Chronic Stress最新文献

{"title":"An Intravenous Injection of Reelin Rescues Endogenous Reelin Expression and Epithelial Cell Apoptosis in the Small Intestine Following Chronic Stress.","authors":"Ciara S Halvorson, Carla Liria Sánchez-Lafuente, Brady S Reive, Lara S Solomons, Josh Allen, Lisa E Kalynchuk, Hector J Caruncho","doi":"10.1177/24705470251381456","DOIUrl":"10.1177/24705470251381456","url":null,"abstract":"<p><p>Chronic stress disrupts the integrity of the gut environment, including leaking of the intestinal epithelium. Reelin, an extracellular matrix protein, is released from cells of the <i>lamina propria</i> and promotes epithelial cell proliferation and migration up the crypt-villus axis to facilitate renewal of the gut lining. In the present study, we evaluated Reelin expression and apoptosis in the small intestine of Long Evan's rats treated with recombinant Reelin (3 µg) or vehicle following 3 weeks of daily corticosterone (40 mg/kg/day) or vehicle injections. We show that Reelin- and cleaved caspase-3- immunoreactive cells are diminished in the <i>lamina propria</i> or epithelial cells of the gut lining following chronic stress (∼ 50% and 55%, respectively), and that a single injection of 3 µg of Reelin delivered intravenously can reverse these parameters. We also found Reelin cell counts in the small intestine did not correlate to counts in the hippocampus regardless of exposure to chronic stress or Reelin treatment. Our results suggest that Reelin may serve a protective function over gut barrier integrity through the restoration of epithelial cell turnover, and that Reelin may have a role in reversing chronic stress-induced changes to the gut environment.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251381456"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do People Seeking Care for Musculoskeletal Symptoms Experience Greater Agency and Better Experience Based on Written Information About Their Illness?","authors":"Emily H Jaarsma, Ali Azarpey, Drew Aronoff, David Ring, Amin Razi","doi":"10.1177/24705470251382668","DOIUrl":"10.1177/24705470251382668","url":null,"abstract":"<p><strong>Objectives: </strong>Current patient-facing health information may unintentionally reinforce unhelpful and less adaptive mindsets regarding musculoskeletal symptoms. This prospective randomized trial evaluated the impact of psychologically-informed educational material, explicitly designed to promote healthier interpretations of bodily sensations according to cognitive science principles, on patient experience when compared to standard professional society materials.</p><p><strong>Methods: </strong>In this trial, 133 adults presenting to an upper extremity specialist with one of eight common non-traumatic musculoskeletal conditions were randomly assigned to review health information produced by either: 1) a professional musculoskeletal society or 2) revised material created by the authors and psychologist collaborators. Participants completed surveys containing validated measures assessing personal health agency (PAM-13), perceived clinician empathy (JSPPPE) and emotional response to the material.</p><p><strong>Results: </strong>There were no significant differences based on the type of material reviewed. However, on multivariable analysis, participants diagnosed with rotator cuff tendinopathy, ganglion cyst, or carpal and cubital tunnel syndrome reported more negative emotional responses compared to those with lateral epicondylitis, regardless of the type of written material reviewed.</p><p><strong>Conclusions: </strong>Cognitively-informed musculoskeletal health information was acceptable to patients but did not yield measurable improvements in emotional response, agency, or perceived empathy when compared to standard material. During the visit, diagnosis-specific factors may influence patient reactions more than information framing.</p><p><strong>Practice implications: </strong>Patients find clear, accessible material designed to cultivate the healthiest possible interpretation of bodily sensations acceptable and non-distressing. Future interventions should explore diagnosis-specific tailoring of information or repeated exposure to impact outcomes.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251382668"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Hardiness and Burnout in the Context of Post-Traumatic Stress Disorder Among South African First Responders.","authors":"Anita Padmanabhanunni, Tyrone B Pretorius","doi":"10.1177/24705470251373021","DOIUrl":"10.1177/24705470251373021","url":null,"abstract":"<p><p>Abstract.</p><p><strong>Background: </strong>Exposure to traumatic events is an inherent aspect of first responder work, placing individuals at heightened risk for post-traumatic stress disorder (PTSD) and burnout. This study examined the relationship between PTSD symptoms and two key dimensions of burnout-emotional exhaustion and depersonalization-among South African first responders, with a particular focus on the mediating role of psychological hardiness.</p><p><strong>Methods: </strong>A total of 429 participants (police officers and paramedics) completed the PTSD Checklist for DSM-5 (PCL-5), the Short Hardiness Scale, and the Emotional Exhaustion and Depersonalization subscales of the Maslach Burnout Inventory.