Reducing racial disparities in pain treatment: The role of empathy and perspective-taking

The Oxytocinergic System and Racial Ingroup Bias in Empathic Neural Activity

Studies have indicated that the human brain exhibits a more robust neural empathic response towards individuals of the same racial ingroup than those of the outgroup. However, the impact of the oxytocinergic system on the dynamic connectivity between brain regions involved in racial ingroup bias in empathy (RIBE) and its implications for real-life social interaction intention remains unclear. To address this gap, we employed functional magnetic resonance imaging (fMRI) to investigate RIBE-modulated neural activities and the influence of the oxytocinergic system at both neural and behavioral levels. Participants homozygous for the A/A and G/G genotypes of the oxytocin receptor gene (OXTR) rs53576 polymorphism underwent scanning while making judgments about painful versus non-painful stimuli in same-race versus other-race scenarios following either oxytocin (OT) or placebo treatment. The results revealed greater activity in the anterior cingulate cortex (ACC) and anterior insula (AI) in response to same-race compared to other-race models in the G/G group but not in the A/A group. RIBE also modulated the connections between bilateral AI and the ACC, and the effect of OT on this modulatory effect was moderated by genotype rs53576 and interpersonal trust. Moreover, more extensive changes in AI-ACC connections were associated with higher levels of revenge intention in the low interpersonal trust group. Overall, our findings suggest a pivotal role of the oxytocinergic system in the RIBE-modulated neural activities and revenge intention in human interactions with the modulatory effect of interpersonal trust.

Documenting Race and Gender Biases in Pain Assessment and a Novel Intervention Designed to Reduce Biases

Disparities in pain care are well-documented such that women and people of color have their pain undertreated and underestimated compared to men and White people. One of the contributors of the undertreatment of pain for people of color and women may be the inaccurate assessment of pain. Understanding the pain assessment process is an important step in evaluating the magnitude of and intervening on pain disparities in care. In the current work, we focus on documenting intersectional race and gender biases in pain assessment and present the results of a novel intervention for reducing these biases. Across 3 studies (N = 532) and a mini meta-analysis using real videotaped people in pain as stimuli, we demonstrate that observers disproportionately underestimated women of color's pain compared to all other groups (men of color, White women, and White men). In study 3 (N = 232), we show that a novel intervention focused on behavioral skill building (ie, practice and immediate feedback) significantly reduced observers' pain assessment biases toward marginalized groups compared to all other types of trainings (raising awareness of societal biases, raising awareness of self-biases, and a control condition). While it is an open question as to how long this type of intervention lasts, behavioral skills building around assessing marginalized people's pain more accurately is a promising training tool for health care professionals. PERSPECTIVE: This article demonstrates the underestimation of pain among people of color and women. We also found support that a novel intervention reduced observers' pain assessment biases toward marginalized groups. This could be used in medical education or clinical care to reduce intersectional pain care disparities.

A Multigenerational Model of Environmental Risk for Black, Indigenous, and People of Color (BIPOC) Children and Families

BACKGROUND

In recent years, public discourse has increasingly brought institutional and structural racism to the foreground of discussion on the well-being of BIPOC (Black, Indigenous, and People of Color) communities. Environmental toxicity in combination with the social triggers of institutional and structural racism are among the factors that shape the short- and long-term health of BIPOC Americans across multiple lifespans.

OBJECTIVES

We outline a 2 + Generation Model for examining the mechanisms through which institutional and structural racism promotes the intergenerational transmission of environmental health risk and family and interpersonal relationships across the life course and across multiple generations. We present the model's theoretical underpinnings and rationale, discuss model limitations and needed sources of data, and implications for research, policy, and intervention.

DISCUSSION

Parents and children are not only biologically linked in terms of transmission of environmental toxicities, but they are also linked socially and intergenerationally. The 2 + Generation Model foregrounds family and interpersonal relationships occurring within developmental contexts that are influenced by environmental toxicity as well as institutional and structural racism. In sum, the 2 + Generation Model highlights the need for an equity-first interdisciplinary approach to environmental health and redirects the burden of risk reduction away from the individual and onto the institutions and structures that perpetuate the racial disparities in exposure. Doing so requires institutional investment in expanded, multigenerational, and multimethod datasets. https://doi.org/10.1289/EHP13110.

Disentangling the effects of racism-related stress on opioid use disorder and chronic pain outcomes

In recent years, Black people in the U.S. have had one of the highest increases in opioid overdose mortality rates, despite being less likely to be prescribed opioids for pain. This population is also less likely to receive medications for opioid use disorder (MOUD). Chronic pain is a central factor in understanding this crisis, as minoritized people are more likely to live with undertreated pain, a major risk factor for developing opioid use disorder (OUD). Current practices fail to effectively treat pain among persons with OUD, a missed opportunity that is worse in minoritized populations and further producing disparities. In this perspective, we discuss how racism-related stress and disparities in addiction treatments may impact the pain experience, diagnosis, treatment, contribute to developing OUD, and perpetuate stigma. This high-level perspective invites clinicians and researchers to reflect on the biopsychosocial burden imposed upon historically minoritized people with pain and OUD. To address such complex issues, multidisciplinary efforts and methodological improvements are required, imbued by antiracist values. Collaboration across disciplines is necessary toward the common goal of improving pain management and mitigating opioid mortality among minoritized populations. As antiracist perspectives inform research practices and cultural humility principles guide care, we will be better equipped to close current gaps in knowledge and address widening healthcare disparities.

Social Class and Social Pain: Target SES Biases Judgments of Pain and Support for White Target Individuals

Social pain, defined as distress caused by negative interpersonal experiences (e.g., ostracism, mistreatment), is detrimental to health. Yet, it is unclear how social class might shape judgments of the social pains of low-socioeconomic status (SES) and high-SES individuals. Five studies tested competing toughness and empathy predictions for SES's effect on social pain judgments. Consistent with an empathy account, in all studies (Ncumulative = 1,046), low-SES White targets were judged more sensitive to social pain than high-SES White targets. Further, empathy mediated these effects, such that participants felt greater empathy and expected more social pain for low-SES targets relative to high-SES targets. Social pain judgments also informed judgments of social support needs, as low-SES targets were presumed to need more coping resources to manage hurtful events than high-SES targets. The current findings provide initial evidence that empathic concern for low-SES White individuals sensitizes social pain judgments and increases expected support needs for lower class White individuals.

