Opioid ‘Deaths of Despair’ Don’t Explain Mortality Gap

MedicalResearch.com Interview with:

Arline T. Geronimus Sc.D Professor, Health Behavior and Health Education School of Public Health Research Professor Population Studies Center Institute for Social Research University of Michigan Member, National Academy of Medicine

Dr. Geronimus

Arline T. Geronimus Sc.D
Professor, Health Behavior and Health Education
School of Public Health
Research Professor
Population Studies Center
Institute for Social Research
University of Michigan
Member, National Academy of Medicine 

MedicalResearch.com: What is the background for this study?

Response: The gap in life expectancy between less and more educated Americans grew over the last 30 years, a deeply troubling fact. We are alone among western nations in these trends. We aimed to determine what causes of death account for this growing educational gap in life expectancy and whether the gap has continued to grow in the most recent years.

Disturbingly, we found the educational gap in life expectancy has continued to grow.

Why? A common theory is that this growing inequality is due to the opioid epidemic. Some even speculate that the less educated are dying from a composite of what they call “deaths of despair” – opioid and other drug overdose, suicide and alcoholic liver disease – with the theory being that as less educated and working class Americans have faced job loss and stagnating wages, they experience hopelessness and despair and turn to drugs, alcohol, or even suicide to ease or end their pain and feelings of hopelessness.

However, while opioid, suicide and alcoholic liver disease deaths have increased among white youth and young adults and is cause for concern, this does not imply that these deaths should be grouped together as “deaths of despair” (DOD) or that they explain the growing educational gaps in life expectancy across all groups – men, women, whites, blacks, or older as well as younger adults.

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Despite Large Numbers of Female Gynecologic Surgeons, Gender Disparities and Harassment Persist

MedicalResearch.com – Responses

Marina Stasenko, MD Memorial Sloan Kettering Cancer Center

Dr. Stasenko
Photo: MSKCC

Marina Stasenko, MD
Memorial Sloan Kettering Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sexual harassment is a form of discrimination that includes gender harassment, unwanted sexual attention, and sexual coercion. A recent report in Fortune magazine noted that over half of US women have experienced sexual harassment at some point in their lives. Until recently, much of the conversation about sexual harassment in the workplace has been relegated to private discussions behind closed doors. However, the MeToo movement has shined a spotlight on the pervasive nature of sexual harassment in various fields, like media and business world. Although there are more female physicians in practice today than ever before, with women accounting for over 50% of young physicians, sexual harassment and gender disparities continue to plague the field of medicine.

Despite the large female representation, gynecologic oncology is not immune from gender disparities. The Society of Gynecologic Oncology is a professional organization of over 2000 physicians, scientists, allied health professionals, nurses, and patient advocates dedicated to the care of patients with gynecologic cancer. As of 2015, 46% of members of the SGO were women, and that number is steadily growing. SGO leadership is also increasingly female – with 2 of the last 3 presidents being women.

Despite the large female representation, gynecologic oncology is not immune from gender disparities. The 2015 SGO practice survey noted that while 22% of male Gynecologic Oncologists held the rank of professor, only 11% of their female counterparts held the title. They also noted that the mean annual salary for male physicians was nearly 150,000$ greater than salary for female physicians.

Given the fact that there is little objective data on sexual harassment in gynecologic oncology, the objective of our study was to evaluate perceptions of sexual harassment and gender disparities among physician members of the Society of Gynecologic Oncology.

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Neurology Residents Learn to Identify Physician Burnout Through Simulation

MedicalResearch.com Interview with:
Dr. Rebecca Stainman
Dr. Arielle Kurzweil MD
Adult Neurology Program Director
New York University School of Medicine
NYU Langone Health

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Physician burnout is prevalent. Neurologists have among the highest burnout rates, ranked third among specialties in a 2011 study, and over half of US Neurologists report at least 1 symptom of burnout in a 2016 survey.  Efforts to address burnout in training programs have mostly been aimed at implementing wellness curricula and offering mental health resources.

Training neurology residents to effectively identify, address, and help impaired colleagues is equally crucial in these efforts, yet there is a paucity of literature on this topic. We used simulation as a means of addressing this topic, via identifying and addressing an impaired colleague through an objective structured clinical examination (OSCE).  Continue reading

Open Communication Linked to Lower Hospital Mortality

MedicalResearch.com Interview with:
Veronica Toffolutti PhD

Postdoctoral researcher working with Professor David Stuckler
Department of Sociology
Bocconi University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Openness has been linked with better patient safety and better understanding of patients’ care goals. In addition, more open environments appear to be linked with positively ranked quality of teamwork, which in turns lead to better health care.

Yet if the expected benefits are to be achieved, it is necessary to show that greater openness actually corresponds to improvements in performance or lower mortality rates. To the best of our knowledge our is the first study to show an association between hospital mortality and openness and more precisely one point increase in the standardized openness score leads to a decrease of 6.48% in the hospital mortality rates. With the term openness we refer to an environment in which communication among patients, staff members and managers is open and transparent.  Continue reading

What Makes Academic Physicians Satisfied With Their Job?

MedicalResearch.com Interview with:

Arabella L. Simpkin,  MD, MMScAssociate Director, Center for Educational Innovation and Scholarship, MGHAssociate Program Director, Education and Curriculum, Internal Medicine Residency, MGHInstructor in Medicine, Harvard Medical SchoolBoston, MA 02114

Dr. Simpkin

Arabella L. Simpkin,  MD, MMSc
Associate Director, Center for Educational Innovation and Scholarship, MGH
Associate Program Director, Education and Curriculum, Internal Medicine Residency, MGH
Instructor in Medicine, Harvard Medical School
Boston, MA 02114

MedicalResearch.com: What is the background for this study?