</p><p><strong>Results: </strong>Path analysis revealed that the control and challenge dimensions of hardiness partially mediated the relationship between PTSD and burnout. While higher control was associated with lower burnout, higher challenge was unexpectedly associated with greater burnout. This suggests that different hardiness dimensions play distinct roles in the PTSD-burnout relationship. In contrast, the commitment dimension did not mediate this relationship.</p><p><strong>Conclusion: </strong>These findings highlight the nuanced and multidimensional role of hardiness in trauma-exposed populations and underscore the importance of resilience-focused interventions that enhance perceived control and constructive engagement with challenge to mitigate burnout in high-risk occupational groups.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251373021"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health in Gaza: The Need for Culturally and Contextually Responsive Models.","authors":"Dominikus David Biondi Situmorang","doi":"10.1177/24705470251351914","DOIUrl":"10.1177/24705470251351914","url":null,"abstract":"","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251351914"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent Classes of Adolescent Trauma Exposure, Posttraumatic Stress Disorder Symptoms, and Substance Use Predict Clinical Diagnoses at 12-Month Follow-Up.","authors":"John Leri, Josh M Cisler, Shaunna L Clark, Cody G Dodd, Saman Siddiqui, Leslie Taylor, Alexa Ayala, Sunita Stewart, Robyn Richmond, Jeffrey D Shahidullah, Justin F Rousseau, John M Hettema, D Jeffrey Newport, Karen D Wagner, Charles B Nemeroff","doi":"10.1177/24705470251350144","DOIUrl":"10.1177/24705470251350144","url":null,"abstract":"<p><strong>Background: </strong>Trauma exposure, posttraumatic stress disorder (PTSD), and substance use commonly co-occur among youth. Identifying specific subgroups of youth based on unique constellations across these domains may provide a novel way to identify and target youth at prospective risk for specific types of negative clinical outcomes.</p><p><strong>Methods: </strong>Trauma exposed youth completed structured clinical assessments as part of a longitudinal study (<i>N</i> = 1826; ages 13-21). Latent class analyses identified distinct subgroups of youth based on lifetime trauma histories and current PTSD symptom and substance use inventories collected at the baseline study visit. Logistic regression analyses determined if the latent classes were associated with elevated risk for PTSD or substance use disorder (SUD) diagnoses as the 12-month follow-up study visit (<i>n</i> = 1029). Logistic regression models controlled for baseline clinical characteristics and demographic factors in a stepwise fashion to elucidate if latent classes carried conferred risk beyond established risk factors. Sensitivity analyses included latent profile analyses and predictive modeling with an alternative number of latent classes.</p><p><strong>Results: </strong>Four latent classes were identified which differentiated participants based on the type of trauma exposure, the number of PTSD symptoms endorsed, and the propensity to be engaged in polysubstance use. Latent classes which were characterized by exposure to interpersonal violence at the baseline study visit had an elevated risk of PTSD 12 months later, relative to the latent class which was principally exposed to incidental trauma (odds ratios ranged from 4.11-5.88). Likewise, a distinct latent class which was characterized by poly-substance use at the baseline study visit had an elevated risk of SUD diagnoses at the 12-month follow-up (odds ratio = 2.48). The findings were robust to sensitivity analyses.</p><p><strong>Conclusion: </strong>These results highlight nuanced patterns of co-occurrences between trauma exposure, PTSD symptomatology, and substance use that differentiate unique sub-groups of youth at varying degrees of risk for negative clinical outcomes one year later. Evaluating the co-expression of trauma and psychopathology inventories, as opposed to only assessing the summative epidemiological indices of these constructs, may help identify adolescents who are most at risk for sustaining deleterious health outcomes.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251350144"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Subjective Well-Being Through EMDR Therapy among PTSD Patients in Jordan: A Quasi-Experimental Study.","authors":"Rabia H Haddad, Malena M Price, Razan Haddad, Ashraf J Abuejheisheh, Younis H Abuhashish, Ayman M Hamdan-Mansour","doi":"10.1177/24705470251352627","DOIUrl":"10.1177/24705470251352627","url":null,"abstract":"<p><strong>Background: </strong>Numerous man-made and naturally occurring incidents cause human suffering, both psychologically and mentally. Such circumstances endanger people's emotional, physical, and social well-being if left untreated or if appropriate intervention is delayed. This trial examines the effectiveness of an Eye Movement Desensitization and Reprocessing (EMDR) intervention on improving the subjective well-being of patients with post-traumatic stress disorder (PTSD) in Jordan.