Chen X. Chen

Interests

Research

Dysmenorrhea, Pain, Women's Health, Integrative Health, Human Microbiome, Health Equity

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No activities entered.

Scholarly Contributions

Journals/Publications

• Carpenter, J. S., Larson, J. C., Hunter, M. S., Lensen, S., Chen, C. X., & Guthrie, K. A. (2024). Correlations among Core Outcomes in Menopause-recommended vasomotor symptom outcomes in MsFLASH trials. Menopause (New York, N.Y.), 31(1), 3-9.
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  This study aimed to advance understanding of vasomotor symptom (VMS) outcomes measurement using pooled data from three Menopause Strategies Finding Lasting Answers to Symptoms and Health (MsFLASH) trials.
• Chen, C. X., Rogers, S. K., Li, R., Hinrichs, R. J., Fortenberry, J. D., & Carpenter, J. S. (2024). Social Determinants of Health and Dysmenorrhea: A Systematic Review. The journal of pain, 25(9), 104574.
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  Social determinants of health play a key role in health disparities. Dysmenorrhea is a highly prevalent and impactful public health problem affecting reproductive-age females. Systematically examining social determinants of health (SDoH) in dysmenorrhea is important for identifying gaps in the literature and informing research, policy, and clinical practice to reduce the public health burden associated with dysmenorrhea. The purpose of this systematic review was to synthesize the literature on SDoH and dysmenorrhea. The review protocol was prospectively registered. We searched Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Google Scholar through February 2024 using search strategies informed by the literature. Screening of the articles, data extraction, and risk-of-bias (RoB) assessment were conducted independently by at least 2 reviewers on the Covidence platform. Among 2,594 unique records screened, 166 met eligibility criteria and were included for data extraction and RoB assessment. Evidence suggests traumatic experiences, toxic environmental exposures, female genital mutilation, job-related stress, lack of menstrual education, and low social support were associated with worse dysmenorrhea outcomes. However, evidence was equivocal regarding the relationships between dysmenorrhea outcomes and SDoH factors, including socioeconomic status, geographical location, race/ethnicity, employment, and religion. Nearly all articles (99.4%) had a high or very high overall RoB. The relationships between SDoH and dysmenorrhea outcomes were often inconsistent and complicated by heterogeneous study populations and methodologies. More rigorous research examining SDoH in dysmenorrhea is needed to inform policy and clinical practice. PERSPECTIVE: This systematic review synthesizes evidence linking SDoH and dysmenorrhea. The relationships between SDoH and dysmenorrhea were often equivocal and complicated by heterogeneous study populations and methodologies. We identify directions for future research and SDoH factors that could be addressed clinically (eg, trauma, menstrual education, and occupational stress).
• Carpenter, J. S., Fagan, R., Alzahrani, M. A., Jaynes, H. A., Tisdale, J. E., Kovacs, R. J., Chen, C. X., & Draucker, C. B. (2023). "Quick flutter skip": midlife women's descriptions of palpitations. Menopause (New York, N.Y.), 30(10), 1014-1021.
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  The objective of this study is to describe peri- and postmenopausal women's experiences of palpitations (quality, frequency, severity, distress, duration and temporal pattern, aura, associated symptoms, and aggravating/alleviating factors) and related healthcare experiences.
• Cole, C. S., Blackburn, J., Carpenter, J. S., Chen, C. X., & Hickman, S. E. (2023). Pain and Associated Factors in Nursing Home Residents. Pain management nursing : official journal of the American Society of Pain Management Nurses, 24(4), 384-392.
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  Understanding factors associated with risk of pain allows residents and clinicians to plan care and set priorities, however, factors associated with pain in nursing home residents has not been conclusively studied.
• Cole, C. S., Carpenter, J. S., Blackburn, J., Chen, C. X., Jones, B. L., & Hickman, S. E. (2023). Pain trajectories of nursing home residents. Journal of the American Geriatrics Society, 71(4), 1188-1197.
