Effect of a Patient Portal Reminder Message After No-Show on Appointment Reattendance in Ophthalmology: A Randomized Clinical Trial.

PURPOSE: To assess the efficacy of electronic health record (EHR) messaging for re-engaging patients with ophthalmology care after a missed appointment. DESIGN: Prospective, randomized clinical trial. METHODS: The study setting was an academic ophthalmology department. The patient population comprised of return patients age 18 years or older with an appointment "no show," or missed appointment. Over 2 phases of recruitment, 362 patients with an active patient portal in the EHR were selected consecutively each business day. Patients were randomized using a web-based tool to receive a reminder to reschedule via a standard mailed letter only (control) or the mailed letter plus an electronic message through the EHR within 1 business day of the missed appointment (intervention). Reengagement with eye care was defined as attendance of a rescheduled appointment within 30 days of the no-show visit. Patient charts were reviewed for demographic and clinical data. RESULTS: The average age of recruited patients was 59.9 years, just under half of the sample was male (42.5%, 154/362), and most patients were White (56.9%, 206/362) or Black (36.2%, 131/362). Patients were most commonly recruited from the retina service (39.2%, 142/362) followed by the glaucoma service (29.3%, 106/362). Many patients in this study had previous no-show appointments, with an average no-show rate of 18.8% out of all scheduled visits across our health system. In total, 22.2% (42/189) of patients in the intervention group attended a follow-up appointment within 30 days of their no-show visit compared to 11.6% (20/173) of the control group (OR, 2.186; 95% CI, 1.225-3.898; P = .008). When including only the 74 patients in the intervention group who read the intervention message in the patient portal, 28.4% (21/74) attended a follow-up compared to 11.6% (20/173) of the control group (P = .001). CONCLUSIONS: EHR-based reminder messages sent within a business day of a missed appointment may promote re-engagement in ophthalmology care after appointment no-show.

The surprise of reaching out: Appreciated more than we think.

People are fundamentally social beings and enjoy connecting with others. Sometimes, people reach out to others-whether simply to check-in on how others are doing with brief messages or to show that they are thinking of others by sending small gifts to them. Yet, despite the importance and enjoyment of social connection, do people accurately understand how much other people value being reached out to by someone in their social circle? Across a series of preregistered experiments, we document a robust underestimation of how much other people appreciate being reached out to. We find evidence compatible with an account wherein one reason this underestimation of appreciation occurs is because responders (vs. initiators) are more focused on their feelings of surprise at being reached out to. A focus on feelings of surprise in turn predicts greater appreciation. We further identify process-consistent moderators of the underestimation of reach-out appreciation, finding that it is magnified when the reach-out context is more surprising: when it occurs within a surprising (vs. unsurprising) context for the recipient and when it occurs between more socially distant (vs. socially close) others. Altogether, this research thus identifies when and why we underestimate how much other people appreciate us reaching out to them, implicating a heightened focus on feelings of surprise as one underlying explanation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Loss to Follow up among Glaucoma Patients at a Tertiary Eye Center over 10 Years: Incidence, Risk Factors, and Clinical Outcomes.

PURPOSE: To assess the incidence, risk factors, and clinical consequences of loss to follow up (LTFU) among glaucoma patients at our institution over a 10-year period. METHODS: This retrospective study examined LTFU among a cohort of glaucoma patients with a clinical encounter in 2010. LTFU was defined as 52 weeks or more without an encounter and without alternative reason for discontinued care, such as discharge, documented move, or death. Baseline demographic and clinical characteristics were collected and compared between LTFU and non-LTFU groups using a logistic regression model to identify risk factors for LTFU. Odds ratios (ORs) are reported with 95% confidence intervals. Clinical outcomes were documented for LTFU patients who returned after a lapse in care. RESULTS: Among the 395 included patients, 132 (33%) were LTFU over the 10-year study period. Characteristics associated with LTFU in a logistic regression model included greater disease severity (OR = 1.03 [1.01-1.05], p = .023, for each worsening decibel of mean deviation) and in-state rather than out-of-state residence (OR = 2.76 [1.12-6.80], p = .027). Other potential risk factors that did not reach significance included male gender (OR = 1.39 [0.92-2.13], p = .124), Black race (OR = 1.40 [0.91-2.16] p = .123), and legal blindness (OR = 1.58 [0.91-2.76] p = .107). Among the 132 patients who were LTFU, only 23 (17%) later returned to care, two-thirds (15/23) of whom returned with disease progression or complication. CONCLUSION: One-third of glaucoma patients became LTFU over a 10-year period, and LTFU may be associated with poor clinical outcomes. More research is needed to understand reasons for LTFU and to promote regular glaucoma care.