Response: The academic health care environment has changed in unprecedented ways over several decades, with mounting evidence that faculty are becoming increasingly more unhappy, dissatisfied, and burnt out in their work. Concern for faculty wellbeing is high, with much speculation about causes of burnout. Comprehending what affects satisfaction at work in academic health care centers is critically important to stem this epidemic of discontent. For physicians, satisfaction has been reported to be associated with quality of care delivered, particularly as measured by patient satisfaction; faculty retention and job satisfaction are intricately linked, with dissatisfied physicians more likely to leave the profession and to discourage others from entering.

Other industries that have suffered similar rises in employee discontent have found that demonstration of respect is the most important leadership behavior in improving employees satisfaction. To our knowledge this factor has not been looked at in healthcare professionals. To address this gap, we sought to determine key variables influencing satisfaction at work for faculty in a large academic medical center in the United States.

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Unhealthy, Binge Behaviors in College Students Disrupts Brain Chemistry

MedicalResearch.com Interview with:

Lina Begdache, PhD, RDN, CDN, CNS-S, FANDAssistant ProfessorHealth and Wellness Studies Department GW 15Decker School of NursingBinghamton University

Dr. Begdache

Lina Begdache, PhD, RDN, CDN, CNS-S, FAND
Assistant Professor
Health and Wellness Studies Department GW 15
Decker School of Nursing
Binghamton University 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: College students engage in activities such as binge drinking, abuse of ADHD medications as “study drugs” or use of illicit drugs during a critical brain developmental window that supports maturation of the brain (the prefrontal cortex) necessary for emotional control, cognitive functions and regulation of impulsive behaviors. These activities not only affect brain function, thus mental health and cognitive functions, but may dampen brain development with potential long-lasting effects.

As for findings, we were able to identify neurobehavioral patterns that associate with mental wellbeing and mental distress in young adults. Based on evidence from the literature, we constructed conceptual models that describe how one behavior may lead to another until virtuous or vicious cycles set-in.  Continue reading

Medical Interns Spend 87 percent of Their Work Time Away From Patients

MedicalResearch.com Interview with:

Krisda Chaiyachati, MD, MPH, MSHPAssistant Professor , Medicine, Perelman School of MedicineClinical Innovation Manager, Penn's Center for Health Care InnovationPerelman School of MedicineMedical Director, Penn Medicine's FirstCall Virtual Care

Dr. Chaiyachati

Krisda Chaiyachati, MD, MPH, MSHP
Assistant Professor
Medicine, Perelman School of Medicine
Clinical Innovation Manager
Penn’s Center for Health Care Innovation
Perelman School of Medicine
Medical Director, Penn Medicine’s FirstCall Virtual Care  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The United States spends more than $12 billion annually on training young doctors who have rates of burnout and depression at an alarmingly high rate. Yet, we have limited evidence as to what they are doing while training in the hospital. We sought to glimpse into how their day is spent. In the largest study to date, we observed 80 first-year internal medicine physicians (“interns”) for nearly 2200 hours across 194 work shifts at 6 different sites. Our research sought to understand what medical residents did by categorizing training activities into themes such as time spent in education or patient care.  Continue reading

Formal Education Not Enough To Teach Effective Patient Handoffs Among Medical Residents

MedicalResearch.com Interview with:

Nicholas A. Rattray, Ph.D.Research Scientist/InvestigatorVA HSR&D Center for Health Information and CommunicationImplementation Core, Precision Monitoring to Transform Care (PRISM) QUERIRichard L. Roudebush Veterans Affairs Medical CenterIndiana University Center for Health Services & Outcomes ResearchRegenstrief Institute, Inc.Indianapolis, Indiana

Dr. Rattray

Nicholas A. Rattray, Ph.D.
Research Scientist/Investigator
VA HSR&D Center for Health Information and Communication
Implementation Core, Precision Monitoring to Transform Care (PRISM) QUERI
Richard L. Roudebush Veterans Affairs Medical Center
Indiana University Center for Health Services & Outcomes Research
Regenstrief Institute, Inc.
Indianapolis, Indiana


on behalf of study co-authors re:
Rattray NA, Flanagan ME, Militello LG, Barach P, Franks Z, Ebright P, Rehman SU,
Gordon HS, Frankel RM

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: End-of-shift handoffs pose a substantial patient safety risk. The transition of care from one doctor to another has been associated with delays in diagnosis and treatment, duplication of tests or treatment and patient discomfort, inappropriate care, medication errors and longer hospital stays with more laboratory testing. Handoff education varies widely in medical schools and residency training programs. Although there have been efforts to improve transfers of care, they have not shown meaningful improvement.

Led for the last decade by Richard Frankel, Ph.D., a senior health scientist at Regenstrief Institute and Indiana University and professor at Indiana University School of Medicine, our team has studied how health practitioners communicate during end-of-shift handoffs. In this current study, funded by VA Health Services and Research Development, we conducted interviews with 35 internal medicine and surgery residents at three VA medical centers about a recent handoff and analyzed the responses. Our team also video-recorded and analyzed more than 150 handoffs.

Published in the Journal of General Internal Medicine, this study explains how the person receiving the handoff can affect the interaction. Medical residents said they changed their delivery based on the doctor or resident who was taking over (i.e., training level, preference for fewer details, day or night shift). We found that handoff communication involves a complex combination of socio-technical information where residents balance relational factors against content and risk. It is not a mechanistic process of merely transferring clinical data but rather is based on learned habits of communication that are context-sensitive and variable, what we refer to as “recipient design”.