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  Understanding changes in nursing home (NH) resident pain over time would provide a more informed perspective, allowing opportunities to alter the course of illness, plan care, and set priorities. Therefore, the purpose of this analysis was to identify and characterize clinically meaningful, dynamic pain trajectories in NH residents.
• Rogers, S. K., Ahamadeen, N., Chen, C. X., Mosher, C. E., Stewart, J. C., & Rand, K. L. (2023). Dysmenorrhea and psychological distress: a meta-analysis. Archives of women's mental health, 26(6), 719-735.
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  Dysmenorrhea is characterized by pelvic pain associated with menstruation. Similar to people with other pain conditions, females who experience dysmenorrhea report increased psychological distress. However, the pooled magnitude of this association has not been quantified across studies. Accordingly, this meta-analytic review quantifies the magnitude of the associations between dysmenorrhea severity and psychological distress. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, Embase, and Web of Science. Analyzed studies provided observational data on dysmenorrhea severity and anxiety symptoms, depressive symptoms, and/or global psychological distress. A total of 44 studies were included, and three random-effects meta-analyses were conducted, with average pooled effect sizes calculated using Person's r. We found significant, positive associations between measures of dysmenorrhea severity and measures of depressive symptoms (r = 0.216), anxiety symptoms (r = 0.207), and global psychological distress (r = 0.311). Our review suggests that females with greater dysmenorrhea severity experience greater psychological distress. Future directions include defining a clinically meaningful dysmenorrhea severity threshold, understanding the mechanisms and directionality underlying the dysmenorrhea-psychological distress relationship, and designing and testing interventions to jointly address dysmenorrhea and psychological distress.
• Rogers, S. K., Galloway, A., Hirsh, A. T., Zapolski, T., Chen, C. X., & Rand, K. L. (2023). Efficacy of psychological interventions for dysmenorrhea: a meta-analysis. Pain medicine (Malden, Mass.), 24(9), 1086-1099.
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  Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (ie, within-group analysis) and 14 examined between-group improvement (ie, between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.
• Carpenter, J. S., Sheng, Y., Pike, C., Elomba, C. D., Alwine, J. S., Chen, C. X., & Tisdale, J. E. (2022). Correlates of palpitations during menopause: A scoping review. Women's health (London, England), 18, 17455057221112267.
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  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.
• Cole, C. S., Carpenter, J. S., Chen, C. X., Blackburn, J., & Hickman, S. E. (2022). Prevalence and Factors Associated with Pain in Nursing Home Residents: A Systematic Review of the Literature. Journal of the American Medical Directors Association, 23(12), 1916-1925.e1.
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  To describe the pain prevalence in nursing home (NH) residents and the factors associated with the experience of pain.
• Sheng, Y., Carpenter, J. S., Elomba, C. D., Alwine, J. S., Yue, M., Chen, C. X., & Tisdale, J. E. (2022). Effect of menopausal symptom treatment options on palpitations: a systematic review. Climacteric : the journal of the International Menopause Society, 25(2), 128-140.
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  This systematic review provides an overview of the effects of menopausal symptom treatment options on palpitations, defined as feelings of missed or exaggerated heart beats, reported by perimenopausal and postmenopausal women. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searches were conducted in PubMed, CINAHL and PsycINFO to identify articles meeting pre-specified inclusion criteria. Of 670 unique articles identified, 37 were included in the review. Treatments included drug therapies and non-drug therapies. Palpitations were studied as an outcome in 89% of articles and as an adverse effect in 11%. Articles provided mostly level II/III evidence due to their design and/or small sample sizes. Based on available evidence, no therapies can be fully recommended for clinical practice. Only some hormonal agents (e.g. estradiol) can be recommended with caution based on some positive evidence for reducing palpitation prevalence or severity. However, other drug therapies (e.g. moxonidine, atenolol), dietary supplementary treatments (e.g. isoflavones, , sage), cognitive-behavioral intervention and auricular acupressure cannot be recommended given the existing evidence. Additional well-designed randomized controlled treatment trials focusing on palpitations during the menopause transition as an inclusion criteria and outcome are needed to advance the field.
