Differences In Self-reported Measures Research Articles

Adjustable Phonatory PEEP to Treat Dysphonia: A Preliminary Investigation of Progressive Masked Voice Exercises (PMVE).

The Progressive Masked Voice Exercises (PMVE) with an innovative semioccluded ventilation mask fitted and adjustable positive end-expiratory pressure (PEEP) valve was evaluated. This study aimed to compare the effectiveness of the PMVE with the PEEP device and the Vocal Function Exercise (VFE) program on acoustic, auditory-perceptual, aerodynamic, and self-report measures. Twenty-five participants diagnosed with voice disorders met the criteria. Participants were randomly assigned to either the PMVE or the VFE group for a 6-week home therapy program. Pre- and post-data were analyzed with parametric and nonparametric statistics. Acoustic and aerodynamic measures showed no between-group or interaction group × time effects; however, a main effect of time was observed for all but one of the eight acoustic variables, indicating that both groups improved. Additional within-group analysis showed improvements in two of the eight variables for the PMVE program and four for the VFE program. No between-group differences were observed for the auditory-perceptual judgments using the GRBASI scale; however, the strain was improved for the VFE group. No differences in self-report measures were also seen, except for the VFE group. This study provides preliminary evidence for the PMVE therapy program. Further research is needed in large and diverse samples and clinical application is invited.

Functional Movement Disorder Is Associated with Abnormal Interoceptive Brain Activity: A Task-based Functional MRI Study.

Aberrant interoceptive processing has been hypothesized to contribute to the pathophysiology of functional neurological disorder, although findings have been inconsistent. Here, we utilized functional magnetic resonance imaging (fMRI) to examine neural correlates of interoceptive attention - the conscious focus and awareness of bodily sensations - in functional movement disorder (FMD). We used voxelwise analyses to compare blood oxygenation level-dependent responses between 13 adults with hyperkinetic FMD and 13 healthy controls (HCs) during a task requiring attention to different bodily sensations and to an exteroceptive stimulus. Additionally, we examined between-group differences in self-reported measures of interoception and evaluated their relationship with neural activity. Interoceptive conditions (heartbeat, stomach and 'body', indicating sensations from the body part or limb affected in FMD participants) activated a network involving the precuneus, the posterior cingulate cortex (PCC) and caudate nucleus (CN) bilaterally, and the right anterior insula (aINS) (p <0.05, corrected). Group differences in brain activity were mainly driven by processing of disease-related interoceptive signals, which in the FMD group was associated with a broader neural activation than monitoring gastric interoception, while no group differences were detected during cardiac interoception. Differences based on interoceptive focus (body vs heartbeat and stomach) between FMD subjects and HCs were found in PCC, CN, angular gyrus, thalamus, and in the mid-insula (p <0.05, corrected). This is, to our knowledge, the first study showing that FMD is associated with abnormal interoceptive processing in regions involved in monitoring body state, attentional focus, and homeostatic inference.

A multi-modality and multi-dyad approach to measuring flexibility in psychotherapy

Introduction Flexibility, the ability of an individual to adapt to environmental changes in ways that facilitate goal attainment, has been proposed as a potential mechanism underlying psychopathology and psychotherapy. In psychotherapy, most findings are based on self-report measures that have important limitations. We propose a multimodal, multi-dyad approach based on a nonlinear dynamical systems framework to capture the complexity of this concept. Method A new research paradigm was designed to explore the validity of the proposed conceptual model. The paradigm includes a psychotherapy-like social interaction, during which body movement and facial expressiveness data were collected. We analyzed the data using Hankel Alternative View of Koopmann analysis to reconstruct attractors of the observed behaviors and compare them. Results The patterns of behavior in the two cases differ, and differences in the reconstructed attractors correspond with differences in self-report measures and behavior in the interactions. Conclusions The case studies show that information provided by a single modality is not enough to provide the full picture, and multiple modalities are needed. These observations can serve as an initial support for our claims that a multi-modal and multi-dyad approach to flexibility can address some of the issues of measurement in the field.

