Perfectionism as a predictor of physician burnout.

BACKGROUND: Burnout is common among physicians and has detrimental effects on patient care and physician health. Recent editorials call attention to perfectionism in medicine; however, no studies to date have examined the effect of perfectionism on burnout in physicians practicing in the United States. This study examined associations among demographics, perfectionism and personality traits, and burnout among practicing physicians. METHODS: This cross-sectional study included general pediatric and pediatric sub-specialist physicians. Out of the 152 physicians contacted, 69 enrolled (Meanage = 44.16 ± 9.98; 61% female). Emotional exhaustion, depersonalization, and personal accomplishment burnout were assessed via the Maslach Burnout Inventory. Validated instruments were used to measure personality and perfectionism. Data were analyzed using linear regression models. RESULTS: Across physicians assessed, 42% reported either high emotional exhaustion burnout or depersonalization burnout. High self-critical perfectionism uniquely predicted both high emotional exhaustion burnout (B = 0.55, 95%CI 0.25-0.85) and depersonalization burnout (B = 0.18, 95%CI 0.05-0.31). Low conscientiousness (B = -6.12; 95%CI, -10.95- -1.28) predicted higher emotional exhaustion burnout and low agreeableness (B = -3.20, 95%CI -5.93- -0.46) predicted higher depersonalization burnout. CONCLUSIONS: Perfectionism is understudied among physicians and the current findings suggest that addressing system and individual-level factors that encourage perfectionism is warranted and may reduce risk for physician burnout.

SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools.

BACKGROUND: Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely. METHODS: We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1 (sd); 7-17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners, and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6-8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured. RESULTS: We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p < 0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face-covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ + T cell responses, and reduced monocytes. CONCLUSIONS: Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses. IMPACT: Successful COVID-19 mitigation was implemented across a diverse range of schools. School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning. Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.

Age, Adverse Childhood Experiences, and Health Care Utilization.

OBJECTIVES: To assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age. METHODS: In this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening. RESULTS: Among 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age. CONCLUSIONS: The association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.

Intraindividual neuropsychological test variability in healthy individuals with high average intelligence and educational attainment.

Knowledge of patterns of neuropsychological performance among normal, healthy individuals is integral to the practice of clinical neuropsychology, because clinicians may not always account for intraindividual variability (IIV) before coming to diagnostic conclusions. The IIV was assessed among a sample of 46 healthy individuals with high average intelligence and educational attainment, utilizing a battery of neuropsychological tests, including the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) and Wechsler Memory Scale, Fourth Edition (WMS-IV). The data indicated substantial variability in neurocognitive abilities. All participants were found to demonstrate scores considered impaired by at least 2 standard deviations (SDs). Despite adjusting for outliers, no participant produced a "normal" testing profile with an intraindividual maximum discrepancy (MD) of less than 1 SD in either direction. When WAIS-IV Full Scale IQ (FSIQ) was considered, participants generally demonstrated cognitive test scores ranging from 2 SDs less than to 1.5 SDs greater than their FSIQ. Furthermore, after demographic corrections, the majority (59%) of participants demonstrated at least 1 impaired cognitive test score, as defined by being 1 to 1.5 SDs below the mean. Overall, results substantiate the need for clinicians to consider FSIQ and educational attainment in interpretation of neuropsychological testing results, given the relevant commonality of "abnormal" test scores within this population. This may ultimately reduce the likelihood of making false-positive conclusions of impairment when educational attainment and intelligence are high, thus improving diagnostic accuracy.

Academic Health Centers and Humanitarian Crises: One Health System's Response to Unaccompanied Children at the Border.

University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021. In collaboration with multiple federal, state, and local agencies, UCH mobilized a multidisciplinary team to deliver acute general and specialty pediatric care to unaccompanied children at 2 Californian emergency intake sites (EISs). The response, which did not disrupt normal UCH operations, mobilized the capacities of the system and resulted in a safe and developmentally appropriate environment that supported the physical and mental health of migrant children during this traumatic period. The capacities of UCH's 6 academic health centers ensured access to trauma-informed medical care and culturally sensitive psychological and social support. Child life professionals provided access to exercise, play, and entertainment. Overall, 260 physicians, 42 residents and fellows, 4 nurse practitioners participated as treating clinicians and were supported by hundreds of staff across the 2 EISs. Over 5 months and across both EISs, a total of 4,911 children aged 3 to 17 years were cared for. A total of 782 children had COVID-19, most infected before arrival. Most children (3,931) were reunified with family or sponsors. Continuity of care after reunification or placement in a long-term shelter was enhanced by use of an electronic health record. The effort provided an educational experience for residents and fellows with instruction in immigrant health and trauma-informed care. The effort benefitted from UCH's recent experience of providing a system-wide response to the COVID-19 pandemic. Lessons learned are reported to encourage the alignment and integration of academic health centers' capacities with federal, state, and local plans to better prepare for and respond to the accelerating need to care for those in the wake of disasters and humanitarian crises.