• Carpenter, J. S., Tisdale, J. E., Chen, C. X., Kovacs, R., Larson, J. C., Guthrie, K. A., Ensrud, K. E., Newton, K. M., & LaCroix, A. Z. (2021). A Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) Investigation of Self-Reported Menopausal Palpitation Distress. Journal of women's health (2002), 30(4), 533-538.
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  Study to describe the degree of menopausal palpitation distress and its demographic, clinical, symptom, and quality-of-life (QOL) correlates. Analysis of existing, baseline, data from peri- and postmenopausal women, 42 to 62 years of age, who participated in the Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) clinical trials testing interventions for vasomotor symptoms ( = 759). Up to 46.8% of menopausal women report having palpitations, yet the symptom is relatively understudied. Little is known about palpitation distress or its correlates. Degree of distress from "heart racing or pounding" was self-reported over the past two weeks as "not at all," "a little bit," "moderately," "quite a bit," or "extremely." Other measures included self-report forms, clinic-verified body mass index (BMI), vasomotor symptom diaries, and validated symptom and QOL tools. The percentage who reported palpitation distress was 19.6%, 25.2%, and 33.5% in the three trials or 25.0% overall. In multivariate analysis, the odds of reporting palpitation distress was lower in past smokers (odds ratio [OR] = 0.59 [95% confidence interval (CI) 0.38-0.90]) and current smokers (OR = 0.48 [0.27-0.87]) relative to never-smokers and lower with every 5 kg/m higher BMI (OR = 0.82 [0.69-0.98]).The odds of reporting palpitation distress was higher with every five point more severe insomnia (OR = 1.28 [1.05-1.54]), five point worse depressive symptoms (OR = 1.47 [1.11-1.95]), five point worse perceived stress (OR = 1.19 [1.01-1.39]), and one point worse menopausal QOL (OR = 1.29 [1.06-1.57]). Menopausal palpitation distress is common and associated with demographic, clinical, symptom, and QOL factors. Findings can be used for screening in clinical practice and to justify additional research on this understudied symptom.
• Carpenter, J. S., Tisdale, J. E., Larson, J. C., Sheng, Y., Chen, C. X., Von Ah, D., Kovacs, R., Reed, S. D., Thurston, R. C., & Guthrie, K. A. (2021). MsFLASH analysis of diurnal salivary cortisol and palpitations in peri- and postmenopausal women. Menopause (New York, N.Y.), 29(2), 144-150.
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  To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women.
• Chen, C. X., Carpenter, J. S., Gao, X., Toh, E., Dong, Q., Nelson, D. E., Mitchell, C., & Fortenberry, J. D. (2021). Associations Between Dysmenorrhea Symptom-Based Phenotypes and Vaginal Microbiome: A Pilot Study. Nursing research, 70(4), 248-255.
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  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.
• Chen, C. X., Carpenter, J. S., LaPradd, M., Ofner, S., & Fortenberry, J. D. (2021). Perceived Ineffectiveness of Pharmacological Treatments for Dysmenorrhea. Journal of women's health (2002), 30(9), 1334-1343.
