Evaluating the relationship of empathic concern to college students' responses to the COVID-19 pandemic.

Objective: Empathic concern (EC) for others may be related to COVID-19 pandemic responses. Participants and methods: The purpose of this survey study was to examine differences in pandemic responses in 1,778 college students rated as low (LE) versus high (HE) on the EC subscale of the Interpersonal Reactivity Index. Results: HE participants reported greater concerns in numerous pandemic-related domains, including acquiring COVID-19; access to COVID-19 treatment; number of COVID-19 cases, hospitalizations, and deaths reported; staying employed; and being isolated for long periods of time. Generalized anxiety symptoms, depressive symptoms, and perceived stress scores were significantly higher for individuals in the HE group compared to the LE group. The HE group reported being significantly more adherent to health and safety recommendations than the LE group. Conclusions: Empathic concern for others is important for promoting college student prosocial behavior but is associated with anxiety and depression symptomatology during times of traumatic stress.

Physician-Patient Communication and Satisfaction in Spanish-Language Primary Care Visits.

Language discordance poses a barrier to effective physician-patient communication, and health care outcomes, such as patient satisfaction, can be associated with language barriers experienced by Spanish-speaking patients. This exploratory study assessed specific aspects of communication between 128 Spanish-speaking primary care patients and their physicians (primary English speakers without an interpreter present). The rating scale developed for this study was used by five raters, who listened to audiotapes of each of these medical visits. Patients and physicians completed measures of visit satisfaction. Results indicated physicians with better Spanish-language skills were less frustrated with medical visit communication and more connected to their patients; patients whose physicians were rated as having better Spanish-speaking ability reported having greater choice in their medical care. Patients whose physicians spoke more Spanish were more satisfied with the information given by their physicians. Physicians rated as having better Spanish-speaking ability were more likely to say they could not understand all the patients wanted to tell them. These data support the importance of language concordance in physician-patient communication and awareness of potential communication barriers between physicians and patients.

Cognitive decline in mid-life: Changes in memory and cognition related to hypothyroidism.

This study assessed specific cognitive impairments within a primarily female, hypothyroid population, while controlling for factors that commonly contribute to cognitive decline. Participants (N = 739) included 461 individuals with hypothyroidism. This study involved an online survey assessing several aspects of memory and cognition. Those with hypothyroidism generally scored worse on self-assessments of memory, higher perceived stress, high rates of depression and anxiety, greater fatigue, poorer concentration, and less motivation. A Receiver Operating Characteristic curve indicated that the cognitive questionnaires are successful at classifying hypothyroidism and a mediation analysis showed fatigue is a mediating symptom of these cognitive outcomes.

Identifying the risk of opioid misuse in a chronic pain population: the utility of the MMPI-2-RF personality psychopathology five (PSY-5-RF) and higher-order scales.

Prescription-related opioid misuse, especially in chronic pain populations, is an ongoing problem and is related to increased mortality. The purpose of this study was to assess the utility of two restructured scales of the MMPI-2-RF: the Personality Psychopathology Five (PSY-5-RF) and the Higher-Order Scales to determine which of their subscales may be beneficial for identifying the risk of opioid misuse in a chronic pain population. A sample of 136 patients with chronic disabling occupational musculoskeletal disorders completed the MMPI-2-RF and the Current Opioid Misuse Measure (COMM) upon admission to a functional restoration program. The PSY-5-RF and H-O subscales were correlated with the baseline COMM scores. Correlation analyses, ROC curve analyses, and multiple binary logistic regression models were developed to determine which subscales were most associated with elevated COMM scores. The results of the regression analyses suggest that Scale elevations on two of the PSY-5-RF Scales and two Higher-Order Scales of the MMPI-2-RF demonstrated significant associations with elevated COMM scores, thus exhibiting the utility of these subscales in identifying the risk of opioid misuse among chronic pain patients. These findings are clinically meaningful in underscoring the importance of identifying specific personality traits as potential predictors of opioid misuse, and identifying those at risk through careful screening. Clinical implications based on each of the PSY-5-RF and H-O scales significantly associated with elevated COMM scores are discussed.

Using the Biopsychosocial Approach to Identify Factors Associated with Major Depressive Disorder for Individuals with Hypothyroidism.

Previous research has found that major depressive disorder (MDD) commonly occurs in hypothyroid populations. The purpose of this study was to use the biopsychosocial model to investigate factors associated with MDD and hypothyroidism by comparing hypothyroid patients with MDD and without MDD. A sample of 386 participants with hypothyroidism completed both cognitive and psychosocial self-reported assessments along with a questionnaire rating the severity of common hypothyroid symptoms. Participants were divided into two groups (MDD and no MDD) using the diagnostic criteria of the Patient Health Questionnaire. Univariate comparisons were used to assess differences in the severity of physical, psychological, and social correlates in participants with and without MDD. Participants with MDD reported significantly worse symptom severity, increased stress, and disruptions of cognitive functioning. Compared to individuals without MDD, they also indicated poorer quality of life, doctor-patient relationships, and treatment adherence. Individuals with comorbid depression and hypothyroidism reported worse outcomes across physical symptoms, social factors, and psychological and cognitive states than individuals without MDD. Integrating depression screeners and independent treatment for MDD, in addition to the patient's hypothyroid treatment plan, may result in hypothyroid symptom relief and greater quality of life.

