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Item Associations Between Dysmenorrhea Symptom-Based Phenotypes and Vaginal Microbiome: A Pilot Study(Wolters Kluwer, 2021) Chen, Chen X.; Carpenter, Janet S.; Gao, Xiang; Toh, Evelyn; Dong, Qunfeng; Nelson, David E.; Mitchell, Caroline; Fortenberry, J. DennisBACKGROUND: Dysmenorrhea is highly prevalent; it places women at risk for other chronic pain conditions. There is a high degree of individual variability in menstrual pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Distinct dysmenorrhea symptom-based phenotypes were previously identified, but the biological underpinnings of these phenotypes are less known. One underexplored contributor is the vaginal microbiome. The vaginal microbiota differs significantly among reproductive-age women and may modulate as well as amplify reproductive tract inflammation, which may contribute to dysmenorrhea symptoms. OBJECTIVES: The objective of this study was to examine associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome compositions on- and off-menses. METHODS: We conducted a prospective, longitudinal, pilot study of 20 women (aged 15-24 years) grouped into three dysmenorrhea symptom-based phenotypes: "mild localized pain," "severe localized pain," and "severe multiple pain and gastrointestinal symptoms." Over one menstrual cycle, participants provided vaginal swabs when they were on- and off-menses. We assayed the vaginal microbiome using 16S rRNA gene sequencing. Permutational multivariate analysis of variance tests were used to compare microbiome compositions across phenotypes, with heat maps generated to visualize the relative abundance of bacterial taxa. RESULTS: The vaginal microbiome compositions (n = 40) were different across the three phenotypes. After separating the on-menses (n = 20) and off-menses (n = 20) specimens, the statistically significant difference was seen on-menses, but not off-menses. Compared to the "mild localized pain" phenotype, participants in the "multiple severe symptoms" phenotype had a lower lactobacilli level and a higher abundance of Prevotella, Atopobium, and Gardnerella when on-menses. We also observed trends of differences across phenotypes in vaginal microbiome change from off- to on-menses. DISCUSSION: The study provides proof-of-concept data to support larger studies on associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome that might lead to new intervention targets and/or biomarkers for dysmenorrhea. This line of research has the potential to inform precision dysmenorrhea treatment that can improve women's quality of life.Item Beliefs About Dysmenorrhea and Their Relationship to Self-Management(Wiley, 2016-05-13) Chen, Chen X.; Kwekkeboom, Kristine L.; Ward, Sandra E.; School of NursingDysmenorrhea is highly prevalent and is the leading cause of work and school absences among women of reproductive age. However, self-management of dysmenorrhea is not well understood in the US, and little research has explored factors that influence dysmenorrhea self-management. Guided by the Common Sense Model, we examined women’s representations of dysmenorrhea (beliefs about causes, symptoms, consequences, timeline, controllability, coherence, and emotional responses), described their dysmenorrhea self-management behaviors, and investigated the relationship between representations and self-management behaviors. We conducted a cross-sectional, web-based survey of 762 adult women who had dysmenorrhea symptoms in the last six months. Participants described various causes of their dysmenorrhea symptoms which were perceived as a normal part of life. Dysmenorrhea symptoms were reported as moderately severe, with consequences that moderately affected daily life. Women believed they understood their symptoms moderately well, and perceived them as moderately controllable, but expected their timeline to continue through menopause. Most women did not seek professional care but rather used a variety of pharmacologic and complementary health approaches. Care seeking and use of self-management strategies were associated with common sense beliefs about dysmenorrhea cause, consequences, timeline, and controllability. The findings may inform development and testing of self-management interventions that address dysmenorrhea representations and facilitate evidence-based management.Item Beliefs About Dysmenorrhea and Their Relationship to Self‐Management(Wiley, 2016-08) Chen, Chen X.; Kwekkeboom, Kristine L.; Ward, Sandra E.; School of NursingDysmenorrhea is highly prevalent and is the