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  Dysmenorrhea affects most reproductive-aged women. Common dysmenorrhea treatments vary in their effectiveness across individuals. Little is known about factors associated with perceived treatment ineffectiveness. The objectives of this study were to describe the perceived ineffectiveness of common pharmacological treatments for dysmenorrhea and investigate factors associated with perceived treatment ineffectiveness. In this cross-sectional study, 678 women with dysmenorrhea (aged 14-42) provided data on perceived treatment ineffectiveness, dysmenorrhea symptom-based phenotypes, demographics, clinical factors, and psychobehavioral characteristics. We used Fisher's exact tests to compare treatment ineffectiveness across three symptom-based phenotypes. We used logistic regressions to explore associations of phenotype, demographic, clinical, and psychobehavioral correlates of perceived treatment ineffectiveness. Percentages perceiving treatments as ineffective were 29.3%-35.6% nonsteroidal anti-inflammatory drugs, 49.9% acetaminophen, and 39.3% combined oral contraceptive pills (OCPs). Factors associated with perceived ineffectiveness varied across treatments and included symptom-based phenotypes, clinical, and psychobehavioral factors. For ibuprofen and acetaminophen, women with severe (vs. mild) pain phenotype and higher number of chronic pain conditions were more likely to perceive the treatments as ineffective. For OCPs, women with severe pain (vs. mild) phenotype, comorbid gynecological condition, less anxiety, and worse depressive symptoms were more likely to perceive the treatment as ineffective. A significant percentage of women reported ineffectiveness of dysmenorrhea treatments. Phenotypes, clinical, and psychobehavioral factors were associated with treatment ineffectiveness. Future research should test if symptom-based phenotypes are associated with treatment effectiveness in clinical trials and investigate other factors that affect dysmenorrhea treatment effectiveness, so treatments can be tailored to individuals.
• Chen, C. X., Carpenter, J. S., Murphy, T., Brooks, P., & Fortenberry, J. D. (2021). Engaging Adolescent and Young Adults in Microbiome Sample Self-Collection: Strategies for Success. Biological research for nursing, 23(3), 402-407.
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  Human microbiome research provides rich opportunities to elucidate factors influencing health, uncover novel biomarkers, and expand disease treatment options. A well-conducted microbiome study depends not only on a rigorous design but also on successfully engaging participants in collecting quality samples. In this paper, we aim to describe (1) strategies our team used to engage adolescents and young adults in vaginal and gut microbiome sample self-collection and (2) their effectiveness. In our prospective, longitudinal, feasibility study of 20 female adolescents and young adults, research participants self-collected vaginal and gut microbiome samples at home. Using a participatory and iterative process, we developed strategies to engage participants in sample self-collection, including (1) providing clear instructions to ensure comprehension and buy-in, (2) providing a user-friendly take-home package, (3) minimizing disgust/embarrassment associated with sample collection, and (4) follow-up communications to facilitate sample collections and return. With these strategies, we achieved 100% participant retention and 100% sample return rates. All samples ( = 80, 100%) were usable for downstream 16s rRNA gene sequencing and analysis. All participants rated the study procedures as acceptable, and qualitative data showed that strategies were well received by participants. This study suggests that carefully planning and implementing strategies to engage participants in sample self-collection can result in high degrees of participant compliance, sample quality, and participant satisfaction in microbiome research.
• Chen, C. X., Carpenter, J. S., Ofner, S., LaPradd, M., & Fortenberry, J. D. (2021). Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study. Nursing research, 70(1), 24-33.
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  Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment.
• Chen, C. X., Murphy, T., Ofner, S., Yahng, L., Krombach, P., LaPradd, M., Bakoyannis, G., & Carpenter, J. S. (2021). Development and Testing of the Dysmenorrhea Symptom Interference (DSI) Scale. Western journal of nursing research, 43(4), 364-373.
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  Dysmenorrhea 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 ( = 30), we created a nine-item scale based on qualitative data from cognitive interviews. During the scale-testing phase ( = 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 > 0.9. Test-retest reliability was acceptable ( = 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.
• Heit, M., Carpenter, J. S., Chen, C. X., & Rand, K. L. (2021). Operationalizing Postdischarge Recovery From Laparoscopic Sacrocolpopexy for the Preoperative Consultative Visit. Female pelvic medicine & reconstructive surgery, 27(7), 427-431.