Impact of the Comprehensive Care for Joint Replacement model on patient-reported outcomes.

To determine whether the Comprehensive Care for Joint Replacement (CJR) model, a mandatory episode-based payment program for knee and hip replacement surgery, affected patient-reported measures of quality. Surveys of Medicare fee-for-service beneficiaries who had hip or knee replacement surgery, collected between July 2018 and March 2019, secondary Medicare administrative data, the Provider of Services file, CJR and Bundled Payments for Care Improvement participant lists from the Centers for Medicare & Medicaid Services, and the Area Health Resource Files. In 2018, participation in the CJR model was mandatory for nearly all hospitals in 34 randomly selected, metropolitan statistical areas (MSAs) that had high historical Medicare payments for lower-extremity joint replacements surgery. The control group included 47 high-payment MSAs randomly assigned as controls. We estimated risk-adjusted differences in self-reported measures of functional status and pain, satisfaction with care, and caregiver help between respondents in CJR hospitals and respondents in hospitals located in the control group. We selected a census of CJR patients and an equal number of control patients to survey. We fielded two waves of surveys using a mail and phone protocol, yielding 8433 CJR and 9014 control respondents. CJR respondents were slightly more likely to depend on caregivers for certain activities of daily living when they got home (either directly from the hospital or after an institutional post-acute care stay). On a 100-point scale, differences ranged from -2.6 points (p< 0.01) for help needed bathing to -1.7 points (p< 0.05) for help needed using the toilet. However, differences in eight measures of self-reported functional status approximately 90-120 days after hospital discharge were not statistically significant, ranging from -1.1% (p= 0.087) to 0.7% (p= 0.437). CJR did not harm patient health or affect patient satisfaction on average but did increase reliance on caregivers during recovery.

Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018

The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. Self-reported race, ethnicity, and income level. Rates and racial and ethnic differences in self-reported health status and health care access and affordability. The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.

Measurement Invariance of Screening Measures of Anxiety, Depression, and Level of Functioning in a US Sample of Minority Older Adults Assessed in Four Languages.

Population aging in the US and its increase in racial/ethnic diversity has resulted in a growing body of literature aimed at measuring health disparities among minority older adults. Disparities in health outcomes are often evaluated using self-reported measures and, to attend to linguistic diversity, these measures are increasingly being used in languages for which they were not originally developed and validated. However, observed differences in self-reported measures cannot be used to infer disparities in theoretical attributes, such as late-life depression, unless there is evidence that individuals from different groups responded similarly to the measures—a property known as measurement invariance. Using data from the Positive Minds-Strong Bodies randomized controlled trial, which delivered evidence-based mental health and disability prevention services to a racially/ethnically diverse sample of minority older adults, we applied invariance tests to two common measures of anxiety and depression (the GAD-7 and the HSCL-25) and two measures of level of functioning (the Late-Life FDI and the WHODAS 2.0) comparing four different languages: English, Spanish, Mandarin, and Cantonese. We found that these measures were conceptualized similarly across languages. However, at the item-level symptom burden, we identified a non-negligible number of symptoms with some degree of differential item functioning. Spanish speakers reported more worry symptoms and less somatic symptoms for reasons unrelated to their psychological distress. Mandarin speakers reported more feelings of restlessness, and both Mandarin and Cantonese speakers reported no interest in things more often for reasons unrelated to their psychological distress. Mandarin and Cantonese speakers were also found to consistently report more difficulties performing physical activities for reasons unrelated to their level of functioning. In general, invariance tests have been insufficiently applied within psychological research, but they are particularly relevant as a prerequisite to accurately measure health disparities. Our results highlight the importance of conducting invariance testing, as we singled out several items that may require careful examination before considering their use to compare symptoms of psychological distress and level of functioning among ethnically and linguistically diverse older adult populations.

