Jordan Silberman

The Relation Between Intelligence and Religiosity A Meta-Analysis and Some Proposed Explanations

A meta-analysis of 63 studies showed a significant negative association between intelligence and religiosity. The association was stronger for college students and the general population than for participants younger than college age; it was also stronger for religious beliefs than religious behavior. For college students and the general population, means of weighted and unweighted correlations between intelligence and the strength of religious beliefs ranged from −.20 to −.25 (mean r = −.24). Three possible interpretations were discussed. First, intelligent people are less likely to conform and, thus, are more likely to resist religious dogma. Second, intelligent people tend to adopt an analytic (as opposed to intuitive) thinking style, which has been shown to undermine religious beliefs. Third, several functions of religiosity, including compensatory control, self-regulation, self-enhancement, and secure attachment, are also conferred by intelligence. Intelligent people may therefore have less need for religious beliefs and practices.

Physician Responses to Ambiguous Patient Symptoms

AbstractOBJECTIVE: To examine how primary care physicians respond to ambiguous patient symptom presentations. DESIGN: Observational study, using thematic analysis within a large cross-sectional study employing standardized patients (SPs), to describe physician responses to ambiguous patient symptoms and patterns of physician-patient interaction. SETTING: Community-based primary care offices within a metropolitan area. PARTICIPANTS: Twenty-three primary care physicians (internists and family physicians). METHOD: Participating physicians had 2 unannounced SP visits randomly inserted into their daily practice schedules and the visits were audiotaped and transcribed. A coding system focusing on physician responses to concerned patients presenting with ambiguous symptoms was developed through an inductive process. Thematic analyses were then applied to coded data. RESULTS: Physicians’ responses to ambiguous symptoms were categorized into 2 primary patterns: high partnering (HP) and usual care (UC). HP was characterized by greater responsiveness to patients’ expression of concern, positivity, sensitivity to patients’ clues about life circumstances, greater acknowledgment of symptom ambiguity, and solicitation of patients’ perspectives on their problems. UC was characterized by denial of ambiguity and less inclusion of patients’ perspectives on their symptoms. Neither HP physicians nor UC physicians actively included patients in treatment planning. CONCLUSIONS: Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes.

Factors Affecting Physicians' Responses to Patients' Requests for Antidepressants : Focus Group Study

BackgroundThe ways in which patients’ requests for antidepressants affect physicians’ prescribing behavior are poorly understood.ObjectiveTo describe physicians’ affective and cognitive responses to standardized patients’ (SPs) requests for antidepressants, as well as the attitudinal and contextual factors influencing prescribing behavior.DesignFocus group interviews and brief demographic questionnaires.ParticipantsTwenty-two primary care physicians in 6 focus groups; all had participated in a prior RCT of the influence of patients’ requests on physicians’ prescribing.MeasurementsIterative review of interview transcripts, involving qualitative coding and thematic analysis.ResultsPhysicians participating in the focus groups were frequently unaware of and denied the degree to which their thinking was biased by patient requests, but were able to recognize such biases after facilitated reflection. Common affective responses included annoyance and empathy. Common cognitive reactions resulted in further diagnostic inquiry or in acquiescing to the patient’s demands to save time or build the patient–clinician relationship. Patients’ requests for medication prompted the participants to err on the side of overtreating versus careful review of clinical indications. Lack of time and participants’ attitudes—toward the role of the patient and the pharmaceutical ads—also influenced their responses, prompting them to interpret patient requests as diagnostic clues or opportunities for efficiency.ConclusionsThis study provides a taxonomy of affective and cognitive responses to patients’ requests for medications and the underlying attitudes and contextual factors influencing them. Improved capacity for moment-to-moment self-awareness during clinical reasoning processes may increase the appropriateness of prescribing.

