All Else Being Equal: Examining Treatment Bias and Stereotypes Based on Patient Ethnicity and Socioeconomic Status With In-Hospital Cardiac Arrest Clinical Vignettes.

BACKGROUND: Research on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination - whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed. OBJECTIVE: The primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals' (HCP) stereotypical beliefs about these groups. METHODS: HCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes). RESULTS: No significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients. CONCLUSIONS: Swedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

Do Social Norms Influence Young People's Willingness to Take the COVID-19 Vaccine?

Although young adults are not at great risk of becoming severely ill with COVID-19, their willingness to get vaccinated affects the whole community. Vaccine hesitancy has increased during recent years, and more research is needed on its situational determinants. This paper reports a preregistered experiment (N = 654) that examined whether communicating descriptive social norms - information about what most people do - is an effective way of influencing young people's intentions and reducing their hesitancy to take the COVID-19 vaccine. We found weak support for our main hypothesis that conveying strong (compared to weak) norms leads to reduced hesitancy and stronger intentions. Furthermore, norms did not produce significantly different effects compared to standard vaccine information from the authorities. Moreover, no support was found for the hypothesis that young people are more strongly influenced by norms when the norm reference group consists of other young individuals rather than people in general. These findings suggest that the practical usefulness of signaling descriptive norms is rather limited, and may not be more effective than standard appeals in the quest of encouraging young adults to trust and accept a new vaccine.

A more conservative test of sex differences in the treatment and outcome of in-hospital cardiac arrest.

BACKGROUND: Studies investigating sex disparities related to treatment and outcome of in-hospital cardiac arrest (IHCA) have produced divergent findings and have typically been unable to adjust for outstanding confounding variables. OBJECTIVES: The aim was to examine sex differences in treatment and survival following IHCA, using a comprehensive set of control variables including e.g., age, comorbidity, and patient-level socioeconomic status. METHODS: This retrospective study was based on data from the Swedish Register of Cardiopulmonary Resuscitation and Statistics Sweden. In the primary analyses, logistic regression models and ordinary least square regressions were estimated. RESULTS: The study included 24,217 patients and the majority (70.4%) were men. In the unadjusted analyses, women had a lower chance of survival after cardiopulmonary resuscitation (CPR) attempt, at hospital discharge (with good neurological function) and at 30 days (p<0.01). In the adjusted regression models, female sex was associated with a higher chance of survival after the CPR attempt (B = 1.09, p<0.01) and at 30-days (B = 1.09, p<0.05). In contrast, there was no significant association between sex and survival to discharge with good neurological outcome. Except for treatment duration (B=-0.07, p<0.01), no significant associations between sex and treatment were identified. CONCLUSIONS: No signs of treatment disparities or discrimination related to sex were identified. However, women had a better chance of surviving IHCA compared to men. The finding that women went from having a survival disadvantage (unadjusted analysis) to a survival advantage (adjusted analysis) attests to the importance of including a comprehensive set of control variables, when examining sex differences.

Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?

AIMS: Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context. METHODS AND RESULTS: In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team's reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52). CONCLUSION: Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

Is clinical, musculoskeletal pain associated with poorer logical reasoning?

INTRODUCTION: It has been hypothesized that pain disrupts system 2 processes (eg, working memory) presumed to underlie logical reasoning. A recent study examining the impact of experimentally induced pain on logical reasoning found no evidence of an effect. OBJECTIVES: The aim of this study was to examine whether clinical pain, which is qualitatively different from experimental pain, would lower the ability to reason logically. METHODS: Ninety-six participants completed a questionnaire containing 3 different logical reasoning tasks (the cognitive reflection test, the belief bias syllogisms task, and the conditional inference task), questions about pain variables (present pain intensity, pain intensity during the last 24 hours, the influence of pain on daily activities, pain duration, and pain persistence), questions about other pain-related states (anxiety, depression, and fatigue), and pain-relieving medication. Correlations between the logical reasoning tasks and the pain variables were calculated. RESULTS: For 2 of the 3 logical reasoning tasks (the cognitive reflection test and the belief bias syllogisms task), clinical pain was unrelated to logical reasoning. Performance on context-free logical reasoning showed a significant negative correlation with present pain intensity, but not with the other pain variables. CONCLUSION: This finding that logical reasoning ability is largely unrelated to clinical pain is highly consistent with previous research on experimentally induced pain. Pain should probably not constitute a significant barrier to logical reasoning in everyday life.

Discriminatory cardiac arrest care? Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest.

AIMS: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors. METHODS AND RESULTS: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay. CONCLUSION: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

Does expertise and thinking mode matter for accuracy in judgments of job applicants' cognitive ability?

The present research examined the role of thinking mode for accuracy in recruiters and laypeople's judgments of applicants' cognitive ability. In Study 1, students who relied on their intuition were somewhat less accurate. In Study 2, an experimental manipulation of thinking mode (intuitive vs analytical) revealed no apparent differences in accuracy. Moreover, there were no differences in accuracy or agreement between recruiters and laypeople. Examination of the use of specific resume content suggested that intuitive thinking corresponds to basing one's judgments more on the way that applicants present themselves in their personal letter and less on diagnostic biographical information such as SAT scores. The findings point to the possibility that professional recruiters may not possess intuitive expertise in this context.