In another paper led by Laura Militello, we focus on how residents cognitively prepare for handoffs. In the paper published in The Joint Commission Journal of Quality and Patient Safety®, researchers detailed the tasks involved in cognitively preparing for handoffs. A third paper, published in BMC Medical Education, reports on the limited training that physicians receive during their residency. Residents said they were only partially prepared for enacting handoffs as interns, and clinical experience and enacting handoffs actually taught them the most.

  Continue reading

Flexible Medical Resident Duty Hours Did Not Pose Risks To Patients

MedicalResearch.com Interview with:

Jeffrey H. Silber, MD, PhDDirector, Center for Outcomes ResearchNancy Abramson Wolfson Endowed Chair in Health Services ResearchChildren's Hospital of PhiladelphiaProfessor of Pediatrics, Anesthesiology and Critical CarePerelman School of Medicine, University of PennsylvaniaProfessor of Health Care ManagementWharton School, University of Pennsylvania

Dr. Silber

Jeffrey H. Silber, MD, PhD
Director, Center for Outcomes Research
Nancy Abramson Wolfson Endowed Chair
Health Services Research
Children’s Hospital of Philadelphia
Professor of Pediatrics, Anesthesiology and Critical Care
Perelman School of Medicine, University of Pennsylvania
Professor of Health Care Management
Wharton School, University of Pennsylvania 

MedicalResearch.com: What is the background for this study?

Response: This was a year-long randomized trial that involved 63 internal medicine residency programs from around the US.  In 2015-2016, about half of the programs were randomized to follow the existing rules about resident duty hours that included restrictions on the lengths of shifts and the rest time required between shifts (the standard arm of the trial) and the other half of the programs didn’t have those shift length or rest period rules (the flexible arm of the trial).  We measured what happened to the patients cared for in those programs (the safety study), and other studies examined how much sleep the residents received, and how alert they were at the end of shifts (the sleep study), and previously we published on the educational outcomes of the interns.

To measure the impact on patient outcomes when allowing program directors the ability to use a flexible shift length for their interns, we compared patient outcomes after the flexible regimen went into place to outcomes the year before in the same program. We did the same comparison for the standard arm. Then we compared the difference between these comparisons. Comparing before and after the implementation of the trial within the same program allowed us to be more confident that a particularly strong or weak program, or a program with especially sick or healthy patients, would not throw off the results of the study. The trial was designed to determine, with 95% confidence, if the flexible arm did not do more than 1% worse than the standard arm. If this were true for the flexible arm, we could say the flexible regimen was “non-inferior” to the standard regimen.

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Childhood Advantages Linked to Bigger Brain Reserves But Faster Cognitive Decline

MedicalResearch.com Interview with:

Marja Aartsen, PhDResearch professor at NOVA - Norwegian Social Research / OsloMetOslo Metropolitan University

Dr. Aartsen

Marja Aartsen, PhD
Research professor at NOVA
Norwegian Social Research / OsloMet
Oslo Metropolitan University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is part of a larger project “Life course influences on health trajectories at older age” conducted at the University of Geneva, of which dr. Stéphane Cullati is the principle investigator (see for more information on the project https://cigev.unige.ch/index.php?cID=887). The aim of that research project is to examine in what way retrospective life course precursors from childhood to late adulthood have long-term impacts on current health trajectories at older age. A number of studies in this project are now published among which our study on childhood conditions and cognitive functioning and cognitive decline in later life.

In our research, we were particularly interested in the origins of cognitive decline in later life.  Studies among children show that the childhood is an important phase in the development of the brain. Growing up in environments in which people are cognitively stimulated stimulates the brain to develop more complex neuronal networks and larger brain reserves, which may compensate for the neuronal losses that occur when people get older. This effect is long visible, even at old age as a number of important studies recently provided quite solid evidence for the beneficial effect of advantaged childhood conditions on level of cognitive functioning in later life. However, not many studies investigated the relation between childhood conditions and the speed of cognitive decline in later life. Those that did found inconsistent results. We reasoned that part of the inconsistencies in study findings might stem from differences in the analytical approach (not sensitive enough), too little cognitive change because of a short follow-up, too young people, or too small sample (all causing too little power to find statistically significant effects) or differences in the measurement of the childhood conditions. To overcome these potential limitations, we used a large study sample with long follow-up, used a multidimensional measurement of childhood condition, and applied a powerful analytical technique.  Continue reading

Study Find No Difference in Standardized Test Scores in Children With/Without Diabetes

MedicalResearch.com Interview with:

Niels Skipper PhD Associate Professor, Department of Economics and Business Economics Aarhus University

Dr. Skipper

Niels Skipper PhD
Associate Professor, Department of Economics and Business Economics
Aarhus University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is unclear if there is an association between type 1 diabetes and school performance in children. Some studies have found type 1 diabetes to be associated with worse performance, while others have found no differences. However, most of the existing literature are based on smaller, non-random samples of children with diabetes. In this study we used data on all public school children in the country of Denmark, involving more than 600,000 schoolchildren where approximately 2,000 had a confirmed diagnosis of type 1 diabetes. The children were tested in math and reading using a nationally standardized testing procedure, and we found no difference in the obtain test scores between children with diabetes compared to children without diabetes.  Continue reading

Screen Time Effects on Child Development

MedicalResearch.com Interview with:

Sheri Madigan, Ph.D, R.Psych Canada Research Chair in Determinants of Child Development Assistant Professor, Department of Psychology Alberta Children's Hospital Research Institute University of Calgary

Dr. Madigan

Sheri Madigan, Ph.D, R.Psych
Canada Research Chair in Determinants of Child Development
Assistant Professor, Department of Psychology
Alberta Children’s Hospital Research Institute
University of Calgary

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Parents are reporting that screen time is one of their major concerns, so we wanted to find out more about how large of a role screen time was playing on children’s developmental outcomes. We were especially interested in the long-term impact of screens, which is why we followed children over time, from ages 2 to 5 and repeatedly assessed both screen time use and children’s achievement of developmental milestones.

