOR =4.473; P=0.021), jaundice (aOR =7.446; P=0.003), persistent fatigue (aOR =22.015; P=0.015), and abnormal imaging tests (aOR =67.124; P=0.001). The model yielded powerful calibration (P=0.953), excellent predictive utility (area under the receiver operating characteristic curve 96.3%; 95% CI =94.1, 98.6), with optimism-corrected area under the curve bootstrap resampling of 94.9%. An optimal cut-off risk probability of 0.513 yielded a sensitivity of 94% and specificity of 84.7% for risk classification. Conclusion: The study developed and validated a risk model for quantifying the risk of pancreatic cancer. Nine characteristics were associated with increased risk of pancreatic cancer. This risk assessment model is feasible and highly sensitive and could be useful to improve screening performance and the decision-making process in clinical settings in Saudi Arabia.

Sickle cell disease (SCD) pain is often acute-on-chronic, likening it to other chronic acute-on-chronic pain conditions. Pain treatment of SCD was already reported as inadequate prior to the current opioid epidemic, but attitudes underlying treatment were understudied. Understanding these attitudes prior to the current epidemic would be revealing. Therefore in 1997, before the current opioid epidemic, we surveyed physicians' attitudes toward pain management and treatment preferences for acute pain exacerbations in the Emergency Department in SCD versus those of chronic pancreatitis and chronic low back pain, two other acute-on-chronic pain diseases. Thirty-nine residency trainees were surveyed in a level one triage hospital. Resident estimates of the rate of opioid addiction in SCD were higher than estimates in both chronic pancreatitis and chronic low back pain. Most residents relied on their personal clinical experience rather than external sources of data or knowledge as the most important driver when they managed chronic pain. This survey research shows that, predating the current opioid epidemic, there was both a backdrop of opioid-phobia and a bias against treating SCD pain compared to other chronic pain conditions among our sample. Repeating this survey research among current training physicians, along with surveys of other attitudes, would provide useful comparisons.

Background. Patients with SCD now usually live well into adulthood. Whereas transitions into adulthood are now often studied, little is published about aging beyond the transition period. We therefore studied age-associated SCD differences in utilization, pain, and psychosocial variables. Methods. Subjects were 232 adults in the Pain in Sickle Cell Epidemiology Study (PiSCES). Data included demographics, comorbidity, and psychosocial measures. SCD-related pain and health care utilization were recorded in diaries. We compared 3 age groups: 16-25 (transition), 26-36 (younger adults), and 37-64 (older adults) years. Results. Compared to the 2 adult groups, the transition group reported fewer physical challenges via comorbidities, somatic complaints, and pain frequency, though pain intensity did not differ on crisis or noncrisis pain days. The transition group utilized opioids less often, made fewer ambulatory visits, and had better quality of life, but these differences disappeared after adjusting for pain and comorbidities. However, the transition group reported more use of behavioral coping strategies. Conclusion. We found fewer biological challenges, visits, and better quality of life, in transition-aged versus older adults with SCD, but more behavioral coping. Further study is required to determine whether age-appropriate health care, behavioral, or other interventions could improve age-specific life challenges of patients with SCD.

ObjectivesTo evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries.DesignObservational, retrospective study using propensity-based matching.SettingA health system in southern California.ParticipantsIndividuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80.InterventionHome- and clinic-based palliative care (PC) services provided by a multidisciplinary team.MeasurementsOutcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission.ResultsIntervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically.ConclusionIn the context of an alternative payment model in which the provider was at risk of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.

Background Individuals living with sickle cell disease (SCD) have significantly increased emergency department (ED) use compared to the general population. In Saudi Arabia, health care is free for all individuals and therefore has no bearing on increased ED visits. However, little is known about the relationship between quality of life (QoL) and frequency of acute care utilization in this patient population. Methods A cross-sectional study was conducted on 366 patients with SCD who attended the outpatient department at King Fahad Hospital, Hofuf, Saudi Arabia. Data were collected through self-administered surveys, which included: demographics, SCD-related ED visits, clinical issues, and QoL levels. We assessed the ED use by asking for the number of SCD-related ED visits within a 6-month period. Results The self-report survey of ED visits was completed by 308 SCD patients. The median number of SCD-related ED visits within a 6-month time period (IQR) was four (2-7 visits). According to the unadjusted negative binomial model, the rate of SCD-related ED visits increased by (46, 39.3, 40, and 53.5 %) for patients with fever, skin redness with itching, swelling, and blood transfusion, respectively. Poor QoL tends to increase the rate of SCD-related ED visits. Well education and poor general health positively influenced the rate of SCD-related ED visits. Well education tends to increase the rate of SCD-related ED visits by 50.2 %. The rate of SCD-related ED visits decreased by 1.4 % for every point increase in general health. Conclusion Saudi patients with sickle cell disease reported a wide range of SCD-related ED visits. It was estimated that six of 10 SCD patients had at least three ED visits within a 6-month period. Well education and poor general health resulted in an increase in the rate of SCD-related ED visits.