An acute phase reaction from zoledronate mimicking symptoms seen in opioid withdrawal: a case report

BACKGROUND

Zoledronate, a bisphosphonate, is a potent first-line treatment for osteoporosis. It is also a preferred treatment for hypercalcemia especially when unresponsive to intravenous fluids. Bisphosphonates can cause acute phase reactions that mimic opioid withdrawal symptoms, which can confound provider decision-making. Our case highlights cognitive bias involving a patient with opioid use disorder who received zoledronate for hypercalcemia secondary to immobilization and significant bone infection.

CASE PRESENTATION

A 41-year-old male is admitted with a past medical history of active intravenous opioid use complicated by group A streptococcal bacteremia with L5-S1 discitis and osteomyelitis, L2-L3 osteomyelitis, and left ankle abscess/septic arthritis status post left ankle washout. His pain was well-controlled by acute pain service with ketamine infusion (discontinued earlier), opioids, acetaminophen, buprenorphine-naloxone, cyclobenzaprine, gabapentin, and naproxen. Intravenous opioids were discontinued, slightly decreasing the opioid regimen. A day later, the patient reported tachycardia, diaphoresis, myalgias, and chills, which the primary team reconsulted acute pain service for opioid withdrawal. However, the patient received a zoledronate infusion for hypercalcemia, on the same day intravenous opioids were discontinued. He had no other medications known to cause withdrawal-like symptoms per chart review. Therefore, it was suspected that an acute phase reaction occurred, commonly seen within a few days of bisphosphonate use.

CONCLUSION

Zoledronate, well known for causing acute phase reactions, was likely the cause of withdrawal-like symptoms. Acute phase reactions with bisphosphonates mostly occur in the first infusion, and the incidence decreases with subsequent infusions. Symptoms typically occur 24-72 h post-infusion, and last at most for 72 h. Cognitive bias led the primary team to be concerned with opioid withdrawal rather than investigating other causes for the patient's presentation. Therefore, providers should thoroughly investigate potential etiologies and rule them out accordingly to provide the best care. Health care providers should also be aware of the implicit biases that potentially impact the quality of care they provide to patients.

Denver pain authenticity stimulus set (D-PASS)

We introduce the Denver Pain Authenticity Stimulus Set (D-PASS), a free resource containing 315 videos of 105 unique individuals expressing authentic and posed pain. All expressers were recorded displaying one authentic (105; pain was elicited via a pressure algometer) and two posed (210) expressions of pain (one posed expression recorded before [posed-unrehearsed] and one recorded after [posed-rehearsed] the authentic pain expression). In addition to authentic and posed pain videos, the database includes an accompanying codebook including metrics assessed at the expresser and video levels (e.g., Facial Action Coding System metrics for each video controlling for neutral images of the expresser), expressers' pain threshold and pain tolerance values, averaged pain detection performance by naïve perceivers who viewed the videos (e.g., accuracy, response bias), neutral images of each expresser, and face characteristic rating data for neutral images of each expresser (e.g., attractiveness, trustworthiness). The stimuli and accompanying codebook can be accessed for academic research purposes from https://digitalcommons.du.edu/lsdl_dpass/1/ . The relatively large number of stimuli allow for consideration of expresser-level variability in analyses and enable more advanced statistical approaches (e.g., signal detection analyses). Furthermore, the large number of Black (n = 41) and White (n = 56) expressers permits investigations into the role of race in pain expression, perception, and authenticity detection. Finally, the accompanying codebook may provide pilot data for novel investigations in the intergroup or pain sciences.

Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report

In critical care, the specific, structured approach to patient care known as a "time-limited trial" has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining therapy in the face of uncertainty. Despite promotion of the time-limited trial approach, a lack of consensus about its definition and essential elements prevents optimal clinical use and rigorous evaluation of its impact. The objectives of this American Thoracic Society Workshop Committee were to establish a consensus definition of a time-limited trial in critical care, identify the essential elements for conducting a time-limited trial, and prioritize directions for future work. We achieved these objectives through a structured search of the literature, a modified Delphi process with 100 interdisciplinary and interprofessional stakeholders, and iterative committee discussions. We conclude that a time-limited trial for patients with critical illness is a collaborative plan among clinicians and a patient and/or their surrogate decision makers to use life-sustaining therapy for a defined duration, after which the patient's response to therapy informs the decision to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial's duration. The plan's 16 essential elements follow four sequential phases: consider, plan, support, and reassess. We acknowledge considerable gaps in evidence about the impact of time-limited trials and highlight a concern that if inadequately implemented, time-limited trials may perpetuate unintended harm. Future work is needed to better implement this defined, specific approach to care in practice through a person-centered equity lens and to evaluate its impact on patients, surrogates, and clinicians.

EEG evidence for racial ingroup bias in collective empathy for pain

Previous research on racial ingroup bias in empathy for pain focused on neural responses to a single person's suffering. It is unclear whether empathy for simultaneously perceived multiple individuals' pain (denoted as collective empathy in this study) is also sensitive to perceived racial identities of empathy targets. We addressed this issue by recording electroencephalography from Chinese adults who responded to racial identities of 2 × 2 arrays of Asian or White faces in which 4 faces, 1 face, or no face showed painful expressions. Participants reported greater feelings of others' pain and their own unpleasantness when viewing 4 compared to 1 (or no) painful faces. Behavioral responses to racial identities of faces revealed decreased speeds of information acquisition when responding to the face arrays with 4 (vs. 1 or no) painful expressions of Asian (but not White) faces. Moreover, Asian compared to White face arrays with 4 (vs. 1 or no) painful expressions elicited a larger positive neural response at 160-190 ms (P2) at the frontal/central electrodes and enhanced alpha synchronizations at 288-1,000 ms at the central electrodes. Our findings provide evidence for racial ingroup biases in collective empathy for pain and unravel its relevant neural underpinnings.

Biased Beliefs About White Releasees' Sensitivity to Social Pain

The accurate perception of others' pain is a prerequisite to provide needed support. However, social pain perception is prone to biases. Multiple characteristics of individuals bias both physical and social pain judgments (e.g., ethnicity and facial structure). The current work extends this research to a chronically stigmatized population: released prisoners (i.e., releasees). Recognizing the large United States releasee rates and the significant role support plays in successful re-integration, we conducted four studies testing whether people have biased judgments of White male releasees' sensitivity to social pain. Compared with the noncriminally involved, people judged releasees as less sensitive to social pain in otherwise identical situations (Studies 1a-3), an effect that was mediated by perceived life hardship (Study 2). Finally, judging releasees' as relatively insensitive to social pain undermined perceivers' social support judgments (Study 3). The downstream consequences of these findings on re-integration success are discussed.