There are three main findings:

  1. Our study revealed that on average children were viewing screens for 2.4, 3.6 and 1.6 hours per day at two, three and five years of age, respectively. This means that the majority of the participants in our sample are exceeding the American Academy of Pediatrics’ guideline of no more than one-hour of high quality programming per day, for children aged 2-5 years.
  2. We found statistically significant, albeit small effects suggesting that greater amounts of screen time at two and three years predict poorer child outcomes at three and five years, respectively. Thus, screen time has a lasting influence on children’s development.
  3. The opposite pattern was not observed. That is, we did not find evidence that children showing poor performance in terms of achieving developmental milestones were more likely to be place in front of screens to help cope with their potentially challenging behaviors.

MedicalResearch.com: What should readers take away from your report?

Response: When used in excess, screen time can have consequences for children’s development. We should think of screens like we do junk food, in small doses it’s ok, but in excess, it is problematic. But it’s never too late to make a change to the way digital technology is used in the home. Media plans can be developed as a family to manage media in the home and determine how often devices will be used, as well as when and where they will be used.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response:  In this study, we asked about total hours of screen time and, as a result, we can’t determine if context matters (i.e., screens viewed with caregivers or not), or if there are certain types of digital mediums or devices that are worse than others (e.g., interactive screens, gaming consoles, or streaming media). Thus, it will be important to decipher in future research whether co-viewing screens with a caregiver, for example, dampens associations between screen time and delays in children’s development and whether certain types of screens are more or less detrimental for children’s development.

No disclosures

Citation:

Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. Published online January 28, 2019. doi:10.1001/jamapediatrics.2018.5056

Feb 3, 2019 @ 1:12 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Why Are There So Few Minority Dermatologists?

MedicalResearch.com Interview with:
Yssra-SolimanYssra S. Soliman, BA
Division of Dermatology, Department of Internal Medicine
Albert Einstein College of Medicine
Bronx, New York

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: As the population of the United States becomes increasingly diverse, certain fields within medicine have not followed this trend. Dermatology is the least diverse field after orthopedics. We wanted to understand what barriers prevent medical students from applying to dermatology and whether these barriers differed based on students’ racial, ethnic or socioeconomic backgrounds.

The main findings of this study are that certain groups are more likely to cite specific barriers than non-minority students. These barriers are significant deterrents to applying to dermatology and include the lack of diversity in dermatology, negative perceptions of minority students by residency programs, socioeconomic barriers such as lack of loan forgiveness and poor accessibility to mentors.  Continue reading

Less Time in the Womb Linked to Less Education and Income in Adulthood

MedicalResearch.com Interview with
"Pregnancy 1" by operalynn is licensed under CC BY 2.0Josephine Funck Bilsteen, MSc
Department of Pediatrics, Hvidovre University Hospital, Hvidovre,
Section of Epidemiology, Department of Public Health
University of Copenhagen
Copenhagen, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The background of this study is that there is increasing recognition of the longer-term health and social outcomes associated with preterm birth such as independent living, quality of life, self-perception and socioeconomic achievements. However, much less is known about differences in education and income among adults born at different gestational weeks in the term period.

In this study shorter gestational duration, even within the term range, was associated with lower chances of having a high personal income and having completed a secondary or tertiary education at age 28 years. This is the first study to show that adults born at 37 and 38 completed weeks of gestation had slightly lower chances of having a high income and educational level than adults born at 40 completed weeks of gestation.  Continue reading

Paid Parental Leave Available to Medical School Faculty but Not Trainees

MedicalResearch.com Interview with:

Kirti Magudia, MD, PhD Diagnostic RadiologyResident, Brigham and Women’s Hospital Clinical Fellow, Radiology, Harvard University
Dr. Magudia


Kirti Magudia, MD, PhD
Diagnostic RadiologyResident, Brigham and Women’s Hospital
Clinical Fellow, Radiology, Harvard University




Debra F. Weinstein, M.D.
Vice President, Graduate Medical Education, Partners Health Care
Associate Professor of Medicine, Harvard Medical School

Christina Mangurian, MD,MAS
Professor and Vice Chair at the UCSF Department of Psychiatry
Weill Institute for Neurosciences
Core Faculty, UCSF Center for Vulnerable Populations
Affiliate Faculty, UCSFPhilip R. Lee Institute for Health Policy Studies

Reshma Jagsi, MD, DPhil
Professor and DeputyChair, Department of Radiation Oncology
Director, Center for Bioethics and Social Sciences in Medicine
University of Michigan

MedicalResearch.com:  What is the background for this study? 
What are the main findings?

Response: Training lengths for medical specialties are increasing and many people are starting training later. Hence, many more trainees are having children during training, an especially difficult time due to long and inflexible work hours. Given the match system, trainees may not have complete control over where they end up in training and thus may not have an optimal support system nearby. Many of the top training institutions are also in high cost of living areas. Since trainees are essentially temporary employees, changing policies to their benefit is challenging. For all of these reasons, prospective and current trainee parents are especially vulnerable.

Parental leave is important to both male and female trainees. We found that just over half of the 15 top graduate medical education (GME) sponsoring institutions associated with the top 12 medical schools did not have parental leave policies. Without these policies, trainees are at the mercy of their departments and program directors. Those institutions that do have parental leave policies for trainees offer significantly less leave to trainees than to faculty. Even then, trainees may not be encouraged to take leave afforded by policy as, depending on specialty board regulations, the leave may extend training time.