Does high scatter on the Wechsler Adult Intelligence Scale-Fourth Edition general ability index reduce validity in predicting Wechsler Memory Scale-Fourth Edition indexes?

We examined whether significant scatter in WAIS-IV GAI will reduce its validity to predict performance on WMS-IV indexes. Participants were 330 individuals with neurological, psychiatric, or neurodevelopmental disorders and 59 referrals who were found to be free of a diagnosable disorder. For VCI > PRI, 59.32% were significant at p < .05 and 12.29% were >22 points. For VCI < PRI, 48.37% were significant at p < .05 and 7.19% were >22 points. Inter-subtest scatter across GAI subtests indicated 82.26% of individuals had a significant scatter range and 13.88% had an unusually large range (≥8). For the VCI, 49.10% had significant scatter (≥3) and 12.08% had an unusually large scatter range (≥5). On the PRI, 43.19% had a significant scatter range (≥4) and 12.85% had an unusually large degree of scatter (≥6). Moderation analyses revealed GAI was a significant predictor of each WMS-IV index. The interaction term of GAI with GAI scatter was not significant for any indexes, indicating that regression equations for predicting WMS-IV scores from GAI did not vary significantly across levels of scatter. Estimation of WMS-IV indexes from the GAI is justified even when significant VCI-PRI discrepancies are present and there is unusual variability across the GAI subtests.

Relative subtest scatter on the WAIS-IV in a clinical sample referred for outpatient neuropsychological evaluation.

OBJECTIVE: The primary aim of this study was to examine relative inter-subtest variability, or scatter, on the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) in a clinical sample of patients referred for neuropsychological evaluation and compare the findings to corresponding data from the scale's standardization sample. METHOD: Participants were 638 individuals diagnosed primarily with neurological, psychiatric, or neurodevelopmental disorders who completed the 10 core subtests of the WAIS-IV as part of a comprehensive assessment battery. RESULTS: Mean participant scores on the WAIS-IV Full Scale IQ and all index composites were within the average range, overall, but were significantly below those of the standardization sample. The correlation between scatter range and highest subtest scaled score was significant, r = .65, indicating a greater degree of subtest scaled score variability in participants with higher than average peak subtest scaled scores than participants with average or below peak subtest scaled scores. Mean variability by highest subtest scaled score was, in most cases, larger in this clinical sample relative to the scale's standardization sample. Exploratory secondary analyses also revealed specific differences in relative scatter based on diagnostic group classification. CONCLUSIONS: Subtest scatter on the WAIS-IV is common among both healthy individuals and clinical patients. Although somewhat higher in this investigation's clinical sample, the significance of this finding generally appears to be of nominal value during interpretation of individual cases but may have some utility in formulating hypotheses when considered in conjunction with reliability data and other approaches for analyzing test scores. High scatter is not pathognomonic of abnormality, and at least some degree of caution is warranted when interpreting subtest scaled score differences on the WAIS-IV.

SARS-CoV-2 Acquisition and Immune Pathogenesis Among School-Aged Learners in Four Diverse Schools.

BACKGROUND: Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely. METHODS: We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1(sd); 7-17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners; and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6-8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured. RESULTS: We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p<0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ+ T cell responses, and reduced monocytes. CONCLUSION: Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses. KEY POINTS: Successful COVID-19 mitigation was implemented across a diverse range of schools.School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning.Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.

Distinguishing Alzheimer's disease from vascular dementia: an exploration of five cognitive domains.

The disease process of Alzheimer's disease (AD) and Vascular Dementia (VaD) are dissimilar; however, the cognitive presentations may be difficult to distinguish as they may present in tandem or result in similar deficits despite different pathogenesis. This study examined the efficacy of memory, confrontational naming, visuoconstructional ability, processing speed, and executive functioning in differentiating AD from VaD. Delayed verbal memory, visuoconstructional ability, and confrontational naming as measured by WMS-R Logical Memory II, WAIS-R Block Design (BD), and Boston Naming Test, respectively, were most effective in discriminating between these two disorders. Results indicated AD was best classified by BD, and BD was the most sensitive to AD-related pathogenesis. Delayed memory and confrontational naming were highly implicated in each subtype, suggesting they are sensitive to each disease process, thus reducing the reliability of utilizing them as sole differentiating agents.

Frequency of occurrence of four- and five-factor WAIS-IV profiles.