Race Differences in Veteran's Affairs Emergency Department Utilization

INTRODUCTION

African Americans (AAs) experience disparities in chronic pain care. This study aimed to identify the rates of emergency department (ED) utilization for visits associated with chronic pain diagnoses among AAs compared to Whites and to determine variables that accounted for any differences.

METHODS

This retrospective observational study used national Veterans Affairs (Veteran's Health Administration) administrative data to identify Veterans with chronic pain diagnoses in 2018. Race/ethnicity was self-reported and assessed to examine if differences exist in ED utilization. Differences between AAs and Whites were examined using negative binomial regression models, controlling for ethnicity. Multivariable models (including demographics, pain characteristics, psychiatric comorbidities, medical comorbidities, pain-related health care utilization, and medication utilization) were examined to determine factors that contributed to these disparities.

RESULTS

Among the 2,261,030 patients, 22% (n = 492,138) were AA. The incidence rate ratio of ED utilization for AAs, relative to Whites, was 1.58 (95% CI: 1.56-1.59). The only independent variable that produced a clinically meaningful reduction in the race effect on ED use was rurality, which was associated with reduced ED use. Post hoc model including all variables reduced the race effect to 1.37 (95% CI: 1.36-1.38).

CONCLUSION

AA Veterans had a 58% greater risk of ED utilization for visits associated with chronic pain diagnoses relative to White Veterans, which remained meaningfully elevated after adjustment for observable confounders (37%). This observation may reflect disparities in outpatient chronic pain care for AAs. Future research could focus on enhancing therapeutic alliance in primary care to improve chronic pain treatment for AAs.

Women exaggerate, men downplay: Gendered endorsement of emotional dramatization stereotypes contributes to gender bias in pain expectations

The current work tested whether perceivers believe that women, relative to men, are likely to exaggerate versus downplay pain, an effect we refer to as the gender-pain exaggeration bias. The gender-pain exaggeration bias was operationalized as the extent to which perceivers believe women, relative to men, claim more pain than they feel. Across four experiments, we found that women were expected to exaggerate pain more than men and men were expected to downplay pain more than women (Studies 1-4). Further, judgments that women were more emotionally dramatizing than men contributed to this gender-pain exaggeration bias (Studies 2 and 4). We also assessed whether perceiver-level differences in endorsement of gendered emotional dramatization stereotypes (Studies 3-4) moderated this gender-pain exaggeration bias and found that endorsement of gendered emotional dramatization stereotypes moderated this bias. In sum, we document a relative gender-pain exaggeration bias wherein perceivers believe women, relative to men, to be emotionally dramatizing and therefore more likely to exaggerate versus downplay their pain. This bias may lead perceivers to interpret women's, relative to men's, pain reports as overstatements, inauthentic, or dramatized. Thus, the current work may have implications for well-documented biases in perceptions of (i.e., underestimating) and responses to (i.e., undertreating) women's pain.

Race-based biases in psychological distress and treatment judgments

Racism creates and sustains mental health disparities between Black and White Americans and the COVID-19 pandemic and ongoing harassment directed at Black Americans has exacerbated these inequities. Yet, as the mental health needs of Black Americans rise, there is reason to believe the public paradoxically believes that psychopathology hurts Black individuals less than White individuals and these biased distress judgments affect beliefs about treatment needs. Four studies (two pre-registered) with participants from the American public and the field of mental health support this hypothesis. When presented with identical mental illnesses (e.g., depression, anxiety, schizophrenia), both laypeople and clinicians believed that psychopathology would be less distressing to Black relative to White individuals. These distress biases mediate downstream treatment judgments. Across numerous contexts, racially-biased judgments of psychological distress may negatively affect mental healthcare and social support for Black Americans.

Creative mindset reduces racial ingroup bias in empathic neural responses

Spontaneous racial categorization of other-race individuals provides a cognitive basis of racial ingroup biases in empathy and prosocial behavior. In two experiments, we investigated whether fostering a creativity mindset reduces racial ingroup biases in empathy and undermines spontaneous racial categorization of other-race faces. Before and after a creative mindset priming procedure that required the construction of novel objects using discreteness, we recorded electroencephalography signals to Asian and White faces with painful or neutral expressions from Chinese adults to assess neural activities underlying racial ingroup biases in empathy and spontaneous racial categorization of faces. We found that a frontal-central positive activity within 200 ms after face onset (P2) showed greater amplitudes to painful (vs. neutral) expressions of Asian compared with White faces and exhibited repetition suppression in response to White faces. These effects, however, were significantly reduced by creative mindset priming. Moreover, the creative mindset priming enhanced the P2 amplitudes to others' pain to a larger degree in participants who created more novel objects. The priming effects were not observed in control participants who copied objects constructed by others. Our findings suggest that creative mindsets may reduce racial ingroup biases in empathic neural responses by undermining spontaneous racial categorization of faces.

Unconscious Bias among Health Professionals: A Scoping Review

BACKGROUND

Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist.

METHODS

We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021.

RESULTS

A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies.

CONCLUSIONS

Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.

Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants

A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.

Pain-related and psychological factors mediate the effect of personality on health-related quality of life. A study in breast cancer survivors with persistent pain

Introduction

Personality characteristics affect the long-term well-being and health-related quality of life (HrQoL) of breast cancer (BC) survivors. Persistent pain significantly affects psychosocial well-being and HrQoL in this patient group. We studied the effects of temperament and character via pain-related and psychological factors on dimensions of HrQoL in BC survivors.

Methods

We studied 273 patients who had been treated for BC and who reported persistent pain at any site of the body in Brief Pain Inventory. The patients were recruited from a longitudinal cohort of patients 4-9 years after surgery for BC. Short-Form-36 inventory was used to assess physical and mental dimensions of HrQoL and Temperament and Character Inventory to assess dimensions of temperament and character. We used parallel mediation modeling for studying effects of temperament and character on physical and mental HrQoL.

Results

A significant total effect was found for harm avoidance (HA) temperament (β_total = -0.665, p < 0.001) and character dimensions self-directedness (SD) (β_total = 0.609, p = 0.001) and cooperativeness (CO) (β_total = 0.584, p = 0.028) on physical and mental HrQoL. Additionally, different combinations of pain-related and psychological variables fully mediated the indirect effects of HA, SD, and CO on physical and mental HrQoL.

Discussion

HA temperament is a potential emotional vulnerability factor for psychological burden and impaired HrQoL in BC survivors. Character dimensions SD and CO may protect from the negative effect of mood on HrQoL. The results provide new insights about the risk-and target-factors for clinical interventions and effective pain management to improve psychosocial well-being and HrQoL in BC survivors.

