Ann I Scher

Uniformed Services University of the Health Sciences, 베서스다, Maryland, United States

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Publications (80)421.43 Total impact

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    ABSTRACT: Background: Sudden cardiac death associated with physical exertion (SCD/E) is a complicated pathophysiological event. This study aims to calculate the incidence rate of SCD/E in the US military population from 2005 to 2010, to characterise the demographic and cardiovascular risk profiles of decedents, and to evaluate aetiologies of and circumstances surrounding the deaths. Methods: Perimortem and other relevant data were collected from the Armed Forces Medical Examiners Tracking System, Armed Forces Health Longitudinal Technology Application, and Defense Medical Epidemiology Database for decedents meeting SCD/E case definition. Incidence rates were calculated and compared using negative binomial regression. Results: The incidence of SCD/E in the Active Component (ie, full-time active duty) US military from 2005 to 2010 was 1.63 per 100 000 person-years (py): 0.98 and 3.84 per 100 000 py in those aged <35 and ≥35 years, respectively. Atherosclerotic cardiovascular disease was the leading cause of death overall (55%) and in the ≥35-year age group (78%), whereas the leading cause of death in the <35-year age group (31%) could not be precisely determined and was termed idiopathic SCD/E (iSCD/E). SCD/E was more common in males than females (incidence rate ratio (IRR) = 5.28, 95% CI 2.16 to 12.93) and more common in blacks than whites (IRR=2.60, 95% CI 1.81 to 3.72). All female cases were black. Conclusions: From 2005 to 2010, the incidence of SCD/E in US military members aged <35 years was similar to most reported corresponding civilian SCD rates. However, the leading cause of death was iSCD/E and not cardiomyopathy. Improved surveillance and age-based prevention strategies may reduce these rates.
    No preview · Article · Nov 2015 · British Journal of Sports Medicine
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    ABSTRACT: Background Post-traumatic stress disorder (PTSD) has been linked with migraine in prior studies.Objective To evaluate the individual and joint burdens of migraine and PTSD in a population-based cohort.Methods The National Comorbidity Survey-Replication (NCS-R) is a general population study conducted in the United States from February 2001–April 2003. PTSD and migraine were assessed, and four groups defined based on their migraine and PTSD status. The four groups included those with no migraine and no PTSD (controls, n=4535), those with migraine and without PTSD (migraine alone, n=236), those with PTSD and without migraine (PTSD alone, n=244), and those with both migraine and PTSD (mig+PTSD, n=68). Logistic and Poisson regression models were used to assess the association between dichotomous/multilevel outcome variables indicating financial, health, and interpersonal burdens and each migraine/PTSD group.ResultsCompared to controls, those with Mig+PTSD were more likely to be in the low poverty index (48% vs 41%, AOR 2.16; CI: 1.10, 4.24) and were less likely to be working for pay or profit in the past week (50% vs 68%, AOR 0.42; CI: 0.24, 0.74) but not those with migraine or PTSD alone. Additionally, the number of days where work quality was cut due to physical or mental health or substance abuse in the past month was greater in all groups compared to controls: (1) migraine alone: mean 2.57 (SEM 0.32) vs mean 1.09 (SEM 0.08) days, ARR=2.39; CI: 2.19, 2.62; (2) PTSD alone: mean 2.43 (SEM 0.33) vs mean 1.09 (SEM 0.08) days, ARR=2.09; CI: 1.91, 2.29; (3) mig+PTSD: mean 8.2 (SEM 0.79) vs 1.09 (SEM 0.08) days, ARR 6.79; CI 6.16, 7.49; and was over 2.5-fold greater in those mig+PTSD than migraine alone (mean 8.0 [SEM 0.79] vs 2.6 days [SEM 0.72], ARR 2.77; CI: 2.45, 3.14). The likelihood of having difficulty getting along or maintaining a social life was also increased in all groups relative to controls: (1) migraine alone: 21% vs 5.4%, AOR 4.20; CI: 2.62, 6.74; (2) PTSD alone: 18% vs 5.4%, AOR 3.40; CI: 2.40, 4.82; (3) Mig+PTSD: 39% vs 5.4%, AOR 9.95; CI: 5.72, 17.32, and was 2-fold greater in those with Mig+PTSD as compared to those with migraine alone (AOR 2.32; CI: 1.15, 4.69).Conclusions These findings support the need for those who treat migraine patients to be aware of the comorbidity with PTSD, as these patients may be particularly prone to adverse financial, health, and interpersonal disease burdens.
    Full-text · Article · Oct 2015 · Headache The Journal of Head and Face Pain
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    Full-text · Article · Sep 2015 · Neurology
  • Tobias Kurth · Ann I Scher
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    ABSTRACT: Approximately 15% of the global adult general population has migraine, a chronic intermittent primary headache disorder with a high degree of disability. 1 In addition to the temporary disability associated with migraine attacks, migraineurs may incur additional disability related to other conditions that affect them more often than would be expected by chance-including in particular depression, anxiety, and noncephalic pain.
    No preview · Article · Aug 2015 · Neurology
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    ABSTRACT: The purpose of this study was to qualitatively explore exposure to deployment-related physical and/or emotional trauma and associated symptoms among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) soldiers. Interviews also focused on in-theater- and reintegration-related experiences. Research Method/Design: OEF/OIF soldiers (N = 103) participated in semistructured interviews, and a qualitative descriptive methodology was used to analyze the data. Themes were identified regarding (a) common experiences related to emotional and physical traumas and associated symptoms and strategies for coping and making meaning of experiences and (b) how combat and reintegration experiences affected soldiers' senses of self, relationships with others, and functioning. Themes identified support a rethinking of deployment-related mild traumatic brain injury and posttraumatic stress disorder as discrete conditions. Dimensional versus categorical models should be considered. The findings also highlight experiences and potentially meaningful constructs (e.g., moral injury, moral repair) that can be used to inform research and clinical efforts aimed at improving the lives of those who have served. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Jul 2015 · Rehabilitation Psychology
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    ABSTRACT: Mild traumatic injuries to the brain (e.g., concussion) are common and have been recognized since antiquity, although definitions have varied historically. Nonetheless, studying the epidemiology of concussion helps clarify the overall importance, risk factors, and at-risk populations for this injury. The present review will focus on recent findings related to the epidemiology of concussion including definition controversies, incidence, and patterns in the population overall and in the military and athlete populations specifically. Finally, as this is an area of active research, we will discuss how future epidemiologic observations hold promise for gaining greater clarity about concussion and mild traumatic brain injury.
    No preview · Article · Jul 2015 · Current Pain and Headache Reports
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    A. Scher · A. Adams · K. M. Fanning · R. B. Lipton