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  The objective was to establish a threshold for postdischarge surgical recovery from laparoscopic sacrocolpopexy for the preoperative consultative visit to answer the "what is my recovery time?" question.
• Heit, M., Chen, C. X., Pan, C., & Rand, K. L. (2021). Recovery expectancies impact postdischarge recovery 42 days after laparoscopic sacrocolpopexy. International urogynecology journal, 32(6), 1527-1532.
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  The aim of this retrospective cohort study was to determine if recovery expectancies were associated with actual postdischarge recovery after laparoscopic sacrocolpopexy.
• Kroenke, K., Stump, T. E., Chen, C. X., Kean, J., Damush, T. M., Bair, M. J., Krebs, E. E., & Monahan, P. O. (2021). Responsiveness of PROMIS and Patient Health Questionnaire (PHQ) Depression Scales in three clinical trials. Health and quality of life outcomes, 19(1), 41.
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  The PROMIS depression scales are reliable and valid measures that have extensive normative data in general population samples. However, less is known about how responsive they are to detect change in clinical settings and how their responsiveness compares to legacy measures. The purpose of this study was to assess and compare the responsiveness of the PROMIS and Patient Health Questionnaire (PHQ) depression scales in three separate samples.
• Rogers, S. K., Rand, K. L., & Chen, C. X. (2021). Comparing dysmenorrhea beliefs and self-management techniques across symptom-based phenotypes. Journal of clinical nursing, 30(13-14), 2015-2022.
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  To compare beliefs about dysmenorrhea and self-management techniques across three dysmenorrhea symptom-based phenotypes.
• Sheng, Y., Carpenter, J. S., Elomba, C. D., Alwine, J. S., Yue, M., Pike, C. A., Chen, C. X., & Tisdale, J. E. (2021). Review of menopausal palpitations measures. Women's midlife health, 7(1), 5.
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  Palpitations are reported commonly by women around the time of menopause as skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding. However, much less is known about palpitations than other menopausal symptoms such as vasomotor symptoms. The objective of this review was to integrate evidence on menopausal palpitations measures. Keyword searching was done in PubMed, CINAHL, and PsycINFO for English-language, descriptive articles containing data on menopause and palpitations and meeting other pre-specified inclusion criteria. Of 670 articles, 110 met inclusion criteria and were included in the review. Results showed that 11 different measures were used across articles, with variability within and between measures. Inconsistencies in the wording of measurement items, recall periods, and response options were observed even when standardized measures were used. Most measures were limited to assessing symptom presence and severity. Findings suggest that efforts should be undertaken to (1) standardize conceptual and operational definitions of menopausal palpitations and (2) develop a patient-friendly, conceptually clear, psychometrically sound measure of menopausal palpitations.
• Heit, M., Carpenter, J. S., Chen, C. X., Stewart, R., Hamner, J., & Rand, K. L. (2020). Predictors of Postdischarge Surgical Recovery Following Laparoscopic Sacrocolpopexy: A Prospective Cohort Study. Female pelvic medicine & reconstructive surgery, 26(5), 320-326.
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  Our aim was to identify sociodemographic/clinical, surgical, and psychosocial predictors of postdischarge surgical recovery after laparoscopic sacrocolpopexy.
• Kroenke, K., Stump, T. E., Chen, C. X., Kean, J., Bair, M. J., Damush, T. M., Krebs, E. E., & Monahan, P. O. (2020). Minimally important differences and severity thresholds are estimated for the PROMIS depression scales from three randomized clinical trials. Journal of affective disorders, 266, 100-108.
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  Patient Reported Outcomes Measurement Information Systems (PROMIS) scales are increasingly being used to measure symptoms in research and practice. The purpose of this study was to determine the minimally important difference (MID) and severity thresholds (cut-points) for the four fixed-length PROMIS depression scales.
• Touza, K. K., Rand, K. L., Carpenter, J. S., Chen, C. X., & Heit, M. H. (2020). A Scoping Study of Psychosocial Factors in Women Diagnosed With and/or Treated for Pelvic Organ Prolapse. Female pelvic medicine & reconstructive surgery, 26(5), 327-348.