Nursing's Critical Role in Driving Toward Health Equity: One Organization's Experience

In the last decade, there has been active discourse within nursing communities regarding healthcare disparities associated with racism. To address this critical problem, a multidisciplinary team at a pediatric healthcare setting identified 33 projects across 4 key drivers of health equity. The drivers of health equity include: 1) developing a diverse nursing workforce; 2) creating a nursing culture with a strong sense of belonging; 3) providing learning and growth opportunities; and 4) providing equitable nursing care. This article describes 1 organization's approach to addressing healthcare disparities associated with racism through a nursing program to address equity, diversity, inclusion, and antiracism.

Disparities in Pain Management

Health disparities in pain management remain a pervasive public health crisis. Racial and ethnic disparities have been identified in all aspects of pain management from acute, chronic, pediatric, obstetric, and advanced pain procedures. Disparities in pain management are not limited to race and ethnicity, and have been identified in multiple other vulnerable populations. This review targets health care disparities in the management of pain, focusing on steps health care providers and organizations can take to promote health care equity. A multifaceted plan of action with a focus on research, advocacy, policy changes, structural changes, and targeted interventions is recommended.

How Pain-Related Facial Expressions Are Evaluated in Relation to Gender, Race, and Emotion

Inequities in pain assessment are well-documented; however, the psychological mechanisms underlying such biases are poorly understood. We investigated potential perceptual biases in the judgments of faces displaying pain-related movements. Across five online studies, 956 adult participants viewed images of computer-generated faces ("targets") that varied in features related to race (Black and White) and gender (women and men). Target identity was manipulated across participants, and each target had equivalent facial movements that displayed varying intensities of movement in facial action-units related to pain (Studies 1-4) or pain and emotion (Study 5). On each trial, participants provided categorical judgments as to whether a target was in pain (Studies 1-4) or which expression the target displayed (Study 5) and then rated the perceived intensity of the expression. Meta-analyses of Studies 1-4 revealed that movement intensity was positively associated with both categorizing a trial as painful and perceived pain intensity. Target race and gender did not consistently affect pain-related judgments, contrary to well-documented clinical inequities. In Study 5, in which pain was equally likely relative to other emotions, pain was the least frequently selected emotion (5%). Our results suggest that perceivers can utilize facial movements to evaluate pain in other individuals, but perceiving pain may depend on contextual factors. Furthermore, assessments of computer-generated, pain-related facial movements online do not replicate sociocultural biases observed in the clinic. These findings provide a foundation for future studies comparing CGI and real images of pain and emphasize the need for further work on the relationship between pain and emotion.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00181-6.

Explicit and implicit weight bias among health care students: a cross-sectional study of 39 Australian universities

Background

Weight bias exhibited by health care students may continue into their future practice, compromising the provision of care that people living with overweight or obesity receive. This highlights the need to comprehensively examine the extent to which weight bias is present among health care students and the factors that may be associated with students' weight bias.

Methods

In this cross-sectional study, Australian university students enrolled in health care courses were invited via social media advertisements, snowball and convenience sampling, and by making direct contact with universities to complete an online survey. Students provided demographic information including discipline of study, perceived weight status, and state of residence. Students then completed several measures which assessed their explicit and implicit weight bias, and empathy. Descriptive statistics established the presence of explicit and implicit weight bias, and ANCOVAs, ANOVA, and multiple regression analyses were conducted to examine the potential factors associated with students' exhibited weight bias.

Findings

Between March 08, 2022, and March 15, 2022, 900 eligible health care students attending 39 Australian universities participated in the study. Students reported varying levels of explicit and implicit weight bias, with minimal differences between disciplines on most outcome measures. Students who identified as men (vs. women) exhibited higher of both explicit and implicit bias (Beliefs About Obese Persons (BAOP): p = 0.0002, Antifat Attitudes Questionnaire (AFA)-Dislike: p = 0.019, AFA Willpower p < 0.0001, Empathy for Obese Patients: p = 0.0011, Implicit Association Test: p = 0.022), and students who displayed greater (vs. less) empathic concern exhibited lower levels of explicit bias (BAOP, AFA Dislike and Willpower, and Empathy for Obese Patients: p < 0.0001). Having witnessed the enactment of weight stigma sporadically (vs. regularly) by role models was associated with greater attribution of the causes of obesity to willpower (a few times a month vs. daily: p = 0.020, a few times a year vs. daily: p = 0.022), and less time spent with people living with overweight or obesity outside of study was associated with more dislike (a few times a month vs. daily: p = 0.0048, once a month vs. daily: p = 0.0002) and less fear of fat (once a month vs. daily: p = 0.036, and once a month vs. a few times a week: p = 0.0028).

Interpretation

Results demonstrate the presence of both explicit and implicit weight bias among Australian health care students. Several characteristics and experiences of students were associated with their weight bias. Validity of the exhibited weight bias should be established in practical interactions with people living with overweight or obesity and novel interventions should be developed to ameliorate weight bias.

Funding

Research Training Program (RTP) Scholarship, Australian Government, Department of Education.

A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S

Context

Cigarette smoking is a public health problem in the U.S. and is marked by pervasive sociodemographic disparities. State-run quitlines may offer greater access to cessation services that could in turn help to reduce smoking disparities. The aim of this review was to synthesize the body of literature regarding sociodemographic disparities in the utilization and effectiveness of state-run quitlines.

Evidence acquisition

The PRISMA guidelines were followed in conducting this review. Included articles were published between January 1, 1992 and May 28, 2019 and sourced from PubMed and Web of Science. Studies that evaluated state-run quitline utilization or effectiveness (cessation) by sex, race/ethnicity, sexual or gender identity, or SES (income, education, insurance) were included.

Evidence synthesis

Our search yielded 2,091 unique articles, 17 of which met the criteria for inclusion. This review found that quitline utilization was higher among Black and Asian/Pacific Islander individuals than among White individuals and among people with lower income and lower education than among people with higher income and higher education. Quitline use was associated with less smoking cessation among females than among males, among American Indian/Alaskan Native individuals than among individuals from all other races and ethnicities, and among individuals of lower than among those of higher income and education.

Conclusions

This review found that although communities disproportionately affected by smoking utilize quitlines more commonly than their White and more affluent peers, disparities in cessation persist for American Indian/Alaskan Native and individuals from lower SES groups who use quitlines.

