The Child Hospital Consumer Assessment of Healthcare Providers and Systems (C-HCAHPS) survey was developed to measure satisfaction levels of pediatric inpatients' caregivers. Studies in adults have revealed that certain demographic groups (people of color or who are multiracial and people with public insurance) respond to surveys at decreased rates, contributing to nonresponse bias. Our primary goal was to determine if results from the C-HCAHPS survey accurately reflect the intended population or reveal evidence of nonresponse bias. Our secondary goal was to examine whether demographic or clinical factors were associated with increased satisfaction levels. METHODS: This was a retrospective cohort study of responses (n 5 421) to the C-HCAHPS survey of patients admitted to a tertiary-care pediatric hospital between March 2016 and March 2017. Respondent demographic information was compared with that of all hospital admissions over the same time frame. Satisfaction was defined as "top-box" scores for questions on overall rating and willingness to recommend the hospital. RESULTS: Caregivers returning surveys were more likely to be white, non-Hispanic, and privately insured (P , .001). Caregivers with the shortest emergency department wait times were more likely to assign top-box scores for global rating (P 5 .025). We found no differences in satisfaction between race and/or ethnicity, length of stay, insurance payer, or total cost. CONCLUSIONS: Caregivers who identified with underrepresented minority groups and those without private insurance were less likely to return surveys. Among the surveys received, short emergency department wait time and older age were the only factors measured that were associated with higher satisfaction. Efforts to increase patient satisfaction on the basis of satisfaction scores may exacerbate existing disparities in health care.

Background Lichen planus (LP) is a chronic inflammatory mucocutaneous disease that commonly affects the oral cavity. Previous reports have suggested a possible association between LP and thyroid gland diseases (TGDs). The purpose of this study was to investigate possible associations between oral lichen planus (OLP) and TGDs. Methods Patients diagnosed with OLP, both clinically and histopathologically ( N = 102), were classified according to clinical course (symptomatic/asymptomatic), type (reticular/plaque, atrophic and erosive) and location of lesions. Data on TGDs was compared to age- and gender-matched controls ( N = 102) without OLP. Diagnosis of any type of TGD and related medication for study and control groups was recorded from the medical files provided by patients’ physicians. Statistical analysis used Student’s t-test and Fisher’s exact test; significance was set at p < 0.05. Results TGDs (all), hypothyroidism and related medications were found in 16.6, 12.7 and 12.7% of patients with OLP, respectively. These findings were similar to the control group: TGDs (all) -15.7%, hypothyroidism - 9.8% and thyroid gland disease-related medication - 9.8% ( p > 0.05). No significant associations were found between different characteristics of OLP and hypothyroidism or other TGD ( p > 0.05). Conclusions We found no significant associations between the co-existence of OLP and TGD or related-medications. Our findings are in agreement with some of the previously published similar studies but in controversy with others. Further well-designed, multicenter studies with large groups of patients and controls may help to establish the nature of the associations between OLP and TGDs.

PurposeThe potential contribution of mindfulness to stress responses has not been fully described. The parasympathetic nervous system (PNS) can modulate stress responses and facilitate recovery from stressful events. Low levels of heart rate variability (HRV), a measure of the PNS, and suppressed vagal responses after stress tasks have been associated with increased morbidity, whereas vagal rebound has been related to better psychological adjustment and health outcomes. We hypothesized that dispositional mindfulness may facilitate recovery from a stressful laboratory task as indexed by greater increases in HRV once the stressor is complete. MethodsPre-intervention measures of mindfulness (Five Facet Mindfulness Questionnaire; FFMQ), and acute stress (Trier Social Stress Test; TSST) were available for 5 of 6 waves of an obese adult population recruited for a diet and lifestyle study. From the TSST, the mean respiratory sinus arrhythmia (RSA), a key HRV measure, was calculated over 5 minutes at 3 time points: resting, acute stress (speech task), and recovery. HRV was calculated for the stress task (stress task-resting) and for recovery (recoverystress task). ResultsOf 154 participants from 5 of 6 waves of enrollment, 139 had complete data and were eligible for this sub-study. Mindfulness measures were not significantly associated with the average change in HRV between baseline and the stress task. In univariate analysis, higher scores for the Observing subscale of the FFMQ were associated with higher vagal rebound after the stress task (coefficient=0.32, 95% CI: 0.03, 0.62; p=0.029). Adjustment for age and gender resulted in a reduced coefficient=0.23 (CI: -0.06, 0.51; p=0.12). ConclusionMindfulness may contribute to recovery of the PNS from stressful events. Although adjustment for age and gender reduced the estimated association, it remained potentially clinically significant even though not statistically significant; further data may clarify this association and address whether changes in mindfulness with training enhance PNS recovery from stress.

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