Background: Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use.Objective: To report on home opioid use among adults with SCD.Design: Cohort study.Participants: Adults with SCD (n = 219) who completed daily pain diaries for up to 6 months and had at least one home pain day.Main measures: Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics.Key results: Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p < 0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables.Conclusions: In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.

BACKGROUND:If and how much dural penetration influences long-term outcome after traumatic brain injury (TBI) is understudied, especially within the civilian population.OBJECTIVES:Using the large TBI Model Systems cohort, this study assessed and compared penetrating TBI (PTBI) and closed TBI with respect to global outcome and late seizures 2 years after injury.METHODS:After performing unadjusted PTBI versus closed TBI comparisons, multivariate regression models were built and analyzed for both outcomes by including the following additional predictors: length of unconsciousness, posttraumatic amnesia duration, hospital length of stay, age, gender, race, marital status, education level, problem substance abuse, and preinjury employment status.RESULTS:The collapsed Glasgow Outcome Scale model (n = 6111) showed significant secondary effects of PTBI with employment status. When employed before injury, individuals with PTBI were 2.62 times more likely (95% confidence interval, 1.92-3.57) to have a lower Glasgow Outcome Scale category. The final model for late seizures (n = 6737) showed a significant main effect for PTBI. Adjusting for other predictors, individuals with PTBI were 2.78 times more likely (95% confidence interval, 1.93-3.99) than those with closed TBI to be rehospitalized for a seizure.CONCLUSION:This study empirically demonstrates that penetrating injury mechanism has important prognostic implications.

Little has been published about long-acting opioid (LAO) versus short-acting opioid (SAO) use for pain in sickle cell disease (SCD), which is often chronic. We report on home LAO versus SAO use among a cohort of SCD adults (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day. We measured daily use of any opioids, LAO, SAO, other analgesics, adjuvants, and pain intensity (0-9 Likert scale), as well as pain frequency (0-100% of days), hydroxyurea (HU) use and avascular necrosis (AVN). Eighty-five patients (38.8%) used LAO ± SAO, and 103 (47.0%) used SAO only. Twenty-one (9.6%) patients used only other analgesics, and 10 (4.6%) used none. Morphine and oxycodone were the most commonly used LAO and SAO, respectively. Compared to SAO only users, LAO users had higher pain intensity (4.8 ±1.5 vs 4.1 ±1.4, p<0.0001) and frequency (81.9 ±25.4% vs 51.9 ±35.3%, p<0.0001). Controlled for pain, HU use was more likely among opioid users than non-users (OR=14.17, CI 1.81-109.69), and among LAO users than SAO users (OR=2.16, CI 1.06-4.38). Controlled for pain, LAO users were more likely to have AVN (p=0.0271). Patients age 25-45 were more likely to be LAO users (p=0.03), but not after controlling for pain. Opioid users with AVN and older users used opioids more frequently (p<.05), but not after controlling for pain. We conclude LAO were used by nearly 40% of SCD adults, and SAO only by >40%. Pain and disease severity variables often correlate with opioid use and LAO use in SCD.

Little is published about the relationship of daily opioid use in sickle cell disease (SCD) to pain and psychosocial health. We report among cohort of SCD adults (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day, the relationship between daily home opioid use, controlled for daily pain intensity (Likert scale 0-9), and psychosocial variables. We measured use of long- or short-acting opioids, other analgesics, or adjuvants, the proportion of home days, home pain days, and home crisis days with opioid use, and these two outcomes according to patient characteristics. Patients used opioids on 12,311 (78%) of 15,778 home pain days. Compared to non-users, opioid users reported higher daily pain intensity (3.04 ± 2.10 vs 0.39 ± 0.66, p<0.0001), and pain frequency (65.5% vs 15.3%, p<0.0001). Significant relationships were found between any opioid use and: somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL), but not depression/anxiety or alcoholism. The relationship with SCD stress and physical QOL remained when controlled for mean pain. Similar associations were found between frequency of opioid use among users and somatic symptom burden, active coping, positive coping, and physical QOL. We conclude that opioids were used on the majority of home days for these adults with SCD, and use was associated with psychosocial variables, even when controlled for pain. Cognitive-behavioral therapy in SCD could target these variables. Little is published about the relationship of daily opioid use in sickle cell disease (SCD) to pain and psychosocial health. We report among cohort of SCD adults (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day, the relationship between daily home opioid use, controlled for daily pain intensity (Likert scale 0-9), and psychosocial variables. We measured use of long- or short-acting opioids, other analgesics, or adjuvants, the proportion of home days, home pain days, and home crisis days with opioid use, and these two outcomes according to patient characteristics. Patients used opioids on 12,311 (78%) of 15,778 home pain days. Compared to non-users, opioid users reported higher daily pain intensity (3.04 ± 2.10 vs 0.39 ± 0.66, p<0.0001), and pain frequency (65.5% vs 15.3%, p<0.0001). Significant relationships were found between any opioid use and: somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL), but not depression/anxiety or alcoholism. The relationship with SCD stress and physical QOL remained when controlled for mean pain. Similar associations were found between frequency of opioid use among users and somatic symptom burden, active coping, positive coping, and physical QOL. We conclude that opioids were used on the majority of home days for these adults with SCD, and use was associated with psychosocial variables, even when controlled for pain. Cognitive-behavioral therapy in SCD could target these variables.