The Power of Empathy: Experimental Evidence of the Impact of Perspective-Focused Interventions on Support for Prison Reform

As a result of COVID-19, individuals have experienced situations that may help them relate to others, including more limited ability to interact with their environment. Thus, this survey experiment (N = 2,229) tests whether perspective-focused interventions can help increase support for prison reform. Findings suggest that perspective-getting (providing the perspective of an incarcerated individual via a narrative description of dealing with confinement) increased self-reported support for prison reform initiatives, compared with information only. In addition, a perspective-taking prompt-nudging participants to put themselves in the shoes of the incarcerated individual when reading their narrative-may help boost intention to take action in support of prison reform. Future avenues for research and implications are discussed.

Using performance art to promote intergroup prosociality by cultivating the belief that empathy is unlimited

Empathy is important for resolving intergroup conflicts. However, people often tend to feel less empathy toward people who do not belong to their social group (i.e., outgroup members). We propose that this tendency is due, in part, to the belief that empathy is a limited resource. To overcome this issue, we develop an intervention synthesizing psychology and art to increase the belief that empathy is unlimited. In six studies (n = 2118), we find that the more people believe empathy is limited, the less outgroup empathy they experience. Moreover, leading people to believe that empathy is unlimited increase outgroup empathy, leads to greater support for prosocial actions toward outgroup members, and encourages more empathic behaviors toward outgroup members in face-to-face intergroup interactions. These intervention effects are observed across various intergroup contexts involving different ethnic, national, religious, and political groups. Thus, changing beliefs about empathy may improve intergroup relations, and conveying this belief through art may promote social change.

The relationship between burnout and empathy in physiotherapists: a cross-sectional study

BACKGROUND

There have been few studies carried out into empathy in physiotherapists. Burnout can debilitate the quality of care and the efficacy of treatment as the empathetic capacity of the professional diminishes.

OBJECTIVE

The objective of the study was to examine the association between the construct burnout, empathy and sociodemographic aspects in Spanish physiotherapists.

METHODS

A cross-sectional electronic survey including the Maslach Burnout Inventory (for burnout assessment), the Interpersonal Reactivity Index (for empathy assessment) and sociodemographic data was answered by 461 Spanish physical therapists. A descriptive, bivariate and lineal regression analysis was performed.

RESULTS

There was an association between burnout and empathy. Specifically, higher levels of burnout are associated with lower levels of empathy, whilst years of work experience is associated with lower levels of burnout.

CONCLUSIONS

The results of this study contribute to a greater understanding of the relationship between the level of burnout and the dimensions of empathy in physiotherapists. The influence of burnout, which causes difficulties in the mobilization of the professional towards the establishment of a quality therapeutic relationship, is highlighted.KEY MESSAGESEmotional exhaustion is associated to greater personal discomfort and less empathy.The depersonalization is associated to personal discomfort and less empathy.Depersonalization is negatively associated to the lack of perspective.

Racial and Ethnic Differences in Outcomes of a 12-Week Digital Rehabilitation Program for Musculoskeletal Pain: Prospective Longitudinal Cohort Study

BACKGROUND

Musculoskeletal (MSK) pain disproportionately affects people from different ethnic backgrounds through higher burden and less access to care. Digital care programs (DCPs) can improve access and help reduce inequities. However, the outcomes of such programs based on race and ethnicity have yet to be studied.

OBJECTIVE

We aimed to assess the impact of race and ethnicity on engagement and outcomes in a multimodal DCP for MSK pain.

METHODS

This was an ad hoc analysis of an ongoing decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were stratified by self-reported racial and ethnic group, and their engagement and outcome changes between baseline and 12 weeks were compared using latent growth curve analysis. Outcomes included program engagement (number of sessions), self-reported pain scores, likelihood of surgery, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was calculated for pain, and multivariable logistic regression was performed to evaluate race as an independent predictor of meeting the MCID.

RESULTS

A total of 6949 patients completed the program: 65.5% (4554/6949) of them were non-Hispanic White, 10.8% (749/6949) were Black, 9.7% (673/6949) were Asian, 9.2% (636/6949) were Hispanic, and 4.8% (337/6949) were of other racial or ethnic backgrounds. The population studied was diverse and followed the proportions of the US population. All groups reported high engagement and satisfaction, with Hispanic and Black patients ranking first among satisfaction despite lower engagement. Black patients had a higher likelihood to drop out (odds ratio [OR] 1.19, 95% CI 1.01-1.40, P=.04) than non-Hispanic White patients. Hispanic and Black patients reported the highest level of pain, surgical intent, work productivity, and impairment in activities of daily living at baseline. All race groups showed a significant improvement in all outcomes, with Black and Hispanic patients reporting the greatest improvements in clinical outcomes. Hispanic patients also had the highest response rate for pain (75.8%) and a higher OR of meeting the pain MCID (OR 1.74, 95% CI 1.24-2.45, P=.001), when compared with non-Hispanic White patients, independent of age, BMI, sex, therapy type, education level, and employment status. No differences in mental health outcomes were found between race and ethnic groups.

CONCLUSIONS

This study advocates for the utility of a DCP in improving access to MSK care and promoting health equity. Engagement and satisfaction rates were high in all the groups. Black and Hispanic patients had higher MSK burden at baseline and lower engagement but also reported higher improvements, with Hispanic patients presenting a higher likelihood of pain improvement.

The Complexity of the Human-Animal Bond: Empathy, Attachment and Anthropomorphism in Human-Animal Relationships and Animal Hoarding

The human-animal relationship is ancient, complex and multifaceted. It may have either positive effects on humans and animals or poor or even negative and detrimental effects on animals or both humans and animals. A large body of literature has investigated the beneficial effects of this relationship in which both human and animals appear to gain physical and psychological benefits from living together in a reciprocated interaction. However, analyzing the literature with a different perspective it clearly emerges that not rarely are human-animal relationships characterized by different forms and levels of discomfort and suffering for animals and, in some cases, also for people. The negative physical and psychological consequences on animals' well-being may be very nuanced and concealed, but there are situations in which the negative consequences are clear and striking, as in the case of animal violence, abuse or neglect. Empathy, attachment and anthropomorphism are human psychological mechanisms that are considered relevant for positive and healthy relationships with animals, but when dysfunctional or pathological determine physical or psychological suffering, or both, in animals as occurs in animal hoarding. The current work reviews some of the literature on the multifaceted nature of the human-animal relationship; describes the key role of empathy, attachment and anthropomorphism in human-animal relationships; seeks to depict how these psychological processes are distorted and dysfunctional in animal hoarding, with highly detrimental effects on both animal and human well-being.