Continue reading

Diversity Standards Linked to More Female, Black and Hispanic Students in Medical Schools

MedicalResearch.com Interview with:

Dr. Dowin H. Boatright, MD Assistant Professor of Emergency Medicine Yale School of Medicine

Dr. Boatright

Dr. Dowin H. Boatright, MD
Assistant Professor of Emergency Medicine
Yale School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This observational study looked at changes in student makeup by sex, race and ethnicity at U.S. medical schools after an accrediting organization introduced diversity standards in 2009.

An analysis of data from 120 medical schools suggests implementation of the diversity standards were associated with increasing percentages of female, black students, and Hispanic students.

MedicalResearch.com: What should readers take away from your report? 

Response: Accreditation standards may be an effective policy lever to increase diversity in the physician workforce. Nevertheless, while study results are promising, women, black, and Hispanic physicians remain underrepresented in the physician workforce.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future studies should evaluate changes in student demographics at individual medical schools. Institutions that have proven to be successful in recruiting diverse medical school classes could serve as a model for other schools looking to improve medical student diversity.

No dislosures

Citation:

Boatright DH, Samuels EA, Cramer L, et al. Association Between the Liaison Committee on Medical Education’s Diversity Standards and Changes in Percentage of Medical Student Sex, Race, and Ethnicity. JAMA.2018;320(21):2267–2269. doi:10.1001/jama.2018.13705

Dec 5, 2018 @ 12:58 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Want To Get Better Grades? Get More…..

MedicalResearch.com Interview with:

Michael K. Scullin, Ph.D. Assistant Professor of Psychology and Neuroscience Director, Sleep Neuroscience and Cognition Laboratory Baylor University Waco, TX 76798 

Dr. Scullin

Michael K. Scullin, Ph.D.
Assistant Professor of Psychology and Neuroscience
Director, Sleep Neuroscience and Cognition Laboratory
Baylor University
Waco, TX 76798 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There is a gap between what health behaviors individuals know they should adopt, and what those individuals actually end up doing. For example, a growing literature shows that simply educating students on the importance of sleep does not change their sleep behaviors. Thus, we need to think outside of the box for solutions.

In three classes, we have now investigated a motivational solution: if students can earn extra credit on their final exam for sleeping better, will they do so even during finals week?

Continue reading

Prenatal Exposure to Phthalates Linked to Language Delay in Preschool Children

MedicalResearch.com Interview with:

Carl-Gustaf Bornehag, PhD Professor, Department of Health Sciences Karlstad University, Karlstad, Sweden Icahn School of Medicine at Mount Sinai New York 

Prof. Bornehag

Carl-Gustaf Bornehag, PhD
Professor, Department of Health Sciences
Karlstad University, Karlstad, Sweden
Icahn School of Medicine at Mount Sinai
New York 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Phthalates have been known for long time as potential endocrine disrupters. Exposure for these kind of compounds during pregnancy have been associated to impacted sexual development, most often seen in boys. However, there is also findings showing that prenatal exposure for phthalates can be associated to neurodevelopment in offspring children.

This study is focusing on prenatal exposure for phthalates and language delay at 30-37 months of age and were conducted in Sweden (the SELMA study including 963 children) and the U.S. (the TIDES study including 370 children) with the same design, measurements and protocols.

In these two independent studies, prenatal exposure for two phthalates (DBP and BBzP) was associated to language delay in pre-school children. Unique things with this study is that we are measuring the exposure during early pregnancy (1st trimester), the size of the study, and that we examined it in two independent populations, one in Europe and one in the U.S. with similar results. 

MedicalResearch.com: What should readers take away from your report?

 Response: These compounds identified in this study are banned in many products, but since many of these (e.g., older vinyl flooring, electric cables, toys, etc.) have long life length, they can exposure people for several decades. From a consumers point of view it is good to try to find information on ingredients in these kind of products, but that can be difficult. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We need other kind of more experimental studies that can tell us the biological mechanisms behind these effects. 

Citation:

Bornehag C, Lindh C, Reichenberg A, et al. Association of Prenatal Phthalate Exposure With Language Development in Early Childhood. JAMA Pediatr. Published online October 29, 2018. doi:10.1001/jamapediatrics.2018.3115

Oct 31, 2018 @ 6:31 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Sexual Harassment in Academic Medicine Affects Both Women and Men

MedicalResearch.com Interview with:

Sabine Oertelt-Prigione, MD, MSc Professor (Strategic Chair) of Gender in Primary and Transmural Care Department of Primary and Community Care Radboud University Medical Center

Dr. Oertelt-Prigione

Sabine Oertelt-Prigione, MD, MSc
Professor (Strategic Chair) of Gender in Primary and Transmural Care
Department of Primary and Community Care
Radboud University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This publication is a part of the WPP (Watch, Protect, Prevent) Study conducted between 2014 and 2017 at Charité – Universitaetsmedizin in Berlin, Germany. The project was designed to achieve three goals: a) acquire information about the prevalence of sexual harassment in academic medicine, b) develop and implement specific preventative measures and c) design and adopt a workplace policy against sexual harassment. The two latter goals have been achieved and this manuscript describes the findings that prompted their adoption.

In our study we carefully dissected the harassment experiences of physicians working in our tertiary referral center. Verbal harassment throughout medical careers appears as a very common phenomenon that almost 70% of women and men experience at some point. Physical harassment is less common. While colleagues appear as the main perpetrators for both sexes, women report more frequently harassment by their superiors. Among the structural factors potentially associated with harassment, we only identified strong hierarchies. 

MedicalResearch.com: What should readers take away from your report?