leading cause of work and school absences among women of reproductive age. However, self‐management of dysmenorrhea is not well understood in the US, and little evidence is available on factors that influence dysmenorrhea self‐management. Guided by the Common Sense Model, we examined women's representations of dysmenorrhea (beliefs about causes, symptoms, consequences, timeline, controllability, coherence, and emotional responses), described their dysmenorrhea self‐management behaviors, and investigated the relationship between representations and self‐management behaviors. We conducted a cross‐sectional, web‐based survey of 762 adult women who had dysmenorrhea symptoms in the last six months. Participants had varied beliefs about the causes of their dysmenorrhea symptoms, which were perceived as a normal part of life. Dysmenorrhea symptoms were reported as moderately severe, with consequences that moderately affected daily life. Women believed they understood their symptoms moderately well and perceived them as moderately controllable but them to continue through menopause. Most women did not seek professional care but rather used a variety of pharmacologic and complementary health approaches. Care‐seeking and use of self‐management strategies were associated with common sense beliefs about dysmenorrhea cause, consequences, timeline, and controllability. The findings may inform development and testing of self‐management interventions that address dysmenorrhea representations and facilitate evidence‐based management.Item Big Data and Dysmenorrhea: What Questions Do Women and Men Ask About Menstrual Pain?(Liebert, 2018-10) Chen, Chen X.; Groves, Doyle; Miller, Wendy R.; Carpenter, Janet S.; School of NursingBackground: Menstrual pain is highly prevalent among women of reproductive age. As the general public increasingly obtains health information online, Big Data from online platforms provide novel sources to understand the public's perspectives and information needs about menstrual pain. The study's purpose was to describe salient queries about dysmenorrhea using Big Data from a question and answer platform. Materials and Methods: We performed text-mining of 1.9 billion queries from ChaCha, a United States-based question and answer platform. Dysmenorrhea-related queries were identified by using keyword searching. Each relevant query was split into token words (i.e., meaningful words or phrases) and stop words (i.e., not meaningful functional words). Word Adjacency Graph (WAG) modeling was used to detect clusters of queries and visualize the range of dysmenorrhea-related topics. We constructed two WAG models respectively from queries by women of reproductive age and bymen. Salient themes were identified through inspecting clusters of WAG models. Results: We identified two subsets of queries: Subset 1 contained 507,327 queries from women aged 13–50 years. Subset 2 contained 113,888 queries from men aged 13 or above. WAG modeling revealed topic clusters for each subset. Between female and male subsets, topic clusters overlapped on dysmenorrhea symptoms and management. Among female queries, there were distinctive topics on approaching menstrual pain at school and menstrual pain-related conditions; while among male queries, there was a distinctive cluster of queries on menstrual pain from male's perspectives. Conclusions: Big Data mining of the ChaCha® question and answer service revealed a series of information needs among women and men on menstrual pain. Findings may be useful in structuring the content and informing the delivery platform for educational interventions.Item Big Data and Dysmenorrhea: What Questions Do Women and Men Ask About Menstrual Pain?(Mary Ann Liebert, 2018-10) Chen, Chen X.; Groves, Doyle; Miller, Wendy R.; Carpenter, Janet S.; School of NursingBACKGROUND: Menstrual pain is highly prevalent among women of reproductive age. As the general public increasingly obtains health information online, Big Data from online platforms provide novel sources to understand the public's perspectives and information needs about menstrual pain. The study's purpose was to describe salient queries about dysmenorrhea using Big Data from a question and answer platform. MATERIALS AND METHODS: We performed text-mining of 1.9 billion queries from ChaCha, a United States-based question and answer platform. Dysmenorrhea-related queries were identified by using keyword searching. Each relevant query was split into token words (i.e., meaningful words or phrases) and stop words (i.e., not meaningful functional words). Word