The Intersection of Race, Racism, and Child and Adolescent Health

There has been an increasing focus on the impact of racism both within pediatrics and throughout society as a whole. This focus has emerged as a result of the current sociopolitical climate in the United States coupled with the recent deaths of Black Americans by law enforcement and the maltreatment of Latina/o immigrants. In 2019, the American Academy of Pediatrics released the landmark policy statement "The Impact of Racism on Child and Adolescent Health," which describes the profound effects of racism on health, its function in perpetuating health disparities, and the potential role of child health professionals in addressing racism as a public health issue. (1) Foundational knowledge regarding race, racism, and their relation to health are not consistently included in standard medical education curricula. This leaves providers, including pediatricians, with varying levels of understanding regarding these concepts. This article seeks to provide an overview of the intersection of race, racism, and child/adolescent health in an effort to reduce knowledge gaps among pediatric providers with the ultimate goal of attenuating racial health disparities among children and adolescents. Please reference the Table for additional resources to reinforce concepts described throughout this article.

Effects of a Curriculum Addressing Racism on Pediatric Residents' Racial Biases and Empathy

BACKGROUND

Racism is a longstanding driver of health inequities. Although medical education is a potential solution to address racism in health care, best practices remain unknown.

OBJECTIVE

We sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy.

METHODS

A pre-post survey study was conducted in 2 urban, university-based, midsized pediatric residency programs between July 2019 and June 2020. The curriculum sessions included Self-Reflection on Implicit Bias, Historical Trauma, and Structural Racism. All sessions were paired with empathy and perspective-taking exercises and were conducted in small groups to facilitate reflective discussion. Wilcoxon signed rank tests were used to assess changes in racial bias and empathy. Linear regression was used to assess the effect of resident characteristics on racial bias and empathy.

RESULTS

Ninety of 111 residents receiving the curriculum completed pre-surveys (81.1%), and among those, 65 completed post-surveys (72.2%). Among participants with baseline pro-White bias, there was a statistically significant shift (0.46 to 0.36, P=.02) toward no preference. Among participants with a baseline pro-Black bias, there was a statistically significant shift (-0.38 to -0.21, P=.02), toward no preference. Among participants with baseline pro-White explicit bias, there was a statistically significant shift (0.54 to 0.30, P<.001) toward no preference. Among all residents, there was a modest but statistically significant decrease in mean empathy (22.95 to 22.42, P=.03).

CONCLUSIONS

Participation in a longitudinal discussion-based curriculum addressing racism modestly reduced pediatric residents' racial preferences with minimal effects on empathy scales.

Racial outgroup favoritism in neural responses to others' pain emerges during sociocultural interactions

Racial ingroup favoritism in empathic brain activity has been widely observed and is associated with biased behavior toward same-race and other-race individuals. We investigated whether racial outgroup favoritism in neural responses to others' pain - an objective measure of empathy - may emerge during sociocultural interactions in a new social environment. We recorded magnetoencephalography to pain and neutral expressions of Asian and White faces from White students who had stayed in China for 6-36 weeks (Experimental group) or 2-4 weeks (Control group). The experimental group showed better neural decoding of and greater insular/sensorimotor responses to pain vs. neutral expressions of Asian compared to White faces. By contrast, the control group showed better neural decoding of pain vs. neutral expressions of White than Asian faces. In addition, participants of the experimental group who had stayed longer in China showed greater sensorimotor responses to pain (vs. neutral) expressions of Asian faces but weaker sensorimotor responses to pain (vs. neutral) expressions of White faces. Our findings revealed emerging racial outgroup favoritism in brain activities associated with sensorimotor resonance and affective sharing of others' pain during sociocultural interactions.

The association between empathy and the physiotherapy-patient therapeutic alliance: A cross-sectional study

BACKGROUND

The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance.

OBJECTIVE

The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them.

DESIGN

Cross-sectional research.

METHODS

An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out.

RESULTS

Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (-0.13 < B > -0.09; p < 0.01).

CONCLUSIONS

The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist's personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.

Achieving Mutual Understanding Without Saying a Word: The Conceptualization of Moqi and a Nomological Network

While the construct of moqi (默契, pronounced ‘mò-chee’) is ubiquitously understood and finds itself in everyday conversations around the home and workplace in China, the theoretical development of moqi has been scarce. In this article, we expand on prior work on moqi and conceptualize moqi as a dyadic level construct that describes a situated state of shared contextualized understanding without saying a word between two counterparties. We further articulate a broader view of moqi as a dyadic communication construct that is both target-specific and situation-specific. We propose a nomological network of moqi that shows how shared contextualized understandings between counterparties are informed by several different layers, including ‘capability’ (a) a generalized proclivity to be able to form such understandings with others, and ‘contributing factors’, (b) how those understandings are formed either (i) through interactions or (ii) without them through overlaps in background characteristics or experiences, and (c) how other factors accentuate the capability and inclination to ultimately achieve moqi. We then discuss several potential consequences of moqi in organizational settings. Finally, we discuss why moqi is a powerful form of effective communication that is meaningful beyond the Chinese cultural context.

Racial Discrimination and Race-Based Biases on Orthopedic-Related Outcomes: An Integrative Review

Musculoskeletal diseases often lead to functional limitations and debility. The burden of these debilitating diseases is not balanced across race and ethnicity. The Institute of Medicine (now referred to as the National Academy of Medicine) identified racial discrimination as a substantive cause of race-based health disparities for racial and ethnic minority groups. The purpose of this integrative review is to summarize the evidence on the relationship among racial discrimination, race-based implicit biases and other types of biases (e.g., gender and appearance), and orthopaedic-related outcomes. Nine studies met inclusion criteria and were included in this review. The orthopaedic outcomes addressed across the nine studies were osteoarthritis, rheumatoid arthritis, low back pain, pain tolerance, disability, and likelihood of being recommended for a total knee arthroplasty. The results reveal that experiences of racial discrimination, race-based implicit biases, and other types of biases contribute to unsatisfactory orthopaedic-related outcomes for minority groups. Orthopaedic nurses can leverage their expertise to address these disparities in orthopaedic-related outcomes across minority groups.

Bias in Musculoskeletal Pain Management and Bias-Targeted Interventions to Improve Pain Outcomes: A Scoping Review

Bias in healthcare negatively impacts disparities in care, treatment, and outcomes, especially among minority populations. A scoping review of the literature was performed to provide a deeper understanding of how bias influences musculoskeletal pain and potential effects of bias-targeted interventions on reducing pain disparities, as well as identify gaps and make suggestions for further research in this area. Publications from peer-reviewed journals were searched using the databases PubMed/MEDLINE, PsycINFO, CINAHL, and Scopus, with 18 studies identified. The literature review revealed that clinician-based bias and discrimination worsen pain and disability by reducing access to treatment and increasing patient pain-related injustice, catastrophizing, depression, and perceived stress. In contrast, clinician education and perspective-taking, patient decision tools, and community outreach interventions can help reduce bias and disparities in musculoskeletal pain outcomes. Increasing the diversity of the healthcare workforce should also be a priority. Models of care focused on health equity may provide an ideal framework to reduce bias and provide sustainable improvement in musculoskeletal pain management.