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  Pelvic organ prolapse (POP) is prevalent and can impact women's physical and psychosocial health. To develop interventions that support this population, an understanding of the state of research on psychosocial factors related to POP is essential. We conducted a scoping study focused on the psychosocial experience of women with POP. The purpose of this review was to (1) inventory and describe the current state of knowledge of the psychosocial experience of women with POP, (2) identify gaps in knowledge, and (3) identify targets for future research.
• Chen, C. X., Kroenke, K., Stump, T., Kean, J., Krebs, E. E., Bair, M. J., Damush, T., & Monahan, P. O. (2019). Comparative Responsiveness of the PROMIS Pain Interference Short Forms With Legacy Pain Measures: Results From Three Randomized Clinical Trials. The journal of pain, 20(6), 664-675.
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  The Patient-Reported Outcomes Measurement Information System 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 with 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 3 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 scale; 36-Item Short Form Survey (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 the curve analysis. The PROMIS-PI scales had largely comparable responsiveness with the Brief Pain Inventory Interference and Pain, Enjoyment, General Activity scales. The 4 PROMIS-PI short forms had comparable responsiveness. For all pain questionnaires, responsiveness varied based on the study population and whether pain improved or worsened. PERSPECTIVE: This article presents 1) how responsive the PROMIS-PI scales were to detect change over time in the context of 3 clinical trials and 2) how their responsiveness compared with legacy pain measures. The findings can help researchers and clinicians choose between different patient-reported pain outcome measures.
• Lor, M., Oyesanya, T., Chen, C. X., Cherwin, C., & Moon, C. (2019). Postdoctoral Opportunities for Nursing PhD Graduates: A Resource Guide. Western journal of nursing research, 41(3), 459-476.
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  Before completing a nursing PhD program, doctoral students are encouraged to seek out and apply for a position in one of many, often highly competitive postdoctoral programs. These programs include the more traditional National Institutes of Health (NIH) funded experiences, such as the T32, as well as the nontraditional institution funded positions, including the associate faculty role. Graduates often need guidance on which postdoctoral programs are available, the resources each program offers to promote development of the applicant's program of research, the disadvantages of each program, and what each program uses as benchmarks for success. This article summarizes both traditional and nontraditional postdoctoral positions including the T32, F32, F99/K00, T90/R90, research supplements, associate faculty, research associate, and hospital-affiliated postdoctoral positions. This article updates previous papers describing postdoctoral opportunities and offers a starting place to aide PhD students planning their postgraduate activities in seeking and evaluating these positions.
• Lovett, J., Gordon, C., Patton, S., & Chen, C. X. (2019). Online information on dysmenorrhoea: An evaluation of readability, credibility, quality and usability. Journal of clinical nursing, 28(19-20), 3590-3598.
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  To evaluate online information on dysmenorrhoea, including readability, credibility, quality and usability.
• Chen, C. X., Draucker, C. B., & Carpenter, J. S. (2018). What women say about their dysmenorrhea: a qualitative thematic analysis. BMC women's health, 18(1), 47.
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  Dysmenorrhea is highly prevalent and is the leading cause of absence from school and work among women of reproductive age. Evidence suggests that dysmenorrhea may also be a risk factor for other chronic pain conditions. Limited research has examined women's experience with dysmenorrhea using qualitative data. Research is warranted to address issues and needs that are important from women's own perspectives. Therefore, the purpose of this study was to describe women's salient thoughts about their experiences of dysmenorrhea.
• Chen, C. X., Groves, D., Miller, W. R., & Carpenter, J. S. (2018). Big Data and Dysmenorrhea: What Questions Do Women and Men Ask About Menstrual Pain?. Journal of women's health (2002), 27(10), 1233-1241.
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  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.