Adjacency Graph (WAG) modeling was used to detect clusters of queries and visualize the range of dysmenorrhea-related topics. We constructed two WAG models respectively from queries by women of reproductive age and bymen. Salient themes were identified through inspecting clusters of WAG models. RESULTS: We identified two subsets of queries: Subset 1 contained 507,327 queries from women aged 13-50 years. Subset 2 contained 113,888 queries from men aged 13 or above. WAG modeling revealed topic clusters for each subset. Between female and male subsets, topic clusters overlapped on dysmenorrhea symptoms and management. Among female queries, there were distinctive topics on approaching menstrual pain at school and menstrual pain-related conditions; while among male queries, there was a distinctive cluster of queries on menstrual pain from male's perspectives. CONCLUSIONS: Big Data mining of the ChaCha® question and answer service revealed a series of information needs among women and men on menstrual pain. Findings may be useful in structuring the content and informing the delivery platform for educational interventions.Item Comparative Responsiveness of the PROMIS Pain Interference Short Forms with Legacy Pain Measures: Results from Three Randomized Clinical Trials(Elsevier, 2019) Chen, Chen X.; Kroenke, Kurt; Stump, Timothy; Kean, Jacob; Krebs, Erin E.; Bair, Matthew J.; Damush, Teresa; Monahan, Patrick O.; School of NursingThe PROMIS Pain Interference (PROMIS-PI) scales are reliable and publicly accessible; however, little is known about how responsive they are to detect change in clinical trials and how their responsiveness compares to legacy measures. The study purpose was to evaluate responsiveness for the PROMIS-PI scales and to compare their responsiveness with legacy pain measures. We used data from three clinical trials totaling 759 participants. The clinical trials included patients with chronic low back pain (n= 261), chronic back or osteoarthritis pain (n = 240), and a history of stroke (n= 258). At both baseline and follow-up, participants completed PROMIS-PI scales and legacy pain measures (Brief Pain Inventory Interference scale, Pain/Enjoyment/General Activity (PEG) scale, SF-36 Bodily Pain scale, and Roland-Morris Disability Questionnaire). We measured global ratings of pain change, both prospectively and retrospectively, as anchors to identify patients as improved, unchanged, or worsened. Responsiveness was assessed with standardized response means, statistical tests comparing change groups, and area-under-curve analysis. The PROMIS-PI scales had largely comparable responsiveness with the Brief Pain Inventory Interference scale and PEG. The four PROMIS-PI short forms had comparable responsiveness. For all pain questionnaires, responsiveness varied based on the study population and whether pain improved or worsened.Item Comparing Dysmenorrhea Beliefs and Self-Management Techniques Across Symptom-Based Phenotypes(Wiley, 2021) Rogers, Sarah K.; Rand, Kevin L.; Chen, Chen X.; Psychology, School of ScienceObjectives: To compare beliefs about dysmenorrhea and self-management techniques across three dysmenorrhea symptom-based phenotypes. Background: Many reproductive-age women experience dysmenorrhea, with varying symptoms and intensity. Dysmenorrhea symptom-based phenotypes have been identified in previous research, defining distinctive phenotypes of mild localised pain, severe localised pain, and multiple severe symptoms. It is unknown if women from different phenotypes hold different beliefs about dysmenorrhea or if they engage in different self-management techniques. Design: Quantitative secondary analysis of cross-sectional survey data. Methods: This online study surveyed 762 women with dysmenorrhea in the United States. Participants reported their dysmenorrhea symptom intensity, beliefs about dysmenorrhea (i.e. beliefs about consequences, timeline, controllability, symptom severity, normalcy, emotional response to symptoms and treatments) and self-management techniques to prevent or treat symptoms. Beliefs regarding dysmenorrhea and types of self-management techniques used were compared across three phenotypes utilising ANOVA tests and Tukey's HSD for pairwise comparisons. Reporting followed the STROBE guidelines. Results: Women with multiple severe symptoms had significantly more negative beliefs regarding dysmenorrhea and utilised significantly more self-management techniques than women with severe localised pain and women with mild localised pain. Women with severe localised pain had