Response: First, we show that although the perpetrator profiles differ, both women and men in our study sample are significantly affected by sexual harassment. Second, our results display a gradient of harassment experiences and their prevalence, i.e. the verbal and non-physical forms are more common than physical forms. We argue that tolerance of non-physical forms of misconduct will increase the risk for physical forms by fostering a belief of impunity. Third, in our sample, strong hierarchies associated with an increased likelihood of experiencing harassment in both females and males.

Overall, this data shows that sexual harassment is not an action perpetrated by a single individual, but has a systemic dimension, which needs to be addressed through cultural change. Only measures targeting communication culture, formal structures and interactions in academic medicine will lead to change. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The investigation of sexual harassment is a complicated matter and should be addressed in detail. In order to design effective prevention measures, we need to know exactly what people have experienced. Hence, a simple question such as “Have you ever experienced sexual harassment?” within a statutory survey will most likely not help much in defining further steps.

The connection between communication patterns, hierarchies and harassment was very apparent in our sample and this area needs further investigation.

Last, the fact that men are also significantly affected emphasizes that this is not a women´s issue but a phenomenon that needs to be addressed to improve the working conditions for all healthcare providers.

Disclosures: Sabine Oertelt-Prigione received funding from the German Ministry of Education and Research, the Charité Foundation, the Hans Boeckler Foundation and the Equal Opportunities Program of the City of Berlin. She has provided expert testimony on the issue of sexual harassment to the German Federal Antidiscrimination Agency and the German Parliament. She is a pro-bono expert advisor for ASTIA.

Citation:

Jenner S, Djermester P, Prügl J, Kurmeyer C, Oertelt-Prigione S. Prevalence of Sexual Harassment in Academic Medicine. JAMA Intern Med. Published online October 03, 2018. doi:10.1001/jamainternmed.2018.4859 

Oct 3, 2018 @ 6:20 pm

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Children with Emotional and Behavioral Issues May Benefit From Drumming Lessons

MedicalResearch.com Interview with:
Dr. Marcus Smith PhD Reader in Sport and Exercise Physiology University of Chichester Co-founder, Clem Burke Drumming ProjectDr. Marcus Smith PhD

Reader in Sport and Exercise Physiology
University of Chichester
Co-founder, Clem Burke Drumming Project

MedicalResearch.com: What is the background for this study?

Response: The research group first started to examine rock drumming from a scientific perspective in 1999 through collaboration with Clem Burke, drummer with the iconic band ‘Blondie’. In 2008 the Clem Burke Drumming Project (CBDP) was formed (visit clemburkedrummingproject.org for further information) where academics from different disciplines came together to not only explore the physiological demands of rock drumming but also the potential use of rock drumming as an intervention in research studies. Rock drumming is attractive to the scientist in that it is a unique activity that requires the coordination of multiple limbs to produce the required drumming pattern. Inherent demands relating to timing, tempo and volume must also be met. Therefore, the ability to manipulate these facets of drumming performance in a research setting is very appealing. In relation to potential research populations drumming has a universal fascination regardless of age, gender, culture, language competency and ethnicity. Anecdotal evidence suggests that drumming is a ‘cool’ activity that has a unique ‘language currency’ in terms of stimulating communication within and between those who can and cannot play the drums.

The impetus for our research study came from parents of autistic children contacting us to express their belief that drumming was having a positive effect on their child’s physical and psychological behaviour. A review of the literature showed a range of anecdotal evidence in support of such statements (Freidman 2000) and an increase in empirical drumming based research being undertaken (Bungay 2010). More recent studies have reported psychosocial benefits such as enhanced communication (Maschi et al. 2010; 2012), emotional processing and tension reduction (Flores et al. 2016; Maschi et al. 2010; 2012), group cohesion and connectedness (Blackett et al. 2005), concentration, psychomotor coordination and posture (Chen et al. 2017). The majority of this work was undertaken with adolescents with very little work focused on younger age groups. Continue reading

Helping Soccer Coaches Teach How To ‘Read The Field’

“Girl Playing Soccer” by Bold Content is licensed under CC BY 2.0MedicalResearch.com Interview with:
Craig Pulling. MSc, PGCE, BA (Hons), FHEA
Head of Physical Education
University of Chichester

MedicalResearch.com: What is the background for this study?

Response: Successful perceptual-cognitive skill in team-sports such as football requires players to pick up task-relevant information during the control of action in complex and dynamic situations. It has been proposed that players could perform visual exploratory activity (VEA) to be able to recognise important cues in the playing environment. VEA is defined as:

“A body and/or head movement in which the player’s face is actively and temporarily directed away from the ball, seemingly with the intention of looking for teammates, opponents or other environmental objects or events, relevant to perform a subsequent action with the ball” (Jordet, 2005, p.143).

Research has suggested that VEA is an important facet of skilled performance in youth and adult football. However, it is currently unknown whether such evidence is commensurate with the views of coaches and whether coaching practices are utilised to develop VEA in training.

In order to further current understanding on VEA and coaching practices, the present study developed an online survey to examine:
(i) when VEA should be introduced in coaching;
(ii) how VEA is delivered by coaches and
(iii) how coaches evaluate VEA.

Further, this study aimed to explore whether distinct groups of football coaches existed who differed in their approach to the delivery of VEA training and, if so, whether there were differences in the demographics of the coaches across these differentiated groups.

Continue reading

Medical Residents and Program Directors Have Different Perceptions of New Parent Leave and Breastfeeding Policies

MedicalResearch.com Interview with:

Prof-Lia E. Gracey

Prof. Gracey

Lia E. Gracey, MD, PhD
Department of Dermatology
Baylor Scott & White Health
Austin, Texas 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The co-authors and I were interested in this issue as new parent leave (or the lack thereof) is increasingly being examined in many professions.  As a mother who had children during dermatology residency, I felt the pressure to take a short new parent leave to avoid having to make up time at the end of my training.