• Chen, C. X., Kroenke, K., Stump, T. E., Kean, J., Carpenter, J. S., Krebs, E. E., Bair, M. J., Damush, T. M., & Monahan, P. O. (2018). Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials. Pain, 159(4), 775-782.
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  Minimally important difference (MID) refers to the smallest meaningful difference that carries implications for patient care. Minimally important differences are necessary to help interpret patient-reported pain outcomes in research and clinical practice. The PROMIS pain interference scales were validated across diverse samples; however, more information about their MIDs could improve their interpretability. The purpose of this study was to estimate MIDs for 4 fixed-length PROMIS pain interference scales, including the 6-item Pain Short Form and the 4-, 6-, and 8-item pain interference scales used in the PROMIS profile instruments. Data were analyzed from 3 randomized controlled trials (N = 759). The 3 samples, respectively, consisted of patients with chronic low back pain (n = 261), chronic back pain or hip/knee osteoarthritis pain (n = 240), and a history of stroke (n = 258). For each sample, anchor- and distribution-based approaches were used to estimate MIDs. Standard error of measurement and effect sizes were used as distribution-based MID estimates. Anchor-based MID estimates were established by mapping PROMIS pain interference scores onto established anchor measures, including the Brief Pain Inventory, and retrospective and prospective global ratings of change. The distribution- and anchor-based MID estimates showed convergence. For the pain samples, MID estimates ranged from 2 to 3 T-score points. For the nonpain sample, MID estimates ranged from 3.5 to 4.5 T-score points. The MID estimates were comparable across the 4 fixed-length scales. These MIDs can be used to evaluate treatment effects in research and clinical care and to calculate estimates for powering clinical trials.
• Chen, C. X., Ofner, S., Bakoyannis, G., Kwekkeboom, K. L., & Carpenter, J. S. (2018). Symptoms-Based Phenotypes Among Women With Dysmenorrhea: A Latent Class Analysis. Western journal of nursing research, 40(10), 1452-1468.
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  Dysmenorrhea is highly prevalent and may increase women's risk for developing other chronic pain conditions. Although it is highly variable, symptom-based dysmenorrhea phenotypes have not been identified. The aims of the study were to identify symptom-based dysmenorrhea phenotypes and examine their relationships with demographic and clinical characteristics. In a cross-sectional study, 762 women with dysmenorrhea rated severity of 14 dysmenorrhea-related symptoms. Using latent class analysis, we identified three distinctive phenotypes. Women in the "mild localized pain" phenotype ( n = 202, 26.51%) had mild abdominal cramps and dull abdominal pain/discomfort. Women in the "severe localized pain" phenotype ( n = 412, 54.07%) had severe abdominal cramps. Women in the "multiple severe symptoms" phenotype ( n = 148, 19.42%) had severe pain at multiple locations and multiple gastrointestinal symptoms. Race, ethnicity, age, and comorbid chronic pain conditions were significantly associated with phenotypes. Identification of these symptom-based phenotypes provides a foundation for research examining genotype-phenotype associations, etiologic mechanisms, and/or variability in treatment responses.
• Chen, C. X., Shieh, C., Draucker, C. B., & Carpenter, J. S. (2018). Reasons women do not seek health care for dysmenorrhea. Journal of clinical nursing, 27(1-2), e301-e308.
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  To identify and describe reasons women do not seek health care for dysmenorrhea symptoms.
• Carpenter, J. S., Bakoyannis, G., Otte, J. L., Chen, C. X., Rand, K. L., Woods, N., Newton, K., Joffe, H., Manson, J. E., Freeman, E. W., & Guthrie, K. A. (2017). Validity, cut-points, and minimally important differences for two hot flash-related daily interference scales. Menopause (New York, N.Y.), 24(8), 877-885.
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  To conduct psychometric analyses to condense the Hot Flash-Related Daily Interference Scale (HFRDIS) into a shorter form termed the Hot Flash Interference (HFI) scale; evaluate cut-points for both scales; and establish minimally important differences (MIDs) for both scales.