Interpretive strategies for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) include Wechsler's four-factor structure and the five-factor Cattell-Horn-Carroll (CHC) model. The frequency of profile occurrence and the contribution of demographic- and ability-related variables to their incidence are unknown. Current participants were 291 referrals (males = 134; female = 157) for neuropsychological evaluation with mean years for age and education of 34.94 (SD = 13.53) and 12.74 (SD = 2.46), respectively. Lichtenberger and Kaufman's guidelines for selecting each model were applied. Of the total, 67.3% were four-factor and 32.6% were five-factor profiles. The same pattern emerged when participants were subdivided by gender, education, ethnicity, IQ, and diagnosis. A noteworthy association between IQ and profile type emerged. When IQ increased, four-factor profiles declined and five-factors increased. A logistic regression, using demographics, IQ, and diagnosis as predictors, correctly classified 64.8% of participants. The average subtest intercorrelations and g saturations in the four-factor group were substantially larger than those for five-factor participants. These findings were consistent with Spearman's differentiation by ability hypothesis.

IQ predicts neuropsychological performance in children.

INTRODUCTION: This study examined whether IQ predicts neuropsychological performance among children with varying ability levels. METHOD: 177 children/adolescents were subdivided as Below Average (BA; N = 71; IQ = 60-85), Average (A; N = 72; IQ = 90-110), or Above Average (AA; N = 34; IQ = 115-140) in IQ. Assessments included intelligence, achievement, memory, and executive functioning measures. RESULTS: Group differences were found on all tests (p < .001). Planned comparisons revealed differences between BA and A on seven variables, and between A and AA on five variables with small-to-medium effect sizes. Correlations were found between IQ and neuropsychological functioning and varied by group membership. DISCUSSION: In children, IQ predicts neuropsychological performance differentially based upon ability level, with stronger relationships shown in lower IQ ranges.

Subcortical profile of memory compromise among HIV-1-infected individuals.

OBJECTIVE: To examine the hypothesis of subcortical pathologic impairment in HIV/AIDS. METHOD: The study included 22 HIV+, 22 HIV- controls, 22 learning disordered (LD) HIV-, and 22 depressive HIV-. The groups were compared on eight WMS-III Indices. RESULTS: Analyses revealed significantly lower scores (p < .05) in HIV+ on visual immediate memory, immediate memory, visual delayed memory, auditory delayed memory, working memory, and general memory. For all cases, HIV+ participants scored below the control group only. CONCLUSIONS: WMS-III indices discriminated HIV+ participants from normal comparisons. Inability to find differences between HIV+ and depressive and LD groups reflects the isolation of the subcortical effect to the HIV+ group.

Corollary-and discrepancy-based approaches for examining the appropriateness of premorbid cognitive estimation in geriatric schizophrenia.

OBJECTIVE: This article addresses whether measures for assessing premorbid intellectual functioning are adequate for geriatric schizophrenia. METHOD: We included geriatric schizophrenia-spectrum disorders (SSD; n = 37), frontotemporal dementia (FTD; n = 41), and geriatric controls (n = 107), and employed measures of verbal ability. RESULTS: Pearson's correlations and ANOVAs for discrepancy comparisons showed unique patterns of spared function in SSD when compared to FTD and controls. CONCLUSIONS: Findings lend support to the specificity of cognitive processes in SSD, even when accounting for processes common to the theoretically similar FTD. SSD showed a distinct pattern of spared ability which supports clinical utilization of discrepant measures of premorbid intellectual estimation for SSD.

Self-change: A pathway to cannabis abuse resolution.

Long-term daily cannabis abusers (N = 25) who without treatment stopped using cannabis for at least one year were interviewed about their past substance use, antecedents to change, and factors supportive of change. Respondents' cannabis problems decreased in the year prior to their recovery compared to their lifetime use. Respondents described their successful quit attempts through structured interviews and autobiographical narratives. The narratives were content analyzed for factors related to recovery. The reports indicated that marijuana cessation was motivated more by internal than external factors, and the most common precipitants of quit attempts were cognitive anti-cannabis factors. The major reason reported by respondents for stopping cannabis was a change in how they viewed their cannabis use, followed by negative personal effects. The most common reported maintenance factors were avoidance of situations in which cannabis was used, changes in lifestyle, and the development of non-cannabis-related interests. Cognitive and respiratory functioning were also assessed. Lastly, more than 75% of respondents reported not seeking treatment because they believed it was not needed or because they wanted to quit on their own. Directions for future research are offered.

Improving neuropsychological function after chronic brain injury with hyperbaric oxygen.

PURPOSE: One suggested treatment for chronic brain injury (CBI) is the use of hyperbaric oxygen therapy (HBOT). The present study was an evaluation of neuropsychological improvement after HBOT in CBI patients. METHOD: Study 1 compared test - retest results of 21 CBI children treated with HBOT against test - retest results of 42 untreated brain injured and normal children. Study 2 compared 21 CBI adults treated with HBOT against 42 untreated normal and brain injured adults. In each study, subjects received pre and post assessments to evaluate neuropsychological function. RESULTS: The HBOT-treated children showed significant improvement when compared with the two control groups on measures of daily living, socialization, communication, and motor skills. The treated adults made significant gains in all neuropsychological areas tested as compared to controls. CONCLUSION: The studies were strongly supportive of HBOT as a treatment for lessening the neurological impact of CBI. These studies indicate that HBOT can be an effective aid in ameliorating the neuropsychological and physiological effects of CBI. The absence of a clear sham HBOT treatment group is an issue as it could be that there was a placebo effect, but it should be noted that the controls were receiving more traditional interventions during the study.