Weight stigma is associated with provider-patient relationship factors and adherence for individuals with hypothyroidism.

The goal of this study was to examine weight stigma experiences during medical visits as related to provider-patient relationship factors and adherence among individuals with hypothyroidism. A total of 362 participants recruited via social media participated in an online survey. Regression and mediation analyses indicated that weight stigma was negatively associated with adherence; this relationship was mediated by decreased trust in provider, less perceived provider empathy, and lower provider-patient depth-of-relationship. Structural equation modeling with BMI controlled revealed that weight stigma is associated with worsened provider-patient relationship and adherence. Findings suggest the importance of eliminating weight stigma experiences for patients.

The Relationship Between Brain Fog and Medication Adherence for Individuals With Hypothyroidism.

Individuals with hypothyroidism suffer from symptoms including impairments to cognition (i.e., "brain fog"). Medication can help reduce symptoms of hypothyroidism; however, brain fog may hinder adherence. The aim of this study was to determine if memory impairment and cognitive failures are related to treatment nonadherence in 441 individuals with hypothyroidism. Participants with a diagnosis of hypothyroidism and currently prescribed a thyroid hormone replacement medication were placed in two groups according to adherence level and compared on validated scales assessing impairments to memory and cognition. Results indicated a significant association between treatment nonadherence and self-reported brain fog, represented by greater cognitive and memory impairments. Nonadherent individuals indicated impairments with prospective, retrospective, and short- and long-term memory; and more cognitive failures, compared to adherent individuals. Findings suggest the importance of interventions to enhance adherence for individuals with brain fog, such as encouraging the use of reminders.

Pandemic-Specific Factors Related to Generalized Anxiety Disorder during the Initial COVID-19 Protocols in the United States.

Little is known about the psychological stress and secondary impacts emerging among the general U.S. population as a result of the ongoing COVID-19 pandemic. The purpose for the current study is to assess the prevalence rates of Generalized Anxiety Disorder (GAD) and to establish psychosocial correlates, pandemic-themed concerns, and other comorbidities for those with GAD at the initial onset of the COVID-19 pandemic. This online study included 2,101 U.S. adults between April 14-22, 2020, during the initial stay-at-home protocols and assessed GAD, psychosocial factors, and pandemic-related factors including concerns, changes in health behaviors, and adherence to protocols. The results demonstrated a high prevalence rate (17.9%) for GAD during the initial COVID-19 outbreak compared with the prior 1.8% 12-month estimate before the pandemic. Individuals with GAD reported significantly higher levels of stress, loneliness, fatigue, and empathic concern, along with reductions in levels of quality of life. Likewise, those with GAD reported significantly higher pandemic-related concerns, poorer changes in general health behaviors, and less confidence in the government's response to the pandemic. For clinical purposes, these findings provide insight into the various types of pandemic-themed worries that individuals meeting clinical criteria for GAD will have the most difficulties controlling.

Geographic Variations of Racial/Ethnic Disparities in Late-Stage Diagnosis of Childhood Cancer in Texas.

OBJECTIVES: This study aimed to identify small geographic areas where the childhood cancer yearly incidence and late-stage diagnosis rates were disproportionately higher among racial/ethnic minorities (Hispanics and non-Hispanic African Americans) in Texas. METHODS: The study examined childhood cancer disparities in Texas from 2005 to 2014, based on geographic location and race/ethnicity. Relative (risk ratio) and absolute (risk difference) measures were used to investigate racial disparities of childhood cancer late-stage diagnosis in small geographic areas (census tracts). The study investigated childhood cancer yearly incidence- and late-stage diagnosis rates for three racial groups combined. The study also analyzed the temporal change of childhood cancer late-stage diagnosis rates based on the data from census tracts where disparities existed for Hispanics and non-Hispanic African Americans compared with a non-Hispanic white reference group. RESULTS: A total of 54% of the cases in the study cohort were diagnosed in the late stage. Although there were fewer non-Hispanic African Americans cases compared with non-Hispanic white and Hispanic cases, they showed significant geographic variation in racial/ethnic disparities compared with the non-Hispanic white reference group. The study also revealed that 58 census tracts for non-Hispanic African Americans and 47 census tracts for Hispanics (of 5265) had significantly higher late-stage diagnosis rates compared with non-Hispanic whites. The findings also demonstrated consistent increases in incidence and late-stage diagnosis from 2005 to 2014 for all cases combined. CONCLUSIONS: Most of the significant census tracts with a higher late-stage diagnosis rate for Hispanics were located on the outskirts of the Dallas-Fort Worth, Houston, and San Antonio areas. In contrast, geographic disparities of childhood cancer late-stage diagnosis for non-Hispanic African Americans were found inside the large metropolitan areas of Houston and Dallas-Fort Worth. The findings of this study will help prioritize the geographical allocation of resources, which, in turn, will help to facilitate preventive healthcare services and alleviate the disease burden in children.