</p><p><strong>Methods: </strong>The current trial employed the quasi-experimental, interrupted time series design. This includes measuring the subjective well-being (SWB) three times: once before intervention (pre-test) and twice after the intervention (post-tests), including immediately and one-month follow-ups for both the intervention and control group. 70 patients (35 patients for each group) were recruited from a specialized psychiatric trauma healing center in Jordan. The primary outcome variable was measured using the World Health Organization- Five Well-Being Index (WHO-5).</p><p><strong>Results: </strong>The statistical analysis of repeated measures using ANCOVA revealed significant differences across all time points within subjects [<i>F (</i> _{1, 56)} = 5.18, <i>p</i> = .027]. The covariate effect was not controlled and showed statistically significant differences in the SWB across all time points in both interventional and control groups (between subjects) (<i>F</i> _1,56 = 12.41,<i>p</i> = .001). There were no statistical differences in the total mean score of SWB correlated with sociodemographics and health-related factors.</p><p><strong>Conclusion: </strong>The results suggest that EMDR may be an effective, pragmatic, and acceptable intervention for increasing SWB in patients with PTSD in Jordan. Findings support the continued investment in and adoption of EMDR among participants affected by trauma in the Arab World.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251352627"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Stroke PTSD: The Protective Role of CCR5-Δ32 Polymorphism.","authors":"Hen Hallevi, Oren Tene, Jeremy Molad, Aviva Alpernas, Dana Niry, Saly Usher, Lital Feldinger, Estelle Seyman, Einor Ben Assayag","doi":"10.1177/24705470251345245","DOIUrl":"10.1177/24705470251345245","url":null,"abstract":"<p><strong>Background: </strong>Up to 25% of stroke survivors develop post-traumatic stress disorder (PTSD) symptoms, yet the predisposing factors remain largely unknown. The C-C-Chemokine receptor-5 gene (CCR5) loss-of-function mutation (LOFM, CCR5-Δ32) has been identified as a protective factor against post-stroke depression. This study investigates whether CCR5-Δ32 also confers protection against post-stroke PTSD, in conjunction with two additional polymorphisms: the 5-HTTLPR in the serotonin transporter gene and the BDNF Val66Met variant.</p><p><strong>Methods: </strong>We conducted a prospective analysis of 432 survivors of first-ever mild-to-moderate ischemic stroke, assessing PTSD symptomatology at 6, 12, and 24 months post-stroke. Genetic screening for CCR5-Δ32 status and PTSD symptom data were available for these participants.</p><p><strong>Results: </strong>PTSD was diagnosed in 48 participants (11%) within the first year post-stroke. CCR5-Δ32 carriers exhibited significantly fewer PTSD symptoms at 6, 12, and 24 months compared to non-carriers (<i>P</i> < .001, <i>P</i> < .001, <i>P</i> = .02, respectively), with sustained improvement over time. Multivariate analysis confirmed that CCR5-Δ32 status was independently associated with lower PTSD risk after adjusting for relevant confounders. Furthermore, individuals with a maladaptive coping style who were non-carriers of CCR5-Δ32 exhibited a higher risk of PTSD development (HR = 4.03; 95% CI, 1.95-6.32, <i>P</i> < .001). Carriers of both 5-HTTLPR-L and CCR5-Δ32 had significantly lower PTSD symptoms at 6 and 12 months post-stroke (<i>P</i> = .026, <i>P</i> = .05), as did carriers of both the BDNF Val allele and CCR5-Δ32 at 6 months (<i>P</i> = .022).</p><p><strong>Conclusions: </strong>Our findings suggest that CCR5-Δ32 carriers are less likely to develop PTSD symptoms following stroke, including individuals with pre-existing maladaptive coping styles. These results highlight a potential genetic target for future intervention strategies, with CCR5 blockade emerging as a promising therapeutic avenue for post-stroke PTSD prevention.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251345245"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating Individual Characteristics Associated with Suicidal Ideations, Plans, and Attempts among low-Income Veterans.","authors":"Jack Tsai, Jie Liang, Vahed Maroufy","doi":"10.1177/24705470251348749","DOIUrl":"10.1177/24705470251348749","url":null,"abstract":"<p><strong>Background: </strong>Low-income veterans are a group that are at high risk for suicidal behaviors and require clinical attention and research.</p><p><strong>Methods: </strong>This brief report analyzed data from a nationally representative sample of 985 low-income veterans participating in the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study in 2021. The lifetime prevalence and correlates of three levels of suicidal behaviors were analyzed, including suicidal ideation (SI), having a suicidal plan (SP), and making a suicide attempt (SA).</p><p><strong>Results: </strong>In the sample, 17.6% reported any SI, 7.0% reported any SP, and 4.5% reported any SA. Multivariable analyses revealed that compared to veterans who only reported SI, those who reported SP had overall lower mental health functioning scores (aOR = 0.97, 95% CI = 0.95-0.99). Compared to veterans who reported only SP, those who reported SA were two times more likely to be unmarried (aOR = 2.38, 95% = 1.09-5.30).