Opioids for chronic pain management in patients with dialysis-dependent kidney failure

Chronic pain is highly prevalent among adults treated with maintenance haemodialysis (HD) and has profound negative effects. Over four decades, research has demonstrated that 50-80% of adult patients treated with HD report having pain. Half of patients with HD-dependent kidney failure (HDKF) have chronic moderate-to-severe pain, which is similar to the burden of pain in patients with cancer. However, pain management in patients with HDKF is often ineffective as most patients report that their pain is inadequately treated. Opioid analgesics are prescribed more frequently for patients receiving HD than for individuals in the general population with chronic pain, and are associated with increased morbidity, mortality and health-care resource use. Furthermore, current opioid prescribing patterns are frequently inconsistent with guideline-recommended care. Evidence for the effectiveness of opioids in pain management in general, and in patients with HDKF specifically, is lacking. Nonetheless, long-term opioid therapy has a role in the treatment of some patients when used selectively, carefully and combined with an ongoing assessment of risks and benefits. Here, we provide a comprehensive overview of the use of opioid therapy in patients with HDKF and chronic pain, including a discussion of buprenorphine, which has potential as an analgesic option for patients receiving HD owing to its unique pharmacological properties.

A Brief Online Implicit Bias Intervention for School Mental Health Clinicians

Clinician bias has been identified as a potential contributor to persistent healthcare disparities across many medical specialties and service settings. Few studies have examined strategies to reduce clinician bias, especially in mental healthcare, despite decades of research evidencing service and outcome disparities in adult and pediatric populations. This manuscript describes an intervention development study and a pilot feasibility trial of the Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for mental health clinicians in schools-where most youth in the U.S. access mental healthcare. Clinicians (N = 12) in the feasibility study-a non-randomized open trial-rated VIBRANT as highly usable, appropriate, acceptable, and feasible for their school-based practice. Preliminarily, clinicians appeared to demonstrate improvements in implicit bias knowledge, use of bias-management strategies, and implicit biases (as measured by the Implicit Association Test [IAT]) post-training. Moreover, putative mediators (e.g., clinicians' VIBRANT strategies use, IAT D scores) and outcome variables (e.g., clinician-rated quality of rapport) generally demonstrated correlations in the expected directions. These pilot results suggest that brief and highly scalable online interventions such as VIBRANT are feasible and promising for addressing implicit bias among healthcare providers (e.g., mental health clinicians) and can have potential downstream impacts on minoritized youth's care experience.

Disparities in Mental Health and Well-Being Among Black and Latinx Patients With Kidney Disease

Black and Latinx individuals in the United States are afflicted disproportionately with kidney disease. Because of structural racism, social risk factors drive disparities in disease prevalence and result in worse outcomes among these patient groups. The impact of social and economic oppression is pervasive in physical and emotional aspects of health. In this review, we describe the history of race and ethnicity among black and Latinx individuals in the United States and discuss how these politicosocial constructs impact disparities in well-being and mental health. Lastly, we outline future research, clinical considerations, and policy considerations to eliminate racial and ethnic disparities in well-being among black and Latinx individuals with kidney disease.

Inter-group conflict affects inter-brain synchrony during synchronized movements

Interpersonal synchrony refers to alignment in time of interacting individuals. Recent neuroimaging findings indicate that the inferior frontal gyrus (IFG) - a core region of the observation-execution system - is not only activated during tasks that involve synchrony, but also coupled between interaction partners, suggesting a key role for the IFG in mediating interpersonal synchrony. In this study we investigated whether inter-brain synchrony (IBS) is modulated by inter-group relationships. We examined this question in the context of the Israeli-Palestinian conflict - one of the world's most prolonged and intractable conflicts. Using functional Near Infra-Red Spectroscopy (fNIRS) hyperscanning, we measured IBS among ingroup vs. inter-group dyads (same-nationality dyads and Jewish-Palestinian dyads, respectively) while they performed a task entailing 2D movement synchrony. The results point to an increase in behavioral synchrony and greater enjoyment in the ingroup dyads, compared to the inter-group dyads. Critically, IBS in the left IFG significantly increased throughout task and it was higher among ingroup compared to inter-group dyads. Our findings highlight the effect of group membership on IBS plasticity.

Increasing Self-Other Similarity Modulates Ethnic Bias in Sensorimotor Resonance to Others' Pain

The tendency to simulate the pain of others within our own sensorimotor systems is a vital component of empathy. However, this sensorimotor resonance is modulated by a multitude of social factors including similarity in bodily appearance, e.g. skin colour. The current study investigated whether increasing self-other similarity via virtual transfer to another colour body reduced ingroup bias in sensorimotor resonance. A sample of 58 white participants was momentarily transferred to either a black or a white body using virtual reality technology. We then employed electroencephalography (EEG) to examine event-related desynchronization (ERD) in the sensorimotor beta (13-23 Hz) oscillations while they viewed black, white, and violet photorealistic virtual agents being touched with a noxious or soft object. While the noxious treatment of a violet agent did not increase beta ERD, amplified beta ERD in response to black agent's noxious vs. soft treatment was found in perceivers transferred to black body. Transfer to the white body dismissed the effect. Further exploratory analysis implied that the pain-related beta ERD occurred only when the agent and the participant were of the same colour. The results suggest that even short-lasting changes in bodily resemblance can modulate sensorimotor resonance to others' perceived pain.

Race Deficits in Pain Detection: Medical Providers and Laypeople Fail to Accurately Perceive Pain Authenticity Among Black People

Across six studies ( N = 904), we suggest a novel mechanism for race disparities in pain treatment: Perceiver deficits in discriminating real from fake pain for Black (relative to White) individuals. Across Studies 1–4, White participants (Studies 1–4) and Black participants (Study 2) were better at discerning authentic from inauthentic pain expressions for White targets than for Black targets. This effect emerged for both subtle (Studies 1 and 2) and intense (Studies 3 and 4) pain stimuli. Studies 5 and 6 examined consequences for medical care decisions by examining pain treatment recommendations by laypeople (Study 5) and pain authenticity judgments by medical providers (Study 6). This work advances theory in pain perception, emotion judgment, and intergroup relations. It also has practical significance for identifying unexplored mechanisms causing racial disparities in medical care.