Recall-Promoting Physician Behaviors in Primary Care

BACKGROUNDEffective treatments can be rendered useless by poor patient recall of treatment instructions. Studies suggest that patients forget a great deal of important information and that recall can be increased through recall-promoting behaviors (RPBs) like repetition or summarization.OBJECTIVETo assess how frequently RPBs are used in primary care, and to reveal how they might be applied more effectively.DESIGNRecordings of 49 unannounced standardized patient (SP) visits were obtained using hidden audiorecorders. All SPs presented with typical gastroesophageal reflux disease symptoms. Transcripts were coded for treatment recommendations and RPBs.PARTICIPANTSForty-nine primary care physicians.RESULTSOf 1,140 RPBs, 53.7% were repetitions, 28.2% were communication of the rationale for a treatment, 11.7% were categorizations of treatments (i.e., stating that a treatment could be placed into a treatment category, such as medication-related or lifestyle-related categories), and 3.8% were emphasis of a recommendation’s importance. Physicians varied substantially in their use of most RPBs, although no physicians summarized or asked patients to restate recommendations. The number of RPBs was positively correlated with visit length.CONCLUSIONSPrimary care physicians apply most RPBs inconsistently, do not utilize several RPBs that are particularly helpful, and may use RPBs inefficiently. Simple principles guiding RPB use may help physicians apply these communication tools more effectively.

Finding and Fostering the Positive in Relationships Positive Interventions in Couples Therapy

Research of positive psychology interventions (PPIs) has expanded dramatically in recent years, and many novel PPIs may be useful in couples therapy. The present work identifies, summarizes, and suggests adaptations of PPIs that may improve couples therapy outcomes. Each intervention is presented as part of a larger organizational framework that may help couples therapists determine how and when each intervention can be effectively applied. Finally, a case illustration demonstrates how these methods can complement traditional therapeutic approaches.

The Impact of an Online Disease Management Program on Medical Costs Among Health Plan Members

Purpose. This study evaluated the economic impact of an online disease management program within a broader population health management strategy. Design. A retrospective, quasi-experimental, cohort design evaluated program participants and a matched cohort of nonparticipants on 2003–2007 claims data in a mixed model. Sample. The study was conducted through Highmark Inc, Blue Cross Blue Shield, covering 4.8 million members in five regions of Pennsylvania. Overall, 413 online self-management program participants were compared with a matched cohort of 360 nonparticipants. Measures. The costs and claims data were measured per person per calendar year. Total payments were aggregated from inpatient, outpatient, professional services, and pharmacy payments. The costs of the online program were estimated on a per-participant basis. All dollars were adjusted to 2008 values. Intervention. The online intervention, implemented in 2006, was a commercially available, tailored program for chronic condition self management, nested within the Blues on CallSM condition management strategy. Analysis. General linear modeling (with covariate adjustment) was used. Data trends were also explored using second-order polynomial regressions. Results. Health care costs per person per year were

Reductions in employee productivity impairment observed after implementation of web-based worksite health promotion programs.

757 less than predicted for participants relative to matched nonparticipants, yielding a return on investment of

The Avalanche Hypothesis and Compression of Morbidity: Testing Assumptions through Cohort-Sequential Analysis.

9.89 for every dollar spent on the program. Conclusions. This online intervention showed a favorable and cost-effective impact on health care cost.

Unpriming or strategizing? A critique of Sparrow and Wegner.

Objective: To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Methods: Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Results: Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. Conclusion: The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

Self‐monitoring in clinical practice: A challenge for medical educators

Background The compression of morbidity model posits a breakpoint in the adult lifespan that separates an initial period of relative health from a subsequent period of ever increasing morbidity. Researchers often assume that such a breakpoint exists; however, this assumption is hitherto untested. Purpose To test the assumption that a breakpoint exists—which we term a morbidity tipping point—separating a period of relative health from a subsequent deterioration in health status. An analogous tipping point for healthcare costs was also investigated. Methods Four years of adults’ (N = 55,550) morbidity and costs data were retrospectively analyzed. Data were collected in Pittsburgh, PA between 2006 and 2009; analyses were performed in Rochester, NY and Ann Arbor, MI in 2012 and 2013. Cohort-sequential and hockey stick regression models were used to characterize long-term trajectories and tipping points, respectively, for both morbidity and costs. Results Morbidity increased exponentially with age (P<.001). A morbidity tipping point was observed at age 45.5 (95% CI, 41.3-49.7). An exponential trajectory was also observed for costs (P<.001), with a costs tipping point occurring at age 39.5 (95% CI, 32.4-46.6). Following their respective tipping points, both morbidity and costs increased substantially (Ps<.001). Conclusions Findings support the existence of a morbidity tipping point, confirming an important but untested assumption. This tipping point, however, may occur earlier in the lifespan than is widely assumed. An “avalanche of morbidity” occurred after the morbidity tipping point—an ever increasing rate of morbidity progression. For costs, an analogous tipping point and “avalanche” were observed. The time point at which costs began to increase substantially occurred approximately 6 years before health status began to deteriorate.