0064 Heightened Neural Responses to Negative Words in Shift Workers Using the Stroop Task

Abstract Introduction Shift work is known to have a negative impact on a wide range of health problems such as sleep disturbance, cognitive impairment, and emotional disorders (e.g., anxiety and depression). It is important to understand underlying mechanisms for negative impact of shift work on health problems. This study aimed to investigate psychological and neural mechanisms associated with shift work. Methods Thirty six shift workers (28 females, age = 29.9 ± 7.4) and 35 non-shift workers (20 females, age = 30.5 ± 5.5) participated in this study. They were performing the word Stroop task during fMRI scanning. This task included sleep-related words and negative words to investigate neural substrates associated with sleep-related information and emotional information processing. Neutral words were included as control stimuli. The participants also completed questionnaires assessing sleep-related problems such as Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale, and emotion-related problems such as Beck Depression Inventory and Beck Anxiety Inventory. Two-sample t-tests were conducted to find group differences in self-report measures and neural response to sleep-related words and negative words compared to neutral words. Results Relative to non-shift workers, shift workers showed greater sleep disturbance (i.e., higher PSQI), but they did not show any evidence of emotion-related problems. Shift workers also demonstrated greater neural response to negative words (vs. neutral words) in several prefrontal regions (e.g., dorsal anterior cingulate cortex and dorsolateral prefrontal cortex), anterior insula and caudate compared to non-shift workers. However, shift workers did not show significantly different neural response to sleep-related words (vs. neutral words) compared to non-shift workers. Conclusion The result from this study provides supporting evidence that shift work is associated with subjective sleep disturbance. Shift workers’ heightened neural response to negative information may reflect their increased sensitivity to negative information, that may contribute to sleep disturbance. Support Brain Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT &amp; Future Planning (Study No.: 2016M3C7A1904338 and NRF-2018R1D1A1B07049704).

No pills, more skills: The adverse effect of hormonal contraceptive use on exposure therapy benefit

Hormonal contraceptive use can aggravate existing symptoms of anxiety and depression and influence the response to pharmacologic treatment. The impact of hormonal contraceptive use on non-pharmacological treatment efficacy in anxiety disorders is less well explored. Oral contraceptives, which suppress endogenous sex hormone secretion, can alter fear extinction learning. Fear extinction is considered the laboratory proxy of exposure therapy in anxiety disorders. This study set out to examine whether oral contraceptive use is related to exposure-based treatment response in specific phobia. We recruited spider-phobic women (n = 28) using oral contraceptives (OC) and free-cycling women (n =26, No-OC). All participants were subjected to an identical in-vivo exposure. Exposure-based symptom improvement was assessed with several behavioral and subjective indices at pre-treatment, post-treatment and six-weeks follow-up. No–OC women showed higher pre-exposure fear levels on the FSQ and SPQ. OC women showed slightly less pronounced exposure benefit compared to their free-cycling counterparts (No-OC woman) as reflected by lower levels of fear reduction from pre-treatment to follow-up on the subjective level. After correction for multiple testing, OC and No-OC women showed differences in self-report measures (SPQ, FAS and SBQ) from pre- to follow-up treatment but not from pre-to post-treatment. These findings implicate that oral contraceptive use can account for differential exposure-based fear symptom improvement. Our study highlights the importance of monitoring and managing hormonal contraceptives use in the context of non-pharmacological exposure-based interventions.

Rotating Shifts Negatively Impacts Health and Wellness Among Intensive Care Nurses.