Pain and social cognition: does pain lead to more stereotyped judgments based on ethnicity and age?

Background and aims Previous research on pain and cognition has largely focused on non-social cognitive outcomes (e.g. attention, problem solving). This study examines the relationship between pain and stereotyping, which constitutes a fundamental dimension of social cognition. Drawing on dual process theories of cognition, it was hypothesized that higher levels of pain would increase stereotyped judgments based on ethnicity and age. The hypothesis was tested in conjunction with experimentally induced pain (Study 1) and clinical pain (Study 2). Methods In Study 1, experimental pain was induced with the cold pressor method on a between-subjects basis. Participants (n = 151) completed a judgment task that assessed to what extent they relied on stereotypes (ethnic and age) when estimating other people's cognitive performance. In Study 2, 109 participants with clinical, musculoskeletal pain completed the same stereotype judgment task. Correlations between stereotyped judgments and various pain qualities (intensity, interference with daily activities, duration, and persistence) were performed. Results In Study 1, pain induced participants did not form significantly more stereotyped judgments compared to pain-free participants. However, higher reported pain intensity was associated with more ethnically stereotyped judgments. In Study 2, there were no significant correlations between different aspects of clinical pain and stereotyped judgments. Conclusions The results provide weak support for the hypothesis that pain increases stereotyped judgments. This was the case for both experimentally induced pain and clinical pain. The present study is the first to investigate the link between pain and stereotyping, suggesting that stereotypical judgments may be a social cognitive outcome that is relatively unaffected by pain. Implications The results have practical implications for the clinic, for example, where chronic pain patients may not have greater difficulties interacting with health care professionals that are members of a stereotyped social group (e.g. ethnic).

Pain here and now: physical pain impairs transcendence of psychological distance.

BACKGROUND: The ability to traverse psychological distance by going beyond the experienced reality of the self, here and now, is fundamental for effective human functioning. Yet, little is known about how physical pain affects transcendence of psychological distance. Using a construal level theory framework of psychological distance, the current research examines the hypothesis that pain impairs people's ability to traverse any kind of psychological distance whether it be temporal, social, and spatial distance, or the hypothetical. METHODS: Using the cold pressor test, 151 participants participated in an experiment where they were either induced with acute pain (treatment group) or no pain (control group) while completing a battery of questions measuring to what extent their current thoughts were transcending psychological distance. RESULTS: The results were largely consistent with the hypothesis. Relative to the control group, pain induced participants showed significantly less transcendence of past temporal distance, social distance, spatial distance, and the hypothetical. Furthermore, greater self-reported pain intensity was significantly associated with less transcendence of temporal (past and future), social, and spatial distance. CONCLUSION: Physical pain impairs the ability to traverse psychological distance. The research has practical implications for the pain clinic and for pain-afflicted individuals in everyday life.

Clinical pain, abstraction, and self-control: being in pain makes it harder to see the forest for the trees and is associated with lower self-control.

OBJECTIVES: Although abstract thinking is a fundamental dimension of human cognition, it has received scant attention in research on pain and cognition. We hypothesized that physical pain impairs abstraction, because when people experience pain at high intensity levels, attention becomes concretely focused on the self in the here and now, where little else matters than finding relief for the pain they are currently experiencing. We also examined the relationship between pain and self-control, predicting that pain would debilitate self-control. PATIENTS AND METHODS: Abstraction and self-reported self-control were assessed in 109 patients with musculoskeletal pain. The influence of specific pain qualities, such as pain intensity, pain interference with daily activities, pain duration, and pain persistence, was examined. Furthermore, we assessed other factors (e.g., anxiety, depression, and fatigue) that could be assumed to play a role in the pain experience and in cognitive performance. RESULTS: Higher pain intensity and persistence were associated with less abstract thinking. Furthermore, self-control decreased with greater pain intensity, persistence, and self-reported pain interference with daily activities. Self-reported depressive symptoms mediated the overall relationship between pain and self-control. CONCLUSION: Abstraction is compromised in patients reporting higher pain intensity and persistence. Different dimensions of pain also predict lower self-control although depression seems to account for the relationship between overall pain and self-control. The current study is the first to report an association between clinical musculoskeletal pain and abstraction. The results suggest that pain patients may suffer from a broader range of cognitive disadvantages than previously believed.

Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.

AIM: To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age. METHODS: Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18-49years), middle-aged (50-64years) and older (65years and above). Comparisons between men and women were age adjusted. RESULTS: The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors. CONCLUSION: When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

Impaired psychomotor ability and attention in patients with persistent pain: a cross-sectional comparative study.