• Carpenter, J. S., Heit, M., Chen, C. X., Stewart, R., Hamner, J., & Rand, K. L. (2017). Validating the Postdischarge Surgical Recovery Scale 13 as a Measure of Perceived Postoperative Recovery After Laparoscopic Sacrocolpopexy. Female pelvic medicine & reconstructive surgery, 23(2), 86-89.
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  No postoperative recovery measurement tools have been validated among women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse, which impedes development and testing of strategies to improve recovery. The purpose of this study was to evaluate the performance of the Postdischarge Surgical Recovery Scale (PSR) as a measure of perceived recovery in laparoscopic sacrocolpopexy patients.
• Chen, C. X., Barrett, B., & Kwekkeboom, K. L. (2016). Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM, 2016, 6295737.
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  This systematic review examines the efficacy of oral ginger for dysmenorrhea. Key biomedical databases and grey literature were searched. We included randomized controlled trials comparing oral ginger against placebo or active treatment in women with dysmenorrhea. Six trials were identified. Two authors independently reviewed the articles, extracted data, and assessed risk of bias. Discrepancies were resolved by consensus with a third reviewer. We completed a narrative synthesis of all six studies and exploratory meta-analyses of three studies comparing ginger with placebo and two studies comparing ginger with a nonsteroidal anti-inflammatory drug (NSAID). Ginger appeared more effective for reducing pain severity than placebo. The weighted mean difference on a 10 cm visual analogue scale was 1.55 cm (favoring ginger) (95% CI 0.68 to 2.43). No significant difference was found between ginger and mefenamic acid (an NSAID). The standardized mean difference was 0 (95% CI -0.40 to 0.41). Available data suggest that oral ginger could be an effective treatment for menstrual pain in dysmenorrhea. Findings, however, need to be interpreted with caution because of the small number of studies, poor methodological quality of the studies, and high heterogeneity across trials. The review highlights the need for future trials with high methodological quality.
• Chen, C. X., Kwekkeboom, K. L., & Ward, S. E. (2016). Beliefs About Dysmenorrhea and Their Relationship to Self-Management. Research in nursing & health, 39(4), 263-76.
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  Dysmenorrhea 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. © 2016 Wiley Periodicals, Inc.
• Chen, C. X., Kwekkeboom, K. L., & Ward, S. E. (2015). Self-report pain and symptom measures for primary dysmenorrhoea: a critical review. European journal of pain (London, England), 19(3), 377-91.
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  Primary dysmenorrhoea (PD) is highly prevalent among women of reproductive age and it can have significant short- and long-term consequences for both women and society as a whole. Validated symptom measures are fundamental for researchers to understand women's symptom experience of PD and to test symptom interventions. The objective of this paper was to critically review the content and psychometric properties of self-report tools to measure symptoms of PD. Databases including PubMed, PsychoINFO, Cumulative Index of Nursing and Allied Health Literature, and Health and Psychosocial Instruments were searched for self-report symptom measures that had been used among women with either PD or perimenstrual symptoms. A total of 15 measures met inclusion criteria and were included in the final analysis. The measures were categorized into generic pain measures, dysmenorrhoea-specific measures, and tools designed to measure perimenstrual symptoms. These measures had varying degrees of comprehensiveness of symptoms being measured, relevance to PD, multidimensionality and psychometric soundness. No single measure was found to be optimal for use, but some dysmenorrhoea-specific measures could be recommended if revised and further tested. Key issues in symptom measurement for PD are discussed. Future research needs to strengthen dysmenorrhoea-specific symptom measures by including a comprehensive list of symptoms based on the pathogenesis of PD, exploring relevant symptom dimensions beyond symptom severity (e.g., frequency, duration, symptom distress), and testing psychometric properties of the adapted tools using sound methodology and diverse samples.