The impact of shift work on sleep and health has been examined in the past, but most studies utilized cross-sectional designs relying on between-subject differences. The purpose this study was to examine the within-subject differences in self-report measures of health and wellness among a group of nurses engaged in rotating shifts. Patient-Reported Outcomes Measurement Information System (PROMIS) measures, collected post-day and post-night shift, were used to assess health, sleep disturbances and sleep-related impairment, fatigue, emotional distress (anger), satisfaction with social roles outside of work, and applied cognitive abilities. Among the sample of 23 White, mostly female (91.3%) nurses, all PROMIS measures were worse indicting lower health and wellness after working night shifts compare to after working day shifts ( p values from .167 to < .001). During both time points of assessment, sleep-related impairment was highly correlated with greater emotional distress, greater fatigue, and worse memory and concentration. Study findings support prior studies that shift work can negatively impact health and wellness.

Measures of Student Non-Cognitive Skills and Political Tolerance after Two Years Of The Louisiana Scholarship Program

This report examines the short-term effects of the Louisiana Scholarship Program (LSP) on students’ non-cognitive skills and civic values. While a growing number of studies have evaluated K-12 school voucher programs along academic dimensions, few have focused on the development of non-cognitive skills and civic values. This study aims to address that gap by providing the first analysis of differences in self-reported measures of grit, locus of control, self esteem, and political tolerance associated with the LSP. Using results from a phone survey of applicants to the program, we find little evidence of differences between LSP scholarship recipients and non-recipients. Nevertheless, diagnostics assessing the precision of our instruments to detect differences between subjects indicate that several of the scales measuring non-cognitive skills performed poorly in our sample. Moreover, our relatively low survey response rate of 11 percent raises concerns about the representativeness of our sample. Given these issues, we caution that our results are best understood as descriptive and not necessarily conclusive: they do not represent reliable estimates of the causal impact of the LSP on student non-cognitive skills and political tolerance.

Cognitive Control Processes Underpin Sex differences in Self-report Measures of Empathy

Cognitive Control Processes Underpin Sex differences in Self-report Measures of Empathy

Does the measure matter? On the association between disgust proneness and OCD symptoms

Although some studies suggest that the association between disgust proneness (DP) and obsessive–compulsive symptoms (OCS) is specific to the contamination subtype, others suggest that DP is associated with OCS more broadly. To examine if the discrepant findings may partially reflect differences in self-report measures used, this investigation employed structural equation modeling to examine the association between DP and OCS in three samples that completed different combinations of measures of DP, OCS, and anxiety/negative affect. In Study 1 (n=626), the path from DP to contamination-based OCS was significantly stronger than the path from DP to non-contamination OCS when controlling for anxiety sensitivity. In Study 2 (n=403), the results showed that the path from DP to contamination-based OCS did not significantly differ from the path from DP to non-contamination OCS when controlling for negative affect. Lastly, Study 3 (n=296) showed that the path from DP to contamination-based OCS was significantly weaker than the path from DP to non-contamination OCS. These findings highlight that the self-report measures employed is an important moderator when making inferences about the association between DP and contamination-based OCS and non-contamination OCS.

Perceptions of Gender Differences in Self-Report Measures of Emotional Intelligence

Emotional Intelligence (EI) refers to the abilities/competencies that an individual has about emotions and has proven to be related to positive aspects in life. Despite its growing relevance, results about the existence and magnitude of gender differences have been inconclusive, with some studies suggesting that such differences depend on the theoretical approach and type of instrument used. In an effort to better understand these relationships, this study examined the stereotyped nature of self-report instruments of EI from the two main theoretical EI approaches (ability-based and mixed models). Two hundred sixty Spanish undergraduates from a university in the South of Spain indicated the extent to which they considered several EI competences as typical of women/men. Results show that most EI dimensions are biased by gender stereotypes, in terms of being perceived as more characteristic of one gender or the other. An in-group gender bias appeared particularly among female participants whereby they attributed higher scores to women than to men in most EI dimensions. Men also favored men giving higher scores than women did in some of the dimensions. These results suggest that self-report EI measures may be influenced by gender stereotypes, which has relevant implications for EI researchers.

Improvement of Adult BTE Hearing Aid Wearers' Front/Back Localization Performance Using Digital Pinna-Cue Preserving Technologies: An Evidence-Based Review.