BACKGROUND AND AIMS: Patients with pain have shown cognitive impairment across various domains. Although the pain qualities vary among patients, research has overlooked how cognitive performance is affected by the duration and persistence of pain. The current study sought to fill this gap by examining how qualitatively different pain states relate to the following cognitive functions: sustained attention, cognitive control, and psychomotor ability. PATIENTS AND METHODS: Patients with musculoskeletal pain in primary care were divided into three pain groups: acute pain (duration <3 months), regularly recurrent pain (duration >3 months), and persistent pain (duration >3 months). These groups were then compared with healthy controls. The MapCog Spectra Test, the Color Word Test, and the Grooved Pegboard Test were used to measure sustained attention, cognitive control, and psychomotor ability, respectively. RESULTS: Patients with persistent pain showed significantly worse sustained attention and psychomotor ability compared with healthy controls. The acute pain group showed a significant decrease in psychomotor ability, and the regularly recurrent pain group showed a significant decrease in sustained attention. These results remained unchanged when age, education, and medication were taken into account. CONCLUSION: Persistent musculoskeletal pain seems to impair performance on a wider range of cognitive tasks than acute or regularly recurrent pain, using pain-free individuals as a benchmark. However, there is some evidence of impairment in psychomotor ability among patients with acute pain and some impairment in sustained attention among patients with regularly recurrent pain. IMPLICATIONS: Caregivers may need to adjust communication methods when delivering information to cognitively impaired patients.

A closer look at the discrimination outcomes in the IAT literature.

To what extent the IAT (Implicit Association Test, Greenwald et al., 1998) predicts racial and ethnic discrimination is a heavily debated issue. The latest meta-analysis by Oswald et al. (2013) suggests a very weak association. In the present meta-analysis, we switched the focus from the predictor to the criterion, by taking a closer look at the discrimination outcomes. We discovered that many of these outcomes were not actually operationalizations of discrimination, but rather of other related, but distinct, concepts, such as brain activity and voting preferences. When we meta-analyzed the main effects of discrimination among the remaining discrimination outcomes, the overall effect was close to zero and highly inconsistent across studies. Taken together, it is doubtful whether the amalgamation of these outcomes is relevant criteria for assessing the IAT's predictive validity of discrimination. Accordingly, there is also little evidence that the IAT can meaningfully predict discrimination, and we thus strongly caution against any practical applications of the IAT that rest on this assumption. However, provided that the application is thoroughly informed by the current state of the literature, we believe the IAT can still be a useful tool for researchers, educators, managers, and students who are interested in attitudes, prejudices, stereotypes, and discrimination.

Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states.

BACKGROUND: Pressure pain thresholds (PPTs) in a non-painful body area are known to be affected in some chronic pain states. The aim of this study is to investigate PPTs in a pain-free body part in relation to pain persistence and intensity in patients with musculoskeletal pain. METHODS: Patients with musculoskeletal pain were divided into three different pain groups: acute pain (pain duration<3 months, n=38), regularly recurrent pain (regularly recurrent pain duration>3 months, n=56), persistent pain (persistent pain duration>3 months, n=52) and a healthy control group (n=51). PPT measures were conducted over the tibialis anterior muscle on the right leg in all groups. RESULTS: The persistent pain group showed significantly lower PPTs over the tibialis anterior muscle compared to controls. No significant differences were found between the acute and regularly recurrent pain groups compared to healthy controls. Significant correlations, albeit small, were found between pain intensity and PPTs. CONCLUSIONS: Increased deep pain sensitivity was found in patients with persistent musculoskeletal pain, but not in regularly recurrent pain or in acute pain. Yet, a limitation of the study is that it did not have sufficient power to detect small levels of increased deep pain sensitivity among the latter groups when compared to healthy controls. IMPLICATIONS: Knowledge about increased general hypersensitivity in persistent musculoskeletal pain could be important in clinical treatment.

The role of automatic obesity stereotypes in real hiring discrimination.

This study examined whether automatic stereotypes captured by the implicit association test (IAT) can predict real hiring discrimination against the obese. In an unobtrusive field experiment, job applications were sent to a large number of real job vacancies. The applications were matched on credentials but differed with respect to the applicant's weight. Discriminatory behavior was quantified by the extent to which the hiring managers invited normal-weight versus obese applicants to a job interview. Several months after the behavioral data were obtained, the hiring managers completed an obesity IAT and explicit hiring preference measures. Only the IAT scores reliably predicted interview decisions. More specifically, hiring managers holding more negative automatic stereotypes about the obese were less likely to invite an obese applicant for an interview. The present research is the first to show that automatic bias predicts labor market discrimination against obese individuals. Practical implications are discussed.

The influence of temporal distance on justice and care morality.

The primary goal of this study was to examine whether changes in the temporal distance of a moral dilemma affect how it is perceived and subsequently resolved. Based on Construal Level Theory (Trope & Liberman, 2003), it was predicted that the relative weight of abstract justice features should increase and the relative weight of concrete care features should decrease with temporal distance. The results showed that females became increasingly justice-oriented with greater temporal distance. However, this was not the case for males who were unaffected by temporal distance. This interaction was conceptually replicated in a follow-up experiment in which abstraction was manipulated directly by a mindset manipulation. The present results suggest that temporal distance is a contextual factor that can alter the extent to which moral judgments and reasoning are based on justice and care, although this effect seems to be moderated by gender.