Characteristics associated with barriers to eye care: A cross-sectional survey at a free vision screening event.

INTRODUCTION: Social determinants of health can limit access to regular eye care, but their role in ophthalmology is underexamined. The purpose of this study is to assess the relationship between patient characteristics and self-reported barriers to eye care. METHODS: This anonymous, cross-sectional survey was conducted at a two-day free eye clinic event in Pittsburgh, Pennsylvania. Adult patients presenting for vision screening were eligible to participate. Patient characteristics (demographics, health status) and self-reported barriers to eye care were collected. Predictors of barriers to eye care were analyzed using binary logistic regression. RESULTS: Of 269 eligible, consecutive patients approached for survey completion, 183 comprised the volunteer sample. The 183 participants (105 female patients [59%]) had a mean (standard deviation) age of 53 (15) years, and generally self-identified as Black (74, 46%) or White (67, 41%). While a third reported having no health insurance (60, 34%), the remaining two-thirds of participants had public (84, 48%) or private coverage (34, 19%). Three-quarters of respondents reported at least one barrier to receiving regular eye care (136, 76%), most commonly medical costs (89, 50%) and insurance issues (73, 41%). Not having health insurance or vision insurance was strongly associated with reporting at least one barrier to care (OR 5.00, p=0.002, and OR 7.46, p<0.001, respectively). Those with self-reported eye disease were more likely to report transportation difficulties (OR 4.45, p=0.013), and employed participants reported difficulty getting time off work to attend eye exams (OR 7.73, p=0.002). Finally, compared to Black race, White race was associated with a higher likelihood of reporting any barrier to care (OR 2.79, p=0.013). CONCLUSION: Three-quarters of vision screening attendees reported at least one barrier to regular eye care, most commonly medical costs and insurance.

Experiences of mimicry in eating disorders.

BACKGROUND: People unknowingly mimic the behaviors of others, a process that results in feelings of affiliation. However, some individuals with eating disorders describe feeling "triggered" when mimicked. This study explores the effects of implicit non-verbal mimicry on individuals with a history of an eating disorder (ED-His) compared to healthy controls (HCs). METHOD: Women (N = 118, nED-His = 31; Mage = 21 years) participated in a laboratory task with a confederate trained to either discreetly mimic (Mimicry condition) or not mimic (No-Mimicry condition) the mannerisms of the participant. Participants rated the likability of the confederate and the smoothness of the interaction. RESULTS: Participants in the No-Mimicry condition rated the confederate as significantly more likable than in the Mimicry condition, and ED-His rated the confederate as more likable than HCs. ED-His in the Mimicry condition rated the interaction as less smooth than HCs, whereas this pattern was not found in the No-Mimicry condition. Among ED-His, longer disorder duration (≥ 3.87 years) was associated with less liking of a confederate who mimicked and more liking of a confederate who did not mimic. CONCLUSIONS: We discuss the implications of these findings for interpersonal therapeutic processes and group treatment settings for eating disorders. Our study on subtle, nonverbal mimicry revealed differences in social behavior for women with a history of an eating disorder compared to healthy women. For participants with an eating disorder history, a longer duration of illness was associated with a worse pattern of affiliation, reflected in lower liking of a mimicker. Further research on how diverging processes of affiliation may function to perpetuate the chronicity of eating disorders and implications for treatment is needed.