This systematic review evaluated the impact of using digital pinna-cue preserving technologies (PPT) on front/back sound localization for adult hearing aid users. Two peer-reviewed studies and two non-peer-reviewed studies were included. Lab-based and self-report outcomes were both assessed. The overall findings suggested that PPT was superior to omni-directional and full directional settings in a relatively quiet, well-controlled laboratory environment but not in the real world. However, observed individual differences in self-report measures suggested that PPT was potentially beneficial to certain hearing aid users. PPT candidacy was discussed and the importance of a pre-fitting interview/consultation was emphasized to assist clinicians in making a solid evidence-based and cost-effectiveness decision when prescribing hearing aids to adults with hearing impairment.

Alternative population sampling frames produced important differences in estimates of association: a case–control study of vasculitis

ObjectiveA common population sampling frame in countries with universal health care is health service registers. We have evaluated the use of such a register, in the United Kingdom, against a commercially available database claiming large population coverage, an alternative that offers ease of access and flexibility of use. Study Design and SettingA case–control study of vasculitis, which recruited cases from secondary care clinics in Scotland, compared two alternative sampling frames for population controls, namely the registers of National Health Service (NHS) primary care practices and a commercially available database. The characteristics of controls recruited from both sources were compared in addition to separate case–control comparison using logistic regression. ResultsA total of 166 of 189 cases participated (88% participation rate), while both the commercial database and NHS Central Register (NHSCR) controls achieved a participation rate of 24% among persons assumed to have received the invitation. On several measures, the NHSCR patients reported poorer health than the commercial database controls: low scores on the physical component score of the Short Form 36 (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.3–4.1), chronic widespread pain (OR: 2.3; CI: 1.1–4.7), and high levels of fatigue (OR: 2.0; CI: 1.3–3.1). These had an important influence on the estimates of association with case status with one association (pain) showing a strong and significant association using commercial database controls, which was absent with NHSCR controls. ConclusionThere are important differences in self-reported measures of health and quality of life using controls from two alternative population sampling frames. It emphasizes the importance of methodological rigor and prior assessment in choosing sampling frames for case–control studies.

Quantification of walking ability in subjects with neurogenic claudication from lumbar spinal stenosis—a comparative study

Walking limitations caused by neurogenic claudication (NC) are typically assessed with self-reported measures, although objective evaluation of walking using motorized treadmill test (MTT) or self-paced walking test (SPWT) has periodically appeared in the lumbar spinal stenosis (LSS) literature. This study compared the validity and responsiveness of MTT and SPWT for assessing walking ability before and after common treatments for NC. Prospective observational cohort study. Fifty adults were recruited from an urban spine center if they had LSS and substantial walking limitations from NC and were scheduled to undergo surgery (20%) or conservative treatment (80%). Walking times, distances, and speeds along with the characteristics of NC symptoms were recorded for MTT and SPWT. Self-reported measures included back and leg pain intensity assessed with 0 to 10 numeric pain scales, disability assessed with Oswestry Disability Index, walking ability assessed with estimated walking times and distances, and NC symptoms assessed with the subscales from the Spinal Stenosis Questionnaires. Motorized treadmill test used a level track, and SPWT was conducted in a rectangular hallway. Walking speeds were self-selected, and test end points were NC, fatigue, or completion of the 30-minute test protocol. Results from MTT and SPWT were compared with each other and self-reported measures. Internal responsiveness was assessed by comparing changes in the initial results with the posttreatment results and external responsiveness by comparing walking test results that improved with those that did not improve by self-reported criteria. Mean age of the participants was 68 years, and 58% were male. Neurogenic claudication included leg pain (88%) and buttock(s) pain (12%). Five participants could not safely perform MTT. Walking speeds were faster and distances were greater with SPWT, although the results from both tests correlated with each other and self-reported measures. Of the participants, 72% reported improvement after treatment, which was confirmed by significant mean differences in self-reported measures. Motorized treadmill test results did not demonstrate internal responsiveness to change in clinical status after treatment but SPWT results did, with increased mean walking times (6 minutes) and distances (387 m). When responsiveness was assessed against external criterion, both SPWT and MTT demonstrated substantial divergence with self-reported changes in clinical status and alternative outcome measures. Both MTT and SPWT can quantify walking abilities in NC. As outcome tools, SPWT demonstrated better internal responsiveness than MTT, but neither test demonstrated adequate external responsiveness. Neither test should be considered as a meaningful substitution for disease-specific measures of function.