Racial and Ethnic Disparities in Discharge Opioid Prescribing From a Hospital Medicine Service

BACKGROUND

Differential opioid prescribing patterns have been reported in non-White patient populations. However, these disparities have not been well described among hospitalized medical inpatients.

OBJECTIVE

To describe differences in opioid prescribing patterns among inpatients discharged from the general medicine service based on race/ethnicity.

DESIGN, SETTING, AND PARTICIPANTS

For this retrospective study, we performed a multivariable logistic regression for patient race/ethnicity and whether patients received an opioid prescription at discharge and a negative binomial regression for days of opioids prescribed at discharge. The study included all 10,953 inpatients discharged from the general medicine service from June 2012 to November 2018 at University of California San Francisco Medical Center who received opioids during the last 24 hours of their hospitalization.

MAIN OUTCOMES AND MEASURES

We examined two primary outcomes: whether a patient received an opioid prescription at discharge, and, for patients prescribed opioids, the number of days dispensed.

RESULTS

Compared with White patients, Black patients were less likely to receive an opioid prescription at discharge (predicted population rate of 47.6% vs 50.7%; average marginal effect [AME], -3.1%; 95% CI, -5.5% to -0.8%). Asian patients were more likely to receive an opioid prescription on discharge (predicted population rate, 55.6% vs 50.7%; AME, +4.9; 95% CI, 1.5%-8.3%). We also found that Black patients received a shorter duration of opioid days compared with White patients (predicted days of opioids on discharge, 15.7 days vs 17.8 days; AME, -2.1 days; 95% CI, -3.3 to -0.9).

CONCLUSION

Black patients were less likely to receive opioids and received shorter courses at discharge compared with White patients, adjusting for covariates. Asian patients were the most likely to receive an opioid prescription.

Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study

Objective

To investigate structural relationships of latent constructs such as occupational wellbeing, resilience, work meaningfulness, and psychological empowerment with affective and cognitive clinical empathy among a community of physicians and advanced practice providers.

Methods

We conducted a cross-sectional observational study. We gathered data by an anonymous self-administered multidimensional questionnaire disseminated electronically between March and May 2016. Participants were physicians and advanced practice providers belonging to the Health Texas Provider Network, a group private practice affiliated with the Baylor Scott and White Health system. We excluded allied health care staff (eg, nurses) and trainees (eg, residents, medical students). We pursued a 3-step strategy: (1) confirmatory factor analysis of a theory-driven measurement model, (2) a modified structural equation model from which pathways with nonsignificant path coefficients were deleted, and (3) multigroup analyses of the modified model.

Results

Cognitive empathy was the strongest predictor of affective empathy. We observed modest positive associations of resilience with cognitive and affective empathy and of well-being and meaning with affective but not with cognitive empathy. Resilience, meaning, and psychological empowerment were surprisingly negatively associated with well-being, suggesting diminished self-care among practitioners. Effects of psychological empowerment on empathy and well-being were mediated by resilience and meaning.

Conclusion

Cognitive empathy directly influenced affective empathy; well-being and meaningfulness exerted direct positive effects on affective but not on cognitive empathy, whereas resilience had direct positive associations with both empathy dimensions. Resilience and meaning manifested direct, negative associations with well-being, revealing clinicians’ disproportionate focus on patient care at the expense of self-care.

The residential stability mindset increases racial in-group bias in empathy

With the deepening of internationalization, the population's mobility has greatly increased, which can impact people's intergroup relationships. The current research examined the hypothesis that residential mobility plays a crucial role in racial in-group bias in empathy (RIBE) with three studies. By manipulating the residential mobility/stability mindset and measuring subjective pain intensity ratings (Study 1) and event-related potentials (ERPs, Study 2) of Chinese adults on painful and neutral expressions of Asian and Caucasian faces, we found that the RIBE in subjective ratings and N1 amplitudes increased and P3 amplitudes decreased in the stability group. Transcranial direct current stimulation (tDCS) manipulation in Study 3 further found that anodal stimulation of the left dorsolateral prefrontal cortex (DLPFC) increased the RIBE of participants with residential stability experience but had no effect on those with residential mobility experience. As residential mobility continues to increase worldwide, we may observe concomitant changes in racial intergroup relationships.

Racial and Language Microaggressions in the School Ecology

The growth trajectory of ethnically and linguistically diverse individuals in the United States, particularly for youth, compels the education system to have urgent awareness of how diverse aspects of culture (e.g., Spanish-speaking, Black Latina student) are implicated in outcomes in American school systems. Students spend a significant amount of time in the school ecology, and this experience plays an important role in their well-being. Diverse ethnic, racial, and linguistic students face significant challenges and are placed at considerable risk by long-observed structural inequities evidenced in society and schools. Teachers must develop the capacity to be culturally sensitive, provide culturally responsive pedagogy, and regularly self-assess for biases implicated in positive academic outcomes for students in kindergarten through Grade 12. Research and practice have suggested that racism and discrimination in the form of racial microaggressions are observed daily in schools and classrooms. This article provides an overview of racial microaggressions in the school context and their damaging effects on students. We provide specific examples of microaggressions that may be observed in the U.S. classroom environment and how schools can serve as a positive intervention point to ameliorate racism, discrimination, and racial and language microaggressions. This comprehensive approach blends theory with practice to support the continued development of cultural humility, culturally sustaining pedagogy, and an equity-responsive climate.

The neural underpinnings of intergroup social cognition: an fMRI meta-analysis

Roughly 20 years of functional magnetic resonance imaging (fMRI) studies have investigated the neural correlates underlying engagement in social cognition (e.g. empathy and emotion perception) about targets spanning various social categories (e.g. race and gender). Yet, findings from individual studies remain mixed. In the present quantitative functional neuroimaging meta-analysis, we summarized across 50 fMRI studies of social cognition to identify consistent differences in neural activation as a function of whether the target of social cognition was an in-group or out-group member. We investigated if such differences varied according to a specific social category (i.e. race) and specific social cognitive processes (i.e. empathy and emotion perception). We found that social cognition about in-group members was more reliably related to activity in brain regions associated with mentalizing (e.g. dorsomedial prefrontal cortex), whereas social cognition about out-group members was more reliably related to activity in regions associated with exogenous attention and salience (e.g. anterior insula). These findings replicated for studies specifically focused on the social category of race, and we further found intergroup differences in neural activation during empathy and emotion perception tasks. These results help shed light on the neural mechanisms underlying social cognition across group lines.