</p><p><strong>Conclusion: </strong>These findings suggest a few factors may be driving differences between veterans who engage in different levels of suicidal behaviors, and these factors may be important treatment targets.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251348749"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Past Adjustment of Unhelpful Thinking Associated with Greater Cognitive Flexibility Among People Seeking Musculoskeletal Specialty Care?","authors":"Juan Pablo Flanagan, Jefferson Hunter, Niels Brinkman, David Ring, Aydin Azarpey, Amin Razi","doi":"10.1177/24705470251342887","DOIUrl":"10.1177/24705470251342887","url":null,"abstract":"<p><strong>Background: </strong>Unhelpful thoughts are associated with greater levels of pain intensity and incapability. Difficulty cultivating a healthier inner narrative regarding sensations is associated with lower tolerance of uncertainty and lower cognitive flexibility. Among people seeking musculoskeletal specialty care we analyzed associations between mindset factors and awareness of prior experiences adjusting unhelpful thinking and trust in the clinician.</p><p><strong>Methods: </strong>In a cross-sectional study, 163 adults completed measures of mindsets (intolerance of uncertainty, cognitive flexibility, and distress and unhelpful thoughts regarding sensations), awareness of prior experiences adjusting unhelpful thinking, and trust and experiences with clinicians. We measured associations between mindsets (both individually and in statistical clusters) awareness of prior experiences and trust in the clinician.</p><p><strong>Results: </strong>Both awareness of prior experiences adjusting thinking and trust in the clinician were modestly associated with greater cognitive flexibility in bivariate analysis, but neither were associated with statistical groupings with healthier mindsets identified in cluster analysis.</p><p><strong>Conclusion: </strong>The modest associations with cognitive flexibility suggest that both the inability to describe a past experience rethinking one's interpretation of bodily sensations, as well as difficulty establishing trust with the clinician, might signal unhealthy fusion with unhelpful thoughts that are known correlates of greater levels of discomfort and incapability.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251342887"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care Utilization and Measures of the Subjective.","authors":"Alexander Drost, Nadia Azib, Ali Azarpey, Philippe Dentino, Diego Tijerina, David Ring, Amin Razi","doi":"10.1177/24705470251339281","DOIUrl":"https://doi.org/10.1177/24705470251339281","url":null,"abstract":"<p><strong>Background: </strong>In musculoskeletal health and care, visits, tests and treatments are often optional. There is some evidence that levels of utilization can be associated with subjective aspects of the illness, mindsets (thoughts and feelings about sensations) and stressful circumstances in particular. In a cross-sectional study of people seeking musculoskeletal specialty care, we addressed two questions: 1) Is there a difference in planned care utilization based on statistical groupings of measures of the subjective aspects of the illness? And 2) Are there any factors specifically associated with scheduling a return visit?</p><p><strong>Methods: </strong>One hundred thirty-five patients seeking musculoskeletal specialty care completed measures of subjective patient factors including unhelpful thoughts and feelings of distress regarding symptoms, personal health agency, social health, and trust and experience with the clinician. Plans for a return visit, an injection, an imaging test, or referral to a physical therapist were documented. Cluster analysis was utilized to identify statistical groupings of scores on measures of subjective personal factors. Bivariate and logistic regression analyses evaluated factors associated with planned care utilization.</p><p><strong>Results: </strong>We identified four statistical groupings of subjective factors through Cluster analysis: Group 1 had low trust, agency, and social health; Group 2 had low social health and high distress; Group 3 had healthy mindset and circumstances; and Group 4 had the highest social health and relatively healthy levels of the other subjective measures. Furthermore, no difference observed between statistical groups of the subjective regarding planned care utilization. Multivariable analysis revealed an association between scheduling a return visit and lower extremity clinicians (RC = 0.3; 95% CI 0.05 to 0.5; P-value, 0.02) but not with statistical groupings of measures of personal factors.</p><p><strong>Conclusion: </strong>The finding that statistical groupings of patient personal factors were not associated with planned utilization of visits, tests, or treatments is inconsistent with other evidence linking mindsets actual utilization. A better understanding of sources of variation in planned and actual utilization is needed to help limit unwarranted variation and enhance effective use of resources.</p>","PeriodicalId":52315,"journal":{"name":"Chronic Stress","volume":"9 ","pages":"24705470251339281"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}