Predicting others' social interaction preferences: What to do, for how long, and how often.

We present a three-dimensional what, how long, and how often framework to discuss three main inferences about other people's preferences for repeated social interactions over time in terms of: (1) what to do together, (2) how long to spend together on each occasion, and (3) how often to spend time together. For each dimension, we discuss when and how people make inferences about other people's preferences, as well as the consequences of making incorrect inferences. The three dimensions are conceptually independent; however, decisions made on one dimension can sometimes affect decisions made on others. More research is needed on the interplay between multiple dimensions, including how inferences made about preferences and decisions on one dimension affect inferences about preferences and decisions on other dimensions.

The Quality Versus Quantity Trade-Off: Why and When Choices for Self Versus Others Differ.

The trade-off between quality and quantity pervades many domains of life, including that of making product choices for ourselves and others, whether as gifts or as everyday favors. In five studies (four pre-registered), participants preferred quality over quantity when choosing for a friend versus for themselves. We demonstrate that one reason why this difference in choice for self and other arises is because of heightened self-presentation concerns: People choosing for friends (vs. self) are more concerned about conveying poor taste, thus increasing choice of quality (vs. quantity). Consistent with this process, the effect is mitigated when choosing for a nonjudgmental friend or when choosing for a person whom one does not highly value. Finally, this effect is particular to quality-quantity trade-offs; it does not occur for flavor-quantity trade-offs, indicating that the effect is driven by the quality aspect rather than by the quantity aspect or by cost-per-unit considerations.

Reminder avoidance: Why people hesitate to disclose their insecurities to friends.

People seek and receive support from friends through self-disclosure. However, when self-disclosures reveal personal insecurities, do people rely on friends as an audience as they normally do? This research demonstrates that they do not. Five preregistered studies show that disclosers exhibit a weaker preference for friends as an audience when disclosures involve revealing personal insecurities than when they involve revealing other neutral or negative personal information. This effect is observed despite that the only alternative audience available to disclosers in these studies is a stranger. We theorize that such an effect occurs because disclosers anticipate stronger pain associated with being reminded of disclosed contents when their disclosures involve personal insecurities than other types of information and, thus, wish to avoid such reminders from happening. Our findings support this theorizing: (a) Disclosers' weaker preference for friends as an audience for insecurity-provoking (vs. noninsecurity-provoking) disclosure is mediated by how painful they anticipate reminders of disclosed contents to be and (b) disclosers' preference for a particular audience is diminished when the perceived likelihood of disclosed-content reminders associated with that audience is enhanced. An additional preregistered exploratory content-analysis study shows that when disclosing personal insecurities, people disclose less and are less intimate in what they disclose when they imagine a friend (vs. a stranger) as an audience. Altogether, disclosers are ironically found to open up less to friends about personal insecurities-self-aspects that may particularly benefit from friends' support-than about other topics, due to their avoidance of potentially painful disclosed-content reminders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Gift of Psychological Closeness: How Feasible Versus Desirable Gifts Reduce Psychological Distance to the Giver.

Gift-giving is a common form of social exchange but little research has examined how different gift types affect the psychological distance between giver and recipient. We examined how two types of gifts influence recipients' perceived psychological distance to the giver. Specifically, we compared desirable gifts focused on the quality of the gift with feasible gifts focused on the gift's practicality or ease of use. We found that feasible (vs. desirable) gifts led recipients to feel psychologically closer to givers (Studies 1-4). Further clarifying the process by which receiving a desirable versus feasible gift affects perceived distance, when recipients were told that the giver focused on the gift's practicality or ease of use (vs. the gift's overall quality), while holding the specific features of the gifts constant, they felt closer to the gift-giver (Study 5). These results shed light on how different gifts can influence interpersonal relationships.

