Assessing the accuracy of electronic health record gender identity and REaL data at an academic medical center.

BACKGROUND: Collection of accurate patient race, ethnicity, preferred language (REaL) and gender identity in the electronic health record (EHR) is essential for equitable and inclusive care. Misidentification of these factors limits quality measurement of health outcomes in at-risk populations. Therefore, the aim of our study was to assess the accuracy of REaL and gender identity data at our institution. METHODS: A survey was administered to 117 random patients, selected from prior day admissions at a large academic medical center in urban central New York. Patients (or guardians) self-reported REaL and gender identity data, selecting from current EHR options. Variables were coded for the presence or absence of a difference from data recorded in the EHR. RESULTS: Race was misreported in the EHR for 13% of patients and ethnicity for 6%. For most White and Black patients, race was concordant. However, self-identified data for all multiracial patients were discordant with the EHR. Most Non-Hispanic patients had ethnicity correctly documented. Some Hispanic patients were misidentified. There was a significant association between reporting both a race and an ethnicity which differed from the EHR on chi square analysis (P < 0.001). Of those who reported an alternative ethnicity, 71.4% also reported an alternative race. Gender identity was missing for most patients and 11% of the gender-identity entries present in the EHR were discordant with the patient's self-identity. Preferred language was 100% concordant with the EHR. CONCLUSIONS: At an academic medical center, multiracial and Hispanic patients were more likely to have their demographics misreported in the EHR, and gender identity data were largely missing. Healthcare systems need strategies that support accurate collection of patients' self-reported ReAL and gender identity data to improve the future ability to identify and address healthcare disparities.

Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial.

Advancing gender equality and women's empowerment (GE/WE) may contribute to better child nutrition and development in low-resource settings. However, few empirical studies have generated evidence on GE/WE and examined the potential of engaging men to transform gender norms and power relations in the context of nutrition and parenting programs. We tested the independent and combined effects of engaging couples and bundling nutrition and parenting interventions on GE/WE in Mara, Tanzania. EFFECTS (ClinicalTrials.gov, NCT03759821) was a cluster-randomized 2 × 2 factorial trial plus control. Eighty village clusters were randomly assigned to one of five intervention conditions: standard of care, mothers nutrition, couples nutrition, mothers bundled nutrition and parenting, or couples bundled nutrition and parenting. Between October 2018-May 2019, 960 households were enrolled with children under 18 months of age residing with their mother and father. Community health workers (CHWs) delivered a bi-weekly 24-session hybrid peer group/home visit gender-transformative behavior change program to either mothers or couples. GE/WE outcomes were analyzed as intention-to-treat and included time use, gender attitudes, social support, couples' communication frequency and quality, decision-making power, intimate partner violence (IPV), and women's dietary diversity (WDD). Data were collected from 957 to 815 mothers and 913 and 733 fathers at baseline and endline, respectively. Engaging couples compared to mothers only significantly increased paternal and maternal gender-equitable attitudes, paternal time spent on domestic chores, and maternal decision-making power. Bundling increased maternal leisure time, decreased maternal exposure to any IPV, and increased WDD over 7 days. A combination of engaging couples and bundling was most effective for paternal gender attitudes, couples communication frequency, and WDD over 24 h and 7 days. Our findings generate novel evidence that CHWs can deliver bundled nutrition and parenting interventions to couples in low-resource community settings that advance GE/WE more than nutrition interventions targeting only women.

Community suicide rates and related factors within a surveillance platform in Western Kenya.