1563 Background: The accuracy of cancer risk perception has implications for preventive behaviors. Studies show that despite receiving personalized breast and colon cancer risk information, people continue to overestimate their numeric risks. It is still not fully understood why this occurs. Breast cancer, especially, is highly visible in the media so an individual may hear more about breast cancer, increasing general knowledge but potentially inflating risk perceptions. This study explores relationships between general knowledge and numeric risk perceptions for breast cancer (BC) and colon cancer (CC) among women. We hypothesize that general knowledge of BC will be high relative to CC, but risk perception for BC will be less accurate. Methods: Data was obtained from the first 369 (final N=490) patients recruited for the Kin Fact study from a Women’s Health Clinic. Kin Fact is a randomized controlled trial examining effects of an intervention to increase cancer risk communication in families. Women complete baseline surveys including knowledge and numeric risk perception measures for BC and CC. We use CA Gene software to calculate actual lifetime risk for BC and CC. Correlations, t-tests and linear regressions were used for the analysis. Results: Women averaged 33 years old, and 58% were African American. Average lifetime risk was 3% for CC and 11% for BC. Women overestimated their numeric risk for both BC and CC, but the mean overestimation for BC (24%) was significantly larger than for CC (19%) (p<0.001). Average scores for BC knowledge were also significantly higher than for CC (p<0.001). Compared to knowledge about CC, women who had greater knowledge of BC also were more inaccurate in terms of their perceived numeric risk (r= -0.131, p=0.016). This finding remained significant controlling for age, race and genetic literacy. Conclusions: Results endorse an apparently paradoxical effect that compared with CC, women with increased knowledge of BC have less accurate risk perception for BC. Inaccuracies in perceived risk can affect psychosocial well-being and adherence to screening and prevention recommendations. Findings reveal a need for increasing knowledge about cancer without adversely impacting the accuracy of risk perceptions.

Objective: Somatic symptoms have been extensively studied in primary care, but infrequently in diseases causing pain in multiple sites. We therefore examined the impact of somatic symptom burden (SSB) on pain, depression, anxiety, health-care utilization, and quality-of-life in adults with sickle cell disease (SCD). Methods: Subjects were 230 adults in the prospective Pain in Sickle Cell Epidemiology Study (PiSCES). Baseline data included demographics, genotype, Patient Health Questionnaire (PHQ), and SF-36 health-related quality of life (HRQOL). In daily diaries for 6 months, patients recorded SCD pain and SCD health-care utilization. To exclude common SCD pain sites, we abridged the PHQ's 15 somatic symptoms to 11 (PHQscd). We divided subjects into two groups: PHQscd >= 11 (high SSB), and PHQscd < 11 (low SSB). Results: High SSB occurred in 18.3% of subjects and was more frequent in women than men (24.6% vs. 9.1%, p = 0.0033). Sixty percent of subjects with anxiety and 37.5% of those with depression had comorbid high SSB. Percentage of pain days not in crisis pain was significantly higher in somatizers, but crisis pain did not differ between groups. The high SSB group's hospitalization, scheduled doctor visits, and overall utilization, particularly on non-crisis days were significantly higher than the low SSB group's (p values < 0.05). All SF-36 subscales were significantly negatively correlated with PHQscd (p < 0.0001). Conclusions: Even after excluding common SCD pain complaints, high somatic symptom burden was 1.5 to 2 times more prevalent in SCD patients than in primary care. High SSB in SCD predicts more non-crisis pain and healthcare utilization for pain, and is associated with depression, anxiety, and poorer HRQOL. (Psychosomatics 2011; 52:272-279)