    Full-text · Article · Apr 2015 · Journal of Pain
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    ABSTRACT: To evaluate ictal adipokine levels in episodic migraineurs and their association with pain severity and treatment response. This was a double-blind, placebo-controlled trial evaluating peripheral blood specimens from episodic migraineurs at acute pain onset and 30 to 120 minutes after treatment with sumatriptan/naproxen sodium vs placebo. Total adiponectin (T-ADP), ADP multimers (high molecular weight [HMW], middle molecular weight, and low molecular weight [LMW]), leptin, and resistin levels were evaluated by immunoassays. Thirty-four participants (17 responders, 17 nonresponders) were included. In all participants, pretreatment pain severity increased with every quartile increase in both the HMW:T-ADP ratio (coefficient of variation [CV] 0.51; 95% confidence interval [CI]: 0.08, 0.93; p = 0.019) and resistin levels (CV 0.58; 95% CI: 0.21, 0.96; p = 0.002), but was not associated with quartile changes in leptin levels. In responders, T-ADP (CV -0.98; 95% CI: -1.88, -0.08; p = 0.031) and resistin (CV -0.95; 95% CI: -1.83, -0.07; p = 0.034) levels decreased 120 minutes after treatment as compared with pretreatment. In addition, in responders, the HMW:T-ADP ratio (CV -0.04; 95% CI: -0.07, -0.01; p = 0.041) decreased and the LMW:T-ADP ratio (CV 0.04; 95% CI: 0.01, 0.07; p = 0.043) increased at 120 minutes after treatment. In nonresponders, the LMW:T-ADP ratio (CV -0.04; 95% CI: -0.07, -0.01; p = 0.018) decreased 120 minutes after treatment. Leptin was not associated with treatment response. Both pretreatment migraine pain severity and treatment response are associated with changes in adipokine levels. Adipokines represent potential novel migraine biomarkers and drug targets. © 2015 American Academy of Neurology.
    Full-text · Article · Mar 2015 · Neurology