BACKGROUND: Suicide is an important contributor to the burden of mental health disorders, but community-based suicide data are scarce in many low- and middle-income countries (LMIC) including Kenya. Available data on suicide underestimates the true burden due to underreporting related to stigma and legal restrictions, and under-representation of those not utilizing health facilities. METHODS: We estimated the cumulative incidence of suicide via verbal autopsies from the Health and Demographic Surveillance System (HDSS) in Kisumu County, Kenya. We then used content analysis of open history forms among deaths coded as accidents to identify those who likely died by suicide but were not coded as suicide deaths. We finally conducted a case-control study of suicides (both verbal autopsy confirmed and likely suicides) compared to accident-caused deaths to assess factors associated with suicide in this HDSS. RESULTS: A total of 33 out of 4306 verbal autopsies confirmed suicide as the cause of death. Content analysis of a further 228 deaths originally attributed to accidents identified 39 additional likely suicides. The best estimate of suicide-specific mortality rate was 14.7 per 100,000 population per year (credibility window = 11.3 - 18.0). The most common reported method of death was self-poisoning (54%). From the case-control study interpersonal difficulties and stressful life events were associated with increased odds of suicide in both confirmed suicides and confirmed combined with suspected suicides. Other pertinent factors such as age and being male differed depending upon which outcome was used. CONCLUSION: Suicide is common in this area, and interventions are needed to address drivers. The twofold increase in the suicide-specific mortality rate following incorporation of misattributed suicide deaths exemplify underreporting and misclassification of suicide cases at community level. Further, verbal autopsies may underreport suicide specifically among older and female populations.

Multiple sclerosis and its impact on dental care.

Multiple sclerosis affects approximately 130,000 people in the UK. Due to the wide variation in the symptoms associated with this condition and their variable severity, the provision of dental care for affected patients must be determined by an individual's specific needs. This will often vary significantly over time. This paper reviews the aetiology, presentation and current management of multiple sclerosis, and explores the impact of these on oral health and the provision of dental care.

Face perception across the adult lifespan: evidence for age-related changes independent of general intelligence.

It is well-documented that face perception - including facial expression and identity recognition ability - declines with age. To date, however, it is not yet well understood whether this age-related decline reflects face-specific effects, or instead can be accounted for by well-known declines in general intelligence. We examined this issue using a relatively large, healthy, age-diverse (18-88 years) sample (N = 595) who were assessed on well-established measures of face perception and general intelligence. Replicating previous work, we observed that facial expression recognition, facial identity recognition, and general intelligence all showed declines with age. Of importance, the age-related decline of expression and identity recognition was present even when the effects of general intelligence were statistically controlled. Moreover, facial expression and identity ability each showed significant unique associations with age. These results indicate that face perception ability becomes poorer as we age, and that this decline is to some extent relatively focal in nature. Results are in line with a hierarchical structure of face perception ability, and suggest that age appears to have independent effects on the general and specific face processing levels within this structure.

Consistent evidence of a link between Alexithymia and general intelligence.

Alexithymia is a personality construct characterised most notably by a difficulty in identifying and expressing feelings. Although the emotional difficulties in alexithymia are well established, to date little work has examined its relationship to broader cognitive abilities, such as general intelligence. Across three independent, healthy adult samples (Ns = 389, 318, & 273), we examined whether alexithymia was associated with general intelligence. In all three samples, we observed a significant negative association between alexithymia and general intelligence. In two of the samples, general intelligence was a significant predictor of alexithymia even when accounting for performance on tests of facial emotion recognition ability and supramodal emotion recognition ability (measured with faces, bodies, and voices). From a theoretical perspective, these results suggest that models of alexithymia need to incorporate a role for more generalised cognitive functioning. From a practical perspective, studies examining links between alexithymia and clinical disorders, many of which have known links to general intelligence, should consider including a measure of general intelligence in order to adjust for this potentially confounding factor.

Emotion recognition ability: Evidence for a supramodal factor and its links to social cognition.

Accurate recognition of others' emotions is an important skill for successful social interaction. Unsurprisingly, it has been an enduring topic of interest, and notable individual differences have been observed. Despite this focus, the underlying functional architecture of this ability has not been thoroughly investigated, particularly concerning emotion recognition across different sensory domains and stimulus modalities. Using a structural equation modelling approach, Study 1 (N = 284) established the structure of emotion recognition ability across three expressive domains - face, body and voice - and observed strong evidence for a superordinate 'supramodal' emotion recognition factor, over and above domain-specific factors. Additionally, we observed a significant moderate negative association between this superordinate factor and alexithymia. In Study 2 (N = 218), findings indicated that supramodal emotion recognition ability and face identity recognition are two related but independent constructs. In Study 3 (N = 249), we examined links from both supramodal emotion recognition and face identity recognition to broader cognitive ability, and observed that general intelligence was a significant predictor of supramodal emotion recognition ability. In contrast, there was no association between intelligence and face identity recognition ability. Across three independent samples, then, our findings offer strong support for an emotion recognition ability factor existing across visual and auditory domains encompassing social signals conveyed by face, body and voice, and outline its associations to broader cognitive and affective traits.