I came back to work only 3 ½ weeks after having my first baby. Anecdotally, other new parent residents (both men and women) reported similar concerns and we noticed a lack of data about new parent leave policies in dermatology residency training programs.

We distributed surveys to dermatology residency program directors and residents and were struck by a basic lack of awareness by residents for whether their institution even offered new parent leave.  Less than 50% of surveyed residents were aware of a written new parent leave policy for their residency program, yet over 80% of program directors stated they had a policy in place. We also found discrepancies between resident and program director perceptions of sufficiency of new parent leave and the availability of pumping facilities for breastfeeding mothers.  Continue reading

How Do Students Choose Where To Sit in a Classroom?

MedicalResearch.com Interview with:
“Lecture Hall” by Sholeh is licensed under CC BY 2.0Dr. David P. Smith, NTF, BSc, PhD, SFHEA

Senior Lecturer in Biochemistry / Course Leader MSc Molecular and Cellular Biology and National Teaching Fellow
Sheffield Hallam University, in the UK

MedicalResearch.com: What is the background for this study?

Response: Lectures are not going to go away, when done well they can be an effective method for teaching large groups of students. To make the lecture experience more effective we wanted to find out why students chose to sit in a given location such that we can better interact with them during taught sessions. We also wanted to find out the reasons they made this choice and if this choice of location had an effect on finial attainment (marks).  Continue reading

Parenting Educational Intervention Can Reduce Childhood Obesity

MedicalResearch.com Interview with:

Ian M. Paul, M.D., M.Sc. Professor of Pediatrics and Public Health Sciences Chief, Division of Academic General Pediatrics Vice Chair of Faculty Affairs, Department of Pediatrics Penn State College of Medicine Hershey, PA 17033-0850

Prof. Paul

Ian M. Paul, M.D., M.Sc.
Professor of Pediatrics and Public Health Sciences
Chief, Division of Academic General Pediatrics
Vice Chair of Faculty Affairs, Department of Pediatrics
Penn State College of Medicine
Hershey, PA 17033-0850

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: 20-25% of 2-5 year old children are overweight or obese in the US, and these children have increased risk of remaining overweight across the lifecourse. To date, research efforts aimed at preventing early life overweight have had very limited success.

In our randomized clinical trial that included 279 mother-child dyads, a responsive parenting intervention that began shortly after birth significantly reduced body mass index z-score compared with controls at age 3 years. Continue reading

Why Do So Few Women Enter or Complete Surgical Residency?

MedicalResearch.com Interview with:

Erika L. Rangel, MD,MS Instructor, Harvard Medical School Trauma, Burn and Surgical Critical Care Department of Surgery, Center for Surgery and Public Health  Brigham and Women’s Hospital  Harvard T. H. Chan School of Public Health Boston, Massachusetts

Dr. Rangel

Erika L. Rangel, MD,MS
Instructor, Harvard Medical School
Trauma, Burn and Surgical Critical Care
Department of Surgery, Center for Surgery and Public Health
Brigham and Women’s Hospital
Harvard T. H. Chan School of Public Health
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Although women make up half of medical student graduates in 2018, they only comprise a third of applicants to general surgery. Studies suggest that lifestyle concerns and perceptions of conflict between career and family obligations dissuade students from the field.

After entering surgical residencies, women residents have higher rates of attrition (25% vs 15%) and cite uncontrollable lifestyle as a predominant factor in leaving the field. Surgeons face reproductive challenges including stigma against pregnancy during training, higher rates of infertility, need for assisted reproduction, and increased rates of pregnancy complications. However, until recently, studies capturing the viewpoints of women who begin families during training have been limited. Single-institution experiences have described mixed experiences surrounding maternity leave duration, call responsibilities, attitudes of coworkers and faculty, and the presence of postpartum support.

Earlier this year, our group presented findings of the first national study of perspectives of surgical residents who had undergone pregnancy during training. A 2017 survey was distributed to women surgical residents and surgeons through the Association of Program Directors in Surgery, the Association of Women Surgeons and through social media via twitter and Facebook. Responses were solicited from those who had at least one pregnancy during their surgical training.

39% of respondents had seriously considered leaving surgical residency, and 30% reported they would discourage a female medical student from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training (JAMA Surg 2018; July 1; 153(7):644-652).

These findings suggested the challenges surrounding pregnancy and childrearing during training may have a significant impact on the decision to pursue or maintain a career in surgery. The current study provides an in-depth analysis of cultural and structural factors within residency programs that influence professional dissatisfaction.

We found that women who faced stigma related to their pregnancies, who had no formal maternity leave at their programs, and who altered subspecialty training plans due to perceived challenges balancing motherhood with the originally chosen subspecialty were most likely to be unhappy with their career or residency. Continue reading

Few Programs Dedicated To Preventing Mistreatment of Medical Trainees

MedicalResearch.com Interview with:
“Doctors with patient, 1999” by Seattle Municipal Archives is licensed under CC BY 2.0Dr. Laura M. Mazer, MD
Goodman Surgical Education Center
Department of Surgery
Stanford University School of Medicine
Stanford, California

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There are numerous articles that clearly document the high prevalence of mistreatment of medical trainees. We have all seen and experienced the results of an “I’ll do unto you like they did unto me” attitude towards medical education. Our motivation for this study was to go beyond just documenting the problem, and start looking at what people are doing to help fix it.

Unfortunately, we found that there are comparatively few reports of programs dedicated to preventing or decreasing mistreatment of medical trainees. In those studies we did review, the study quality was generally poor. Most of the programs had no guiding conceptual framework, minimal literature review, and outcomes were almost exclusively learner-reported.