  • No preview · Article · Mar 2015 · Journal of the American College of Cardiology
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    ABSTRACT: ObjectiveA qualitative study among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Soldiers was conducted to explore potential constructs underlying suicide according to the interpersonal–psychological theory of suicide (IPTS); these include burdensomeness, failed belonging, and acquired capability.Methods Qualitative semistructured interviews were conducted with 68 Soldiers at 3 months post-OEF/OIF deployment. Soldiers were asked about changes in their experiences of pain, burdensomeness, and lack of belonging. The methodology employed was descriptive phenomenological.ResultsTranscripts were reviewed and themes related to the IPTS constructs emerged. Soldiers’ postdeployment transition experiences included higher pain tolerance, chronic pain, emotional reactivity, emotional numbing and distancing, changes in physical functioning, combat guilt, discomfort with care seeking, and difficulties reintegrating into family and society.Conclusions Findings highlight the utility of the IPTS in understanding precursors to suicide associated with transition from deployment, as well as treatment strategies that may reduce risk in Soldiers during reintegration.
    No preview · Article · Mar 2015 · Journal of Clinical Psychology

  • No preview · Article · Mar 2015 · Journal of the American College of Cardiology
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    RB Lipton · D Serrano · AM Adams · DC Buse · AI Scher

    Full-text · Article · Sep 2014 · The Journal of Headache and Pain
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    Full-text · Article · Sep 2014 · The Journal of Headache and Pain
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    ABSTRACT: Objective: In the present study, we tested the hypothesis that having migraine in middle age is related to late-life parkinsonism and a related disorder, restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED). Methods: The AGES-Reykjavik cohort (born 1907-1935) has been followed since 1967. Headaches were classified based on symptoms assessed in middle age. From 2002 to 2006, 5,764 participants were reexamined to assess symptoms of parkinsonism, diagnosis of Parkinson disease (PD), family history of PD, and RLS/WED. Results: Subjects with midlife migraine, particularly migraine with aura (MA), were in later life more likely than others to report parkinsonian symptoms (odds ratio [OR]MA = 3.6 [95% CI 2.7-4.8]) and diagnosed PD (ORMA = 2.5 [95% CI 1.2-5.2]). Women with MA were more likely than others to have a parent (ORMA = 2.26 [95% CI 1.3-4.0]) or sibling (ORMA = 1.78 [95% CI 1.1-2.9]) with PD. Late-life RLS/WED was increased for headache generally. Associations were independent of cardiovascular disease and MRI-evident presumed ischemic lesions. Conclusions: These findings suggest there may be a common vulnerability to, or consequences of, migraine and multiple indicators of parkinsonism. Additional genetic and longitudinal observational studies are needed to identify candidate pathways that may account for the comorbid constellation of symptoms.
    No preview · Article · Sep 2014 · Neurology
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    Full-text · Article · Jun 2014 · Headache The Journal of Head and Face Pain
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    ABSTRACT: Childhood obesity and headache are both significant health concerns that often have a marked impact both personally and socially, that if not addressed can carry over into adulthood. For many individuals, these effects may be magnified when obesity and headache are seen in conjunction. It is this overlap between obesity and headache in children, as well as similarities in the known mechanism of action for feeding and headache, which led to a suspected association between the two. Unfortunately, although recent studies have supported this association, only a limited number have been conducted to directly address this. Furthermore, despite rising rates of childhood obesity and headache, the associated medical comorbidities, and the significant financial cost for these conditions, there is a relative void in studies investigating treatment options that address both underlying conditions of obesity and headache in children.
    Full-text · Article · May 2014 · Current Pain and Headache Reports
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    ABSTRACT: Obesity and headache are both associated with a substantial personal and societal impact, and epidemiologic studies have consistently identified a positive association between obesity and headache in general, as well as obesity and migraine specifically (see part I). In the current manuscript, we will discuss the potential mechanisms for the migraine-obesity association, with a focus on the central and peripheral pathophysiological pathways which overlap between migraine and those modulating the drive to feed. We then discuss surgical, behavioral, and pharmacological treatment considerations for overweight and obese migraineurs as well as for those with idiopathic intracranial hypertension. We close by briefly discussing where future research may be headed in light of this data.