Behavioral economics and diabetic eye exams.

Diabetic retinopathy is a common microvascular complication of diabetes mellitus and is the leading cause of new blindness among working-age adults in the United States. Timely intervention to prevent vision loss is possible with early detection by regular eye examinations. Unfortunately, adherence to recommended annual diabetic eye exams is poor. Public health interventions have targeted traditional barriers to care, such as cost and transportation, with limited success. Behavioral economics provides an additional framework of concepts and tools to understand low screening rates and to promote regular diabetic eye exams for populations at risk. In particular, behavioral economics outlines biases and heuristics that affect decision-making and underlie pervasive barriers to care, such as not viewing diabetic eye exams as a priority or perceiving oneself as too healthy to need an examination. In this review, we examine the literature on the use of behavioral economics interventions to promote regular diabetic eye exams. From the results of the included studies, we outline how concepts from behavioral economics can improve eye examination rates. In particular, the default bias, present bias, and self-serving bias play a significant role in precluding regular diabetic eye examinations. Potential tools to mitigate these biases include leveraging default options, using reminder messages, providing behavioral coaching, applying commitment contracts, offering financial incentives, and personalizing health messages. When combined with traditional public health campaigns, insights from behavioral economics can improve understanding of pervasive barriers to care and offer additional strategies to promote regular preventive eye care for patients with diabetes.

Sharing Extraordinary Experiences Fosters Feelings of Closeness.

Every social relationship begins somewhere. Yet, little is known about which initial encounters bring people closer. This article investigates whether feelings of closeness are shaped by the type of experience shared between two individuals. Using different procedures and stimuli, we find that one determining factor is whether unacquainted individuals initially share a relatively more ordinary or extraordinary experience: more extraordinary (vs. ordinary) experiences facilitate greater closeness between unacquainted individuals (Studies 1a-1c). We also find that this closeness-fostering effect does not occur for interactions between well-acquainted individuals (Study 2), when there is presumably little discomfort associated with the interaction. Furthermore, this effect appears to be driven by more extraordinary experiences' capacity to absorb individuals' attention (Study 3). Thus, we suggest that extraordinary experiences foster feelings of closeness because they direct unacquainted individuals' attention toward the extraordinariness of the experience and away from the discomfort of initial interactions.

Combining food type(s) and food quantity choice in a new food choice paradigm based on vice-virtue bundles.

Given the prevalence and rising rates of obesity in many countries, including the United States, much food decision-making research ultimately aims at understanding how consumers can make healthier choices. The two predominant choice paradigms used in food decision-making research ask consumers to choose (a) between a "vice" (or unhealthy food) and a "virtue" (or healthy food) or (b) among varying portion sizes of "vice." We propose a new food choice paradigm that encourages consumers to jointly consider both food type(s) choice and food portion size at each decision point. The purpose of this paradigm is two-fold. First, it aims to allow examination of more comprehensive eating behavior (e.g., to examine the overall composition of a plate of food rather than choice of a single food). Second, it aims to shift consumers towards including large proportions of virtues and smaller proportions of vice in their overall consumption portfolios. For this paradigm, we draw upon a recently introduced food product innovation called "vice-virtue bundles" (Liu et al., 2015) that illustrates the basis of this new food choice paradigm, in which food type(s) and portion decisions are made simultaneously. Accordingly, we first discuss relevant findings on vice-virtue bundles as well as the differences between simultaneous and sequential choice of multiple products. Second, we examine the benefits for managing and controlling one's consumption that are provided by vice-virtue bundles and this joint food choice paradigm more generally. Third and finally, we point out opportunities for future research by discussing (a) multiple factors that influence food choices, (b) decision processes affected by food choice paradigms, and (c) issues of generalizability related to the presence of vice-virtue bundles.

Half-size me? How calorie and price information influence ordering on restaurant menus with both half and full entrée portion sizes.