Neuropsychological consequences of HIV in children: a review of current literature.

Pediatric HIV has reached epidemic proportions. In 1997, 1.1 million children younger than 15 were living with HIV or AIDS. The virus affects children cognitively and developmentally due to the immaturity of their nervous systems and immune systems. Studies in the area of neuropsychological deficits are as yet limited in number and less well developed than studies on adult HIV. However, despite methodological weaknesses, the literature has proven conclusively that pediatric HIV affects children cognitively, developmentally, emotionally, psychologically, behaviorally, and educationally. Although treatments are allowing these children to live longer, the effects of the virus remain, requiring special care. This review examines the mechanisms behind HIV in children, the neuropsychological findings to date, and the limitations of this work. Possible useful future approaches in understanding the neuropsychological course of the disorder, as well as directions for treatment and prevention are addressed.

Bilingualism, brain injury, and recovery: implications for understanding the bilingual and for therapy.

Psychologists and other therapists are seeing an increasingly large number of bilingual individuals. Such clients are a special challenge when there has been some type of brain injury or disease because of the seemingly unpredictable effect such disorders may have on language skills, impacting either or both of the client's languages and interfering with internal speech that plays a role in higher cognitive functions such as insight and awareness. While there are many clinical assumptions about which language will show the least impairment or recover the best, such suppositions based on clinical lore are often contradictory. A review of the literature finds that the outcome of brain injury may be influenced by factors such as cerebral representation of a secondary language, method of language acquisition, age of acquisition, premorbid language proficiency, and style of learning in an individual. Neuropsychological concepts that can explain these findings are examined, along with their implications for therapy, and rehabilitation.

Abbreviated form of the Wechsler Memory Scale-III Faces subtest.

A major criticism of the Wechsler Memory Scale-III Faces subtest is the number of items, which can be daunting and time-consuming for an impaired client or boring for a normal client. An analysis of several versions, with data from a sample of 50 clinical referrals, revealed that a 32-item subtest was best overall. Using this version, 100% (Faces I) and 94% (Faces II) of the predicted raw scores were less than 4 points away from the actual raw scores, whereas 66% (Faces I) and 70% (Faces II) were less than 2 points away. Limitations of this procedure are discussed.

Relationships of objectively scored Bender variables with MMPI scores in an outpatient psychiatric population.

The purpose of the present study was to examine whether the Advanced Psychodiagnostic Interpretation system for the Bender Gestalt Test could reasonably predict the results of the most widely used objective measure of personality, the MMPI. Despite the widespread use of both tests, no previous studies could be found which correlated actual Bender scores with MMPI results, arising partly from the lack of a well-accepted, reliable, and objective scoring system for the Bender. The study compared the performance of 279 adult psychological outpatients on both the MMPI and Bender. The 55 Bender scorable points, which are seen most frequently in the outpatient population, were factor analyzed to yield 17 factors which were correlated with the MMPI. Significant multiple correlations were found between the Bender factors and 10 of 12 MMPI scales, with significant correlations ranging from .36 to .47. The Bender overall was able to discriminate moderately high scorers on the MMPI from low scorers. The overall results suggested that the Advanced Psychodiagnostic Interpretation scoring system includes measures that reflect general psychopathology and correlate with the MMPI as well as more specific content that is independent of the MMPI scales. The potential of this scoring system and joint use of the MMPI and Bender in personality assessment are discussed. Replication with a larger sample than 279 is encouraged for these 55 Bender and 12 MMPI items.

Cell phone use and visual attention.

The purpose of the present study was to evaluate how much cell phones and just speaking (similar to speaking to someone in the car vs a hands-free cell phone task) interfere with visual attention skills as might be required in a driving situation. Influence of cell phones on attention has been noted but little research has been completed. Licensed adult drivers were divided into three groups (ns = 15) with all subjects taking the Connors Continuous Performance Test II. Group 1 performed without any distractions: those in Group 2 performed with someone in the same room talking to them: Group 3 engaged in a cell phone conversation during the task. Overall, there were substantial differences among groups on all variables, but primarily between the control group and the two experimental groups. While the cell phone group had lower mean scores than the talking group overall, the differences were not significant. Thus, while cell phones were distracting to visual attention functions on the Connors task, they were not more distracting than a similarly active conversation without a cell phone.