Sex differences in emotion recognition: Evidence for a small overall female superiority on facial disgust.

Although it is widely believed that females outperform males in the ability to recognize other people's emotions, this conclusion is not well supported by the extant literature. The current study sought to provide a strong test of the female superiority hypothesis by investigating sex differences in emotion recognition for five basic emotions using stimuli well-calibrated for individual differences assessment, across two expressive domains (face and body), and in a large sample (N = 1,022: Study 1). We also assessed the stability and generalizability of our findings with two independent replication samples (N = 303: Study 2, N = 634: Study 3). In Study 1, we observed that females were superior to males in recognizing facial disgust and sadness. In contrast, males were superior to females in recognizing bodily happiness. The female superiority for recognition of facial disgust was replicated in Studies 2 and 3, and this observation also extended to an independent stimulus set in Study 2. No other sex differences were stable across studies. These findings provide evidence for the presence of sex differences in emotion recognition ability, but show that these differences are modest in magnitude and appear to be limited to facial disgust. We discuss whether this sex difference may reflect human evolutionary imperatives concerning reproductive fitness and child care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Recognition of facial expression and identity in part reflects a common ability, independent of general intelligence and visual short-term memory.

Recognising identity and emotion conveyed by the face is important for successful social interactions and has thus been the focus of considerable research. Debate has surrounded the extent to which the mechanisms underpinning face emotion and face identity recognition are distinct or share common processes. Here we use an individual differences approach to address this issue. In a well-powered (N = 605) and age-diverse sample we used structural equation modelling to assess the association between face emotion recognition and face identity recognition ability. We also sought to assess whether this association (if present) reflected visual short-term memory and/or general intelligence (g). We observed a strong positive correlation (r = .52) between face emotion recognition ability and face identity recognition ability. This association was reduced in magnitude but still moderate in size (r = .28) and highly significant when controlling for measures of g and visual short-term memory. These results indicate that face emotion and face identity recognition abilities in part share a common processing mechanism. We suggest that face processing ability involves multiple functional components and that modelling the sources of individual differences can offer an important perspective on the relationship between these components.

Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication.

Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy-related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.

Endocrine Therapy for Hormone Receptor-Positive Metastatic Breast Cancer: American Society of Clinical Oncology Guideline.

PURPOSE: To develop recommendations about endocrine therapy for women with hormone receptor (HR) -positive metastatic breast cancer (MBC). METHODS: The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of evidence from 2008 through 2015 to create recommendations informed by that evidence. Outcomes of interest included sequencing of hormonal agents, hormonal agents compared with chemotherapy, targeted biologic therapy, and treatment of premenopausal women. This guideline puts forth recommendations for endocrine therapy as treatment for women with HR-positive MBC. RECOMMENDATIONS: Sequential hormone therapy is the preferential treatment for most women with HR-positive MBC. Except in cases of immediately life-threatening disease, hormone therapy, alone or in combination, should be used as initial treatment. Patients whose tumors express any level of hormone receptors should be offered hormone therapy. Treatment recommendations should be based on type of adjuvant treatment, disease-free interval, and organ function. Tumor markers should not be the sole criteria for determining tumor progression; use of additional biomarkers remains experimental. Assessment of menopausal status is critical; ovarian suppression or ablation should be included in premenopausal women. For postmenopausal women, aromatase inhibitors (AIs) are the preferred first-line endocrine therapy, with or without the cyclin-dependent kinase inhibitor palbociclib. As second-line therapy, fulvestrant should be administered at 500 mg with a loading schedule and may be administered with palbociclib. The mammalian target of rapamycin inhibitor everolimus may be administered with exemestane to postmenopausal women with MBC whose disease progresses while receiving nonsteroidal AIs. Among patients with HR-positive, human epidermal growth factor receptor 2-positive MBC, human epidermal growth factor receptor 2-targeted therapy plus an AI can be effective for those who are not chemotherapy candidates.