Many restaurants are increasingly required to display calorie information on their menus. We present a study examining how consumers' food choices are affected by the presence of calorie information on restaurant menus. However, unlike prior research on this topic, we focus on the effect of calorie information on food choices made from a menu that contains both full size portions and half size portions of entrées. This different focus is important because many restaurants increasingly provide more than one portion size option per entrée. Additionally, we examine whether the impact of calorie information differs depending on whether full portions are cheaper per unit than half portions (non-linear pricing) or whether they have a similar per unit price (linear pricing). We find that when linear pricing is used, calorie information leads people to order fewer calories. This decrease occurs as people switch from unhealthy full sized portions to healthy full sized portions, not to unhealthy half sized portions. In contrast, when non-linear pricing is used, calorie information has no impact on calories selected. Considering the impact of calorie information on consumers' choices from menus with more than one entrée portion size option is increasingly important given restaurant and legislative trends, and the present research demonstrates that calorie information and pricing scheme may interact to affect choices from such menus.

Potential problems with increasing serving sizes on the Nutrition Facts label.

The United States Food and Drug Administration recently announced that the serving sizes on the Nutrition Facts labels for many products will be increased, but the effect of these increases remains unclear. The present research examined consumers' interpretation of the meaning of serving size information (study 1) and tested whether exposing consumers to the increased serving sizes of the proposed Nutrition Facts label leads consumers to serve and purchase more food for themselves and others (studies 2-4). Study 1 (N = 101; 44.7% female) tested what consumers believe the serving sizes on Nutrition Facts labels refer to, and the majority of participants (over 78%) incorrectly believed that the serving sizes refer to how much food can or should be consumed in one sitting as part of a healthy diet. Study 2 (N = 51; 41.2% female) tested how exposure to the current versus proposed Nutrition Facts label influences the amount of food that consumers serve themselves, and studies 3 (N = 60; 46.7% female) and 4 (N = 61; 48.2% female) assessed how exposure to the current versus proposed label influences the amount of food that people serve and purchase for others. In studies 2-4, the proposed label (vs. the current label) led consumers to serve themselves 41% more cookies (study 2); serve 27% more cheese crackers to another person (study 3); and buy 43% more lasagnas for others and divide a lasagna into 22% larger slices (study 4). The results suggest that the proposed Nutrition Facts label's increased serving sizes may lead people who use this information as a reference to serve more food to themselves and others.

'How many calories are in my burrito?' Improving consumers' understanding of energy (calorie) range information.

OBJECTIVE: Energy (calorie) ranges currently appear on menu boards for customized menu items and will likely appear throughout the USA when menu-labelling legislation is implemented. Consumer welfare advocates have questioned whether energy ranges enable accurate energy estimates. In four studies, we examined: (i) whether energy range information improves energy estimation accuracy; (ii) whether misestimates persist because consumers misinterpret the meaning of the energy range end points; and (iii) whether energy estimates can be made more accurate by providing explicit information about the contents of items at the end points. DESIGN: Four studies were conducted, all randomized experiments. SETTING: Study 1 took place outside a Chipotle restaurant. Studies 2 to 4 took place online. SUBJECTS: Participants in study 1 were customers exiting a Chipotle restaurant (n 306). Participants in studies 2 (n 205), 3 (n 290) and 4 (n 874) were from an online panel. RESULTS: Energy ranges reduced energy misestimation across different menu items (studies 1-4). One cause of remaining misestimation was misinterpretation of the low end point's meaning (study 2). Providing explicit information about the contents of menu items associated with energy range end points further reduced energy misestimation (study 3) across different menu items (study 4). CONCLUSIONS: Energy range information improved energy estimation accuracy and defining the meaning of the end points further improved accuracy. We suggest that when restaurants present energy range information to consumers, they should explicitly define the meaning of the end points.

Patient and family attitudes about an eye donation registry for research.