significantly more negative beliefs regarding dysmenorrhea and utilised significantly more self-management techniques than women with mild localised pain. Negative beliefs regarding dysmenorrhea included: consequences of dysmenorrhea, timeline of symptoms, personal and treatment control, symptom severity, normalcy of symptoms, emotional response to symptoms and willingness to utilise complementary medicine. Conclusion: Results further support the distinction between dysmenorrhea symptom-based phenotypes. Not only do women in different phenotypes experience different severity and number of dysmenorrhea symptoms, they also perceive and manage their dysmenorrhea differently. Relevance to clinical practice: These findings have implications for tailoring interventions to different dysmenorrhea symptom-based phenotypes.Item Correlates of palpitations during menopause: A scoping review(Sage, 2022) Carpenter, Janet S.; Sheng, Ying; Pike, Caitlin; Elomba, Charles D.; Alwine, Jennifer S.; Chen, Chen X.; Tisdale, James E.; School of NursingObjective: Palpitations during peri- and post-menopause are common. It is unclear what variables are related to palpitations in peri- and post-menopausal women. The purpose of this scoping review was to summarize potential correlates of palpitations in women transitioning through menopause. Methods: The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Authors included English-language, full-length, peer-reviewed, cross-sectional research articles on palpitations in menopausal women published through December 18, 2021, from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO searches. Following de-duplication, screening of titles and abstracts, and review of full-texts, independent reviewers extracted data on variables studied in relationship to palpitations from 84 articles and resolved discrepancies. Authors extracted data on (1) demographic, clinical, biomarker, and symptom/quality of life variables and (2) data analysis method (bivariate, multivariate). Authors classified each variable as a likely, unlikely, or unclear correlate of palpitations. Results: Articles were diverse in region of origin, sample sizes, and variables assessed in relationship to palpitations. Evidence for any one variable was sparse. Likely correlates of palpitations included race/ethnicity, lower physical activity, worse vasomotor symptoms (VMSs), worse sleep, and worse quality of life. Unlikely correlates included age, employment, education, marital status, socioeconomic status, comorbidities, body mass index, and sexual difficulties. Unclear correlates due to equivocal evidence were menopausal status, smoking, and depression. Unclear correlates due to insufficient evidence (less than three articles) included all of the assessed biomarkers, anxiety, and stress. Conclusion: Likely correlates were identified including race/ethnicity, physical activity, VMS, sleep, and quality of life. However, additional research is needed to better understand potential correlates of palpitations.Item Development and Testing of the Dysmenorrhea Symptom Interference (DSI) Scale(2020-07-17) Chen, Chen X.; Murphy, Tabitha; Ofner, Susan; Yahng, Lilian; Krombach, Peter; LaPradd, Michelle; Bakoyannis, Giorgos; Carpenter, Janet S.; School of NursingDysmenorrhea affects most reproductive-age women and increases the risk of future pain. To evaluate dysmenorrhea interventions, validated outcome measures are needed. In this two-phase study, we developed and tested the dysmenorrhea symptom interference scale. During the scale-development phase (n = 30), we created a nine-item scale based on qualitative data from cognitive interviews. During the scale-testing phase (n = 686), we evaluated reliability, validity, and responsiveness to change. The scale measures how dysmenorrhea symptoms interfere with physical, mental, and social activities. Internal consistency was strong with Cronbach's α > 0.9. Test-retest reliability was acceptable (r = 0.8). The scale showed satisfactory content validity, construct validity (supported by confirmatory factor analysis), concurrent validity, and responsiveness to change. The minimally important difference was 0.3 points on a scale with a possible total score ranging from 1 to 5. This new psychometrically sound scale can be used in research and clinical practice to facilitate the measurement and management of dysmenorrhea.Item Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study(2020-09-16) Chen, Chen X.; Carpenter, Janet S.; Ofner, Susan; LaPradd, Michelle; Fortenberry, J. Dennis; School of Nursing