Continue reading

Medical Textbooks Riddled With Undisclosed Conflicts of Interest

MedicalResearch.com Interview with:

Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

Dr. Piper

Brian J. Piper, PhD, MS
Department of Basic Sciences
Geisinger Commonwealth School of Medicine
Scranton, PA 18509

MedicalResearch.com: What is the background for this study?

Response: The authors of this study are biomedical scientists, health care providers and educators who teach medical and pharmacy students. It is a standard practice in reputable medical journals like the New England Journal of Medicine to disclose conflicts of interest (CoI). Reputable sources like the Cochrane Library also disclose CoIs and analyze for their potential impact on the evidence base. Unfortunately, textbooks, which can be highly influential in the training of medical professionals, usually do not disclose their conflicts of interest.

A prior study in this quantitative bioethics area found that more than one-quarter of a team-authored pharmacology textbook, Goodman and Gilman’s Pharmacological Basis of Therapeutics, had an undisclosed patent (PLoS One, 2015; 10: e0133261).  The goal of this investigation was to determine whether there were undisclosed CoIs in textbooks used in the training and as a reference for allopathic physicians, osteopathic physicians, dentists, pharmacists, nurses and other allied healthcare providers.  Continue reading

Most Pediatricians are Women, But Men’s Opinions are Valued More

MedicalResearch.com Interview with:

Julie Silver, MD Associate Professor and Associate Chair Department of Physical Medicine and Rehabilitation at Harvard Medical School and staff physician at Massachusetts General Brigham and Women’s and Spaulding Rehabilitation Hospitals

Dr. Silver

Julie Silver, MD
Associate Professor and Associate Chair
Department of Physical Medicine and Rehabilitation at Harvard Medical School and
Staff physician at Massachusetts General
Brigham and Women’s and Spaulding Rehabilitation Hospitals 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many documented disparities for women in medicine that include promotion and compensation. For physicians in academic medicine, both promotion and compensation may be directly or indirectly linked to publishing. Similarly, opportunities that stem from publishing such as speaking engagements, may be affected by a physician’s ability to publish.

For more than twenty years, there have been reports of women being underrepresented on journal editorial boards and gaps in their publishing rates. For example, a report titled “Is There a Sex Bias in Choosing Editors?” by Dickersin et al was published in JAMA in 1998 and made a compelling case for bias. Moreover, the authors noted that “a selection process favoring men would have profound ramifications for the professional advancements and influence of women”. Despite a steady stream of reports over the years, gaps have not been sufficiently addressed, and in 2014 Roberts published an editorial in Academic Psychiatry titled “Where Are the Women Editors?”. The 2017 review by Hengel titled “Publishing While Female” highlights many of the gaps, disparities and barriers for women in medicine.

Conventional reasons for disparities, such as there are not enough women in the pipeline or women do not want to conduct research or pursue leadership positions, are simply not valid. Therefore, it is important to look at other barriers, such as unconscious (implicit) bias that may affect the editorial process.

In this study, we analyzed perspective type articles from four high impact pediatric journals. We selected pediatrics, because most pediatricians are women, and therefore there are plenty of highly accomplished women physicians. We found that women were underrepresented among physician first authors in all of the journals (140 of 336 [41.7%]).

We also found that underrepresentation was more pronounced in article categories that were described as more scholarly (range, 15.4%-44.1%) versus narrative (52.9%-65.6%).  Continue reading

Visual Problems Common in Children with Dyslexia

MedicalResearch.com Interview with:

Aparna Raghuram, OD, PhD Optometrist, Department of Ophthalmology Instructor, Harvard Medical School

Dr. Raghuram

Aparna Raghuram, OD, PhD
Optometrist, Department of Ophthalmology
Instructor, Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Developmental dyslexia is a specific learning disability of neurobiological origin whose core cognitive deficit is widely believed to involve language (phonological) processing. Although reading is also a visual task, the potential role of vision has been controversial, and experts have historically dismissed claims that visual processing might contribute meaningfully to the deficits seen in developmental dyslexia.

Nevertheless, behavioral optometrists have for decades offered vision therapy on the premise that correcting peripheral visual deficits will facilitate reading. Yet there is a surprising dearth of controlled studies documenting that such deficits are more common in children with developmental dyslexia, much less whether treating them could improve reading.

In the present study, we simply assessed the prevalence and nature of visual deficits in 29 school aged children with developmental dyslexia compared to 33 typically developing readers. We found that deficits in accommodation 6 times more frequent in the children with developmental dyslexia and deficits in ocular motor tracking were 4 times more frequent.

In all, more than three-quarters of the children with developmental dyslexia had a deficit in one or more domain of visual function domain compared to only one third of the typically reading group.

Continue reading

Thousands of Students Sneak JUUL To Use School Hours

MedicalResearch.com Interview with:

Jon-Patrick Allem, Ph.D., M.A. Research Scientist Keck School of Medicine of USC

Dr. Allem

Jon-Patrick Allem, Ph.D., M.A.
Research Scientist
Keck School of Medicine of USC

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by JUUL? 

Response: The JUUL vaporizer is the latest advancement in electronic cigarette technology, delivering nicotine to the user from a device about the size and shape of a thumb drive.

JUUL has taken the electronic cigarette market by storm experiencing a year-over-year growth of about 700 percent.

In our most recent study, we wanted to document and describe the public’s initial experiences with JUUL. We collected posts to Twitter containing the term “Juul” from April 1, 2017 to December 14, 2017. We analyzed over 80,000 posts representing tweets from 52,098 unique users during this period and used text classifiers (automated processes that find specified words and phrases) to identify topics in posts.

Continue reading