Racial bias in pediatric pain perception.

Racial disparities in pediatric pain care are prevalent across a variety of healthcare settings, and likely contribute to broader disparities in health, morbidity, and mortality. The present research expands on prior work demonstrating potential perceptual contributions to pain care disparities in adults and tests whether racial bias in pain perception extends to child targets. We examined the perception and hypothetical treatment of pain in Black and White boys (Experiment 1), Black and White boys and girls (Experiment 2), Black and White boys and adult men (Experiment 3), and Black, White, Asian, and Latinx boys (Experiment 4). Across this work, pain was less readily perceived on Black (versus White) boys' faces-though this bias was not observed within girls. Moreover, this perceptual bias was comparable in magnitude to the same bias measured with adult targets and consistently predicted bias in hypothetical treatment. Notably, bias was not limited to Black targets-pain on Hispanic/Latinx boys' faces was also relatively underperceived. Taken together, these results offer strong evidence for racial bias in pediatric pain perception. PERSPECTIVE: This article demonstrates perceptual contributions to racial bias in pediatric pain recognition. Participants consistently saw pain less readily on Black boys' faces, compared to White boys, and this perceptual bias consistently predicted race-based gaps in treatment. This work reveals a novel factor that may support pediatric pain care disparities.

Young Adult Pain Rehabilitation: Interdisciplinary Development and Preliminary Outcomes of a Novel Treatment Program.

BACKGROUND: Young adults with chronic pain and symptoms experience disruptions to their social, emotional, physical, and vocational functioning. Interdisciplinary pain rehabilitation programs for pediatric and adult populations are not designed specifically to address the developmental needs of young adults. METHODS: This article describes the development of a novel intensive interdisciplinary outpatient rehabilitation program tailored to the unique needs of young adults with chronic pain and symptoms. Tailored content included vocational assessment and consultation, financial literacy education, and sexual health education. RESULTS: Outcome data demonstrate treatment gains, with reductions in pain interference, pain severity, pain catastrophizing, and depressive symptoms, as well as improvements in mental and physical quality of life, perceived performance, perceived satisfaction with performance, and objective measures of physical functioning. CONCLUSIONS: The article concludes with clinical recommendations for the management of chronic pain and symptoms in young adults, applicable across multiple treatment settings.

Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up.

BACKGROUND: Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary pain rehabilitation. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning; conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. OBJECTIVE: To prospectively evaluate interdisciplinary pain rehabilitation outcomes, as well as to evaluate the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. METHODS: Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a 3-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, depressive symptom questionnaires, and measures of physical performance were assessed before and after treatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and from pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. RESULTS: Significant improvements from pre- to posttreatment in pain outcomes were observed, and more than 80% evidenced a reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. CONCLUSIONS: Interdisciplinary pain rehabilitation is an effective treatment, and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.

Evaluation of the Bangor Dyslexia Test (BDT) for use with Adults.

The Bangor Dyslexia Test (BDT) is a short, easy-to-administer screener for use with a broad age range, which has been in use in the UK for over three decades. A distinctive feature of the battery is its focus on skills requiring aspects of verbal and phonological processing without, however, measuring literacy skills per se. Despite its longstanding existence and usage, there has been no evaluation of the psychometric properties of the battery as an adult dyslexia screener. We examined the psychometric properties of the BDT and evaluated its capacity to discriminate between adults with and without dyslexia. A large archival sample of university students with dyslexia (n = 193) and students with no reported literacy difficulties (n = 40) were compared on the BDT as well as on literacy and cognitive measures. Statistical analyses revealed the BDT to be a reliable (α = .72) and valid dyslexia screening tool with the capacity to effectively identify adults at risk of the disorder with an overall classification rate of 94% (sensitivity 96.4% and specificity 82.5%). In addition, higher indices of dyslexia risk on the BDT were associated with lower scores on standardized measures of literacy.

Telehealth applications in speech-language pathology: a modified narrative review.

We conducted a modified narrative review of the literature on telehealth applications used in speech-language pathology assessment and treatment. The following databases and information resources were used: MEDLINE, CINAHL, PSYCInfo, ERIC, Digital Dissertations, CSA Social Services Abstracts, CSA Sociological Abstracts, On-line ASHA publications and personal contacts. Sixty-two full-text documents were located. Twenty-eight provided sufficient detail to be reviewed using a checklist adapted from the Scottish Intercollegiate Guideline Network (SIGN) recommendations for level of evidence rankings and quality assessment ratings. Five of the 28 studies received a ranking indicating a high level of evidence (larger sample sizes, assessed outcomes with valid and reliable measures, performed statistical analysis of study results, measured reliability of study results, ensured internal and external validity, and ensured randomization of participants to groups). These five studies concluded that the service delivery results from telehealth were equivalent to traditional face-to-face results. However, telehealth was not a complete replacement for face-to-face service delivery and further research is required.

Early detection of psychosis: finding those at clinical high risk.

AIM: In early detection work, recruiting individuals who meet the prodromal criteria is difficult. The aim of this paper was to describe the development of a research clinic for individuals who appear to be at risk of developing a psychosis and the process for educating the community and obtaining referrals. METHODS: The outcome of all referrals to the clinic over a 4-year period was examined. RESULTS: Following an ongoing education campaign that was over inclusive in order to aid recruitment, approximately 27% of all referrals met the criteria for being at clinical high risk of psychosis. CONCLUSIONS: We are seeing only a small proportion of those in the community who eventually go on to develop a psychotic illness. This raises two important issues, namely how to remedy the situation, and second, the impact of this on current research in terms of sampling bias and generalizability of research findings.

Changing attitudes of nurses - abstract

It is believed that the attitudes of nurses have changed over the years from the orientation of 'ideal service to the public' (altruism) to self interest as a primary goal. The study aimed at investigating if there is in fact a change of attitude and the reasons for change. The convenient sample included Registered Nurses, other health care workers and members of the public. The findings revealed that there is a change in the attitude of nurses towards patients and that dissatisfaction with salary and inadequacy factors contributed to this change. The demands imposed by society influence to some extent the change in the orientation of the nurses. Members of the public are concerned and express some degree of sympathy with the nurses in view of their adverse working condition and economic deprivation. The information gained from this study can serve at least two purposes: 1. To sensitize nurses to the importance of examining our attitudes towards clients and seek to bring some improvement. 2. To provide information to make recommendation for improvement in the social and economic welfare of nurses. (AU)