    Full-text · Article · Feb 2014 · Headache The Journal of Head and Face Pain
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    Full-text · Dataset · Feb 2014
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    ABSTRACT: Individually, both obesity and headache are conditions associated with a substantial personal and societal impact. Recent data support that obesity is comorbid with headache in general and migraine specifically, as well as with certain secondary headache conditions such as idiopathic intracranial hypertension. In the current manuscript, we first briefly review the epidemiology of obesity and common primary and secondary headache disorders individually. This is followed by a systematic review of the general population data evaluating the association between obesity and headache in general, and then obesity and migraine and tension-type headache disorders. Finally, we briefly discuss the data on the association between obesity and a common secondary headache disorder that is associated with obesity, idiopathic intracranial hypertension. Taken together, these data suggest that it is important for clinicians and patients to be aware of the headache/migraine-obesity association, given that it is potentially modifiable. Hypotheses for mechanisms of the obesity-migraine association and treatment considerations for overweight and obese headache sufferers are discussed in the companion manuscript, as part II of this topic.
    Full-text · Article · Feb 2014 · Headache The Journal of Head and Face Pain
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    ABSTRACT: The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. Among the initiatives of the Global Campaign against Headache to improve and standardize methods in use for cross-sectional studies, the most important is the production of consensus-based methodological guidelines. This report describes the development of detailed principles and recommendations. For this purpose we brought together an expert consensus group to include experience and competence in headache epidemiology and/or epidemiology in general and drawn from all six WHO world regions. The recommendations presented are for anyone, of whatever background, with interests in designing, performing, understanding or assessing studies that measure or describe the burden of headache in populations. While aimed principally at researchers whose main interests are in the field of headache, they should also be useful, at least in parts, to those who are expert in public health or epidemiology and wish to extend their interest into the field of headache disorders. Most of all, these recommendations seek to encourage collaborations between specialists in headache disorders and epidemiologists. The focus is on migraine, tension-type headache and medication-overuse headache, but they are not intended to be exclusive to these. The burdens arising from secondary headaches are, in the majority of cases, more correctly attributed to the underlying disorders. Nevertheless, the principles outlined here are relevant for epidemiological studies on secondary headaches, provided that adequate definitions can be not only given but also applied in questionnaires or other survey instruments.
    Full-text · Article · Jan 2014 · The Journal of Headache and Pain

Publication Stats

4k Citations
421.43 Total Impact Points

Institutions

  • 2004-2015
    • Uniformed Services University of the Health Sciences
      • Department of Preventive Medicine & Biometrics
      베서스다, Maryland, United States
  • 2012
    • Womack Army Medical Center
      Fort Bragg, North Carolina, United States
  • 2009
    • Drexel University College of Medicine
      • Department of Neurology
      Philadelphia, Pennsylvania, United States
    • Reykjavik University
      Reikiavik, Capital Region, Iceland
  • 2008
    • Albert Einstein College of Medicine
      • Department of Neuroradiology
      New York City, New York, United States
  • 2007
    • Thomas Jefferson University
      • Department of Neurology
      Philadelphia, Pennsylvania, United States
  • 2003-2007
    • National Institute on Aging
      • Laboratory of Epidemiology, Demography and Biometry (LEDB)
      Baltimore, Maryland, United States
  • 1998-2003
    • Johns Hopkins University
      • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2002
    • National Institutes of Health
      • Branch of Epidemiology (EPI)
      Maryland, United States
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, Maryland, United States