PURPOSE: There is a shortage of human eye tissue available for scientists, and it is unknown how willing ophthalmic patients are to donate their eyes for research. Therefore, we assessed eye patient and family member attitudes regarding the establishment of an eye donation registry for research purposes. MATERIALS AND METHODS: Surveys were distributed to consecutive patients attending the clinics of an academic ophthalmology practice over a period of 8 days. This survey consisted of questions about demographic information of the participant, attitudes regarding eye donation and attitudes regarding a registry for research-specific eye donation. An additional nested survey was administered to family members who accompanied survey participants. RESULTS: A total of 207 patients and 76 accompanying family members returned their respective surveys. Of the patients, 55% indicated that they would consider joining a proposed eye donation registry for research, 30% were undecided and 15% would not consider joining (n = 193). Over 95% of family members indicated that they would support their relative's decision to enroll in the registry (n = 74). Of the potential donors, 41% indicated they would most prefer to learn about the registry from their eye doctor and 37% from a pamphlet (n = 180). CONCLUSIONS: A majority of patients with eye disease and their family members support the idea of establishing an advance-directive eye donation registry for research. This registry for research donors could be incorporated into the current eye donation registry. Such an addendum would bridge the current disconnect between ophthalmic patients who want to donate their eyes for research on their disease (and are ineligible to donate for corneal transplantation) and scientists who need more human eye tissue for experimentation.

The use of sports references in marketing of food and beverage products in supermarkets.

OBJECTIVE: Food marketing has been identified as a significant driver of the childhood obesity epidemic. The purpose of the present study was to (i) conduct a content analysis of the types of sports references that appear on supermarket food and beverage products and (ii) assess each product's nutritional and marketing profile. DESIGN: This was a descriptive study. Every product featuring sports references on the packaging was purchased in two major supermarkets during 2010. A content analysis was conducted and nutritional evaluations were made based on the Nutrient Profile Model, a validated nutrition model. Marketing data were obtained from The Nielsen Company. SETTING: Two major supermarkets in Connecticut, USA. SUBJECTS: Food and beverage products (n 102) were selected from two supermarkets. RESULTS: The 102 products (fifty-three foods and forty-nine beverages) had sports references as part of their packaging: 72·5 % featured a character exercising, 42·2 % were endorsed by a professional sports entity and 34·0 % were child-targeted. The median nutrition score for food products was 36 (1 = unhealthiest and 100 = healthiest; scores of ≥63 are considered healthy according to this model). More than two-thirds of beverages (69·4 %) were 100 % sugar-sweetened. Children saw significantly more commercials for these products than adults. CONCLUSIONS: Companies place sports figures on food and beverage products that are child-targeted and unhealthy.

The science on front-of-package food labels.

OBJECTIVE: The U.S. Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research. DESIGN: A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011. RESULTS: Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation. CONCLUSIONS: The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems' abilities to influence consumer behaviour is needed.

A test of different menu labeling presentations.

Chain restaurants will soon need to disclose calorie information on menus, but research on the impact of calorie labels on food choices is mixed. This study tested whether calorie information presented in different formats influenced calories ordered and perceived restaurant healthfulness. Participants in an online survey were randomly assigned to a menu with either (1) no calorie labels (No Calories); (2) calorie labels (Calories); (3) calorie labels ordered from low to high calories (Rank-Ordered Calories); or (4) calorie labels ordered from low to high calories that also had red/green circles indicating higher and lower calorie choices (Colored Calories). Participants ordered items for dinner, estimated calories ordered, and rated restaurant healthfulness. Participants in the Rank-Ordered Calories condition and those in the Colored Calories condition ordered fewer calories than the No Calories group. There was no significant difference in calories ordered between the Calories and No Calories groups. Participants in each calorie label condition were significantly more accurate in estimating calories ordered compared to the No Calories group. Those in the Colored Calories group perceived the restaurant as healthier. The results suggest that presenting calorie information in the modified Rank-Ordered or Colored Calories formats may increase menu labeling effectiveness.