A Qualitative Approach to Understanding HIV-Related Stress in Texas(1).

Much of the southern United States is characterized by unique social, structural, and political systems that may relate to increased stress and poor health outcomes for those living with HIV. Notably, research indicates that Texas has higher survival rates for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) than general southern trends, which might suggest that Texans living with HIV experience HIV-related stressors and coping strategies influential to health differently than those living elsewhere in the South. This study used grounded theory and semi-structured interviews to increase understanding of HIV-related stress in Texas. Participants (N=20) were 12 people living with HIV in Texas and 8 HIV-care providers in Texas. Results indicated 5 emergent stress-related themes: housing strain, substance use, limited financial abilities, relationship dynamics, and internal pressures and psychosocial resiliency. Results also highlighted some of the potentially unique ways in which this sample experienced these themes, which may relate to relatively better HIV-related outcomes in Texas. Overall, our findings deepen understanding of how people living with HIV in Texas may experience stress and inform potential approaches to HIV care elsewhere.

Psychosocial Factors Related to Functional Restoration Treatment Completion and Return-to-Function for Patients With Chronic Disabling Occupational Musculoskeletal Disorders.

OBJECTIVE: The aim of this study was to identify demographic and psychosocial variables associated with successful completion of a functional restoration program and return-to-function within 3 months of treatment completion. METHODS: Three hundred seven patients admitted to the functional restoration program were evaluated for completion status and 200 patients with valid data were assessed for 3-month return-to-function status following completion. Psychosocial and functional status was assessed at baseline. RESULTS: Key factors associated with program completion included lower perceived disability, lower pain, lower functional impairment, and lower fear avoidance. Factors associated with 3-month return-to-function included lower perceived disability, lower depression, greater belief that pain is not associated with impairment, and higher quality of life. CONCLUSIONS: Psychosocial and functional factors contribute to both functional restoration completion and 3-month return-to-function outcomes.

White coat hypertension: improving the patient-health care practitioner relationship.

White coat hypertension is characterized by the variability of a patient's blood pressure measurements between the physician's office and the patient's home environment. A patient with white coat hypertension has high blood pressure levels in the physician's office and normal blood pressure levels in their typical environment. This condition is likely caused by the patient's anxiety within the physician's office and in the presence of the physician. Research has shown that improving the relationship between a patient and their health care provider can decrease the patient's anxiety, with the implication of decreasing the patient's likelihood of demonstrating white coat hypertension. This review provides an overview of the previous literature regarding white coat hypertension, its prevalence, and the consequences for those who develop persistent hypertension. Furthermore, this review discusses the implications of improving patient and health care provider interactions through effective communication, empathy, and trust, as well as the implications for future research studies in improving the patient and health care provider's relationship.

Communication about patient pain in primary care: development of the Physician-Patient Communication about Pain scale (PCAP).

OBJECTIVE: This paper describes the development of the 47-item Physician-Patient Communication about Pain (PCAP) scale for use with audiotaped medical visit interactions. METHODS: Patient pain was assessed with the Medical Outcomes Study SF-36 Bodily Pain Scale. Four raters assessed 181 audiotaped patient interactions with 68 physicians. Descriptive statistics of PCAP items were computed. Principal components analyses with 20 scale items were used to reduce the scale to composite variables for analyses. Validity was assessed through (1) comparing PCAP composite scores for patients with high versus low pain and (2) correlating PCAP composites with a separate communication rating scale. RESULTS: Principal components analyses yielded four physician and five patient communication composites (mean alpha=.77). Some evidence for concurrent validity was provided (5 of 18 correlations with communication validation rating scale were significant). Paired-sample t tests showed significant differences for 4 patient PCAP composites, showing the PCAP scale discriminates between high and low pain patients' communication. CONCLUSION: The PCAP scale shows partial evidence of reliability and two forms of validity. PRACTICE IMPLICATIONS: More research with this scale (developing more reliable and valid composites) is needed to extend these preliminary findings before this scale is applicable for use in practice.

Serious psychological distress and diabetes care among California adults.

OBJECTIVE: To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin A 1 C checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD). METHOD: Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD. RESULTS: Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin A 1 C checks. CONCLUSIONS: The findings highlight a specific area--foot complication evaluation and prevention--for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.

Development and validation of the Physician-Patient Humor Rating Scale.

The purpose of this study was the development of a rating instrument to assess the use of humor in physician- patient interactions, and to compare humor use as a function of patients' socioeconomic status. The 46-item Physician-Patient Humor Rating Scale (PPHRS) was used to rate 246 audiotaped primary care interactions. Four subscales were reliable and valid, demonstrating correlations with patient satisfaction and reports of physician humor, with physician satisfaction and with separate affective communication ratings. There was a significant difference in use of humor as a function of patient socioeconomic status, such that there was greater mutual trust between physicians and high versus low income patients.