Sexual Arousal in East Asian and Euro-Canadian Women: A Psychophysiological Study

Studies of ethnic differences in self-report measures of sexuality have shown East Asian women to be more sexually conservative and less sexually experienced than Caucasian women. There is also strong evidence supporting the notion of ethnic group differences in general measures of nonsexual psychophysiological arousal; however, there have been no previous studies exploring ethnicity and physiological sexual arousal. The objective of this study was to explore group differences in self-reported and physiological sexual arousal in Euro-Canadian and East Asian women living in Canada; we also aimed to explore the association between level of acculturation (both mainstream and heritage) and sexual arousal in East Asian women only. Seventy-five women (N=38 Euro-Canadian, N=37 East Asian) completed a battery of questionnaires and underwent psychophysiological sexual arousal testing using the vaginal photoplethysmograph. They also completed a self-report measure of subjective arousal before and after erotic stimulus exposure. All women completed the Female Sexual Function Index, Vancouver Index of Acculturation, and Sexual Beliefs and Information Questionnaire. Change in genital sexual arousal (vaginal pulse amplitude; VPA), and change in subjective sexual arousal were measured during exposure to erotic stimuli. The groups did not differ in the percent increase in VPA induced by erotic stimuli, nor was there a correlation between VPA and subjective sexual arousal. Among East Asian women alone, neither heritage nor mainstream acculturation was correlated with change in VPA. East Asian and Euro-Canadian women who show similar ratings of sexual behaviors and self-reported sexual arousal do not differ in physiological or subjective arousal induced by erotic stimuli in the laboratory.

Disability in two health care systems: Access, quality, satisfaction, and physician contacts among working-age Canadians and Americans with disabilities

Background An overarching question in health policy concerns whether the current mix of public and private health coverage in the United States can be, in one way or another, expanded to include all persons as it does in Canada. As typically high-end consumers of health care services, people with disabilities are key stakeholders to consider in this debate. The risk is that ways to cover more persons may be found only by sacrificing the quantity or quality of care on which people with disabilities so frequently depend. Yet, despite the many comparisons made of Canadian and U.S. health care, few focus directly on the needs of people with disabilities or the uninsured among them in the United States. This research is intended to address these gaps. Given this background, we compare the health care experiences of working-age uninsured and insured Americans with Canadian individuals (all of whom, insured) with a special focus on disability. Two questions for research guide our inquiry: (1) On the basis of disability severity level and health insurance status, are there differences in self-reported measures of access, utilization, satisfaction with, or quality of health care services within or between the United States and Canada? (2) After controlling covariates, when examining each level of disability severity, are there any significant differences in these measures of access, utilization, satisfaction, or quality between U.S. insured and Canadian persons? Methods Cross-sectional data from the Joint Canada/United States Survey of Health (JCUSH) are analyzed with particular attention to disability severity level (none, nonsevere, or severe) among three analytic groups of working age residents (insured Americans, uninsured Americans, and Canadians). Differences in three measures of access, one measure of satisfaction with care, one quality of care measure, and two varieties of physician contacts are compared. Multivariate methods are then used to compare the healthcare experiences of insured U.S. and Canadian persons on the basis of disability level while controlling covariates. Results In covariate-controlled comparisons of insured Americans and Canadians, we find that people with disabilities report higher levels of unmet need than do their counterparts without disabilities, with no difference in this result between the nations. Our findings on access to medications and satisfaction with care among people with disabilities are similar, suggesting worse outcomes for people with disabilities, but few differences between insured U.S. and Canadian individuals. Generally, we find higher percentages who report having a regular physician, and higher contact rates with physicians among people with disabilities than among people without them in both countries. We find no evidence that total physician contacts are restricted in Canada relative to insured Americans at any of the disability levels. Yet we do find that quality ratings are lower among Canadian respondents than among insured Americans. However, bivariate estimates on access, satisfaction, quality, and physician contacts reveal particularly poor outcomes for uninsured persons with severe disabilities in the United States. For example, almost 40% do not report having a regular physician, 65% report that they need at least one medication that they cannot afford, 45% are not satisfied with the way their care is provided, 40% rate the overall quality of their care as fair or poor, and significant reductions in contacts with two types of physicians are evident within this group as well. Conclusion Based on these results, we find evidence of disparities in health care on the basis of disability in both Canada and the United States. However, despite the fact that Canada makes health insurance coverage available to all residents, we find few significant reductions in access, satisfaction or physician contacts among Canadians with disabilities relative to their insured American counterparts. These results place a spotlight on the experiences of uninsured persons with disabilities in America and suggest further avenues for research.

Ethnic differences in the nociceptive flexion reflex (NFR)

A substantial body of literature suggests that the experience of both clinical and experimental pain differs among ethnic groups, with African Americans generally reporting greater sensitivity to chronic and experimentally induced pain when compared to non-Hispanic whites. However, no studies to date have examined nociceptive processes that may underlie these differences. The nociceptive flexion reflex (NFR) is based on the measurement of stimulus-induced spinal reflexes. Prior research suggests that the NFR threshold, or RIII response, is highly correlated with subjective pain thresholds. The current study evaluated responses to the nociceptive flexion reflex in healthy young adults from two different ethnic groups: African Americans ( n = 29) and non-Hispanic whites ( n = 28). Perceptual responses (e.g., pain ratings) as well as physiological reflex responses (i.e., biceps femoris EMG) were assessed. Significant ethnic group differences were observed for NFR reflex threshold, with African Americans producing a reflex at lower stimulation intensities relative to non-Hispanic whites. Interestingly, verbal pain ratings at NFR threshold were not significantly different between the groups, suggesting that the lower stimulation intensities required to elicit a reflex in African–American versus non-Hispanic white participants were nonetheless perceived as similar. Psychological Involvement, Positive and Negative Mood, and Rumination were correlated with NFR threshold in a pattern that was consistent across both ethnic groups. These results extend previous research on ethnic differences in self-report measures of pain by demonstrating group differences in a nociceptive muscle reflex.

Self-Reported Aggression and Impulsivity in Forensic and Non-Forensic Populations: The Role of Gender and Experience

Gender differences in aggressive behavior are traditionally seen as extremely robust. Yet, on closer inspection, the reasons for these differences appear to be incredibly complex as a wide range of moderating variables appears to influence the behaviour. Further, the effect of these variables is often gender specific. We examined aggressive beliefs and self-rated aggressive behaviour and impulsivity in forensic (115 males, 133 females at three closed prisons in the North of England) and non-forensic populations (114 males, and 122 females at the University of Leeds). Participants completed the Revised EXPAGG Questionnaire, the Buss-Perry Aggression Questionnaire, the Aggressive Acts Questionnaire and the Barratt Impulsivity Scale. Violent men and women, while more aggressive than both undergraduates and non-violent offenders, were equally likely to report their involvement in physical acts of aggression and showed similar levels of aggression and impulsivity. Previous experience of aggression, together with elevated levels of anger and impulsivity were better predictors of aggressive behavior than gender in all participants. These results suggest that gender differences in self-report measures (on cognitive, affective, and behavioral dimensions) in forensic populations may be less clear-cut than many have previously believed, particularly in the most aggressive individuals.