Healthy Behaviors and Academic Success Go ‘Hand in Hand’

MedicalResearch.com Interview with:

Catherine N. Rasberry, PhD Health Scientist, Division of Adolescent and School Health CDC Atlanta

Dr.Raspberry

Catherine N. Rasberry, PhD
Health Scientist, Division of Adolescent and School Health
CDC Atlanta

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

Response: For many years, researchers have documented links between health-related behaviors and educational outcomes such as letter grades, test scores, and other measures of academic achievement. However, many of those studies are becoming out-of-date or have used samples that were not nationally representative. The aim of this study was to see if previous findings held in a current, national sample of high school students.

Consistent with previous studies, our findings revealed that regardless of sex, race/ethnicity and grade-level, high school students who received mostly A’s, mostly B’s, or mostly C’s had higher levels of most protective health-related behaviors and lower levels of most health-related risk behaviors. For example, we found that:

  • Students who reported receiving mostly Ds and Fs, were nine times more likely than students who received mostly As to report having ever injected any illegal drugs.
  • Also, students who reported receiving mostly Ds and Fs were more than four times more likely than students who received mostly As to report that they had four or more sexual partners.
  • Conversely, students who reported receiving mostly As were twice as likely as students who received mostly Ds and Fs to report eating breakfast every day in the past week.

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More Time in School Associated With Less Cardiovascular Disease

MedicalResearch.com Interview with:

Dr. Julien Vaucher  Physician and clinical research fellow (joint first author) Department of Internal Medicine Lausanne University Hospital Lausanne, Switzerland

Dr. Vaucher

Dr. Julien Vaucher 
Physician and clinical research fellow (joint first author)
Department of Internal Medicine
Lausanne University Hospital
Lausanne, Switzerland

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

Response: Since the sixties, traditional studies have found that people who stay longer in the educational system subsequently develop less coronary heart disease. However, whether this association is causal is not clear, partly because randomised controlled trials are practically infeasible in this area. In our study, we used a genetic approach, called Mendelian randomization, that represents the next best thing to do.Based on genetic variants randomized by nature, we were able to randomize individuals according to 162 genetic markers that associate with more or less education. In other words, we used genetic markers, free from condounding factors, as proxies of education to reproduce the conditions of a trial. Then, if the genetic markers also associate together with coronary heart disease, the association between education and coronary heart disease is likely to be causal.

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Remediation Programs Linked To Reduced Attrition Among Surgical Residents

MedicalResearch.com Interview with:

Christian de Virgilio, MD LA BioMed lead researcher and corresponding author for the study He also is the former director of the general surgery residency program Harbor-UCLA Medical Center and the recipient of several teaching awards.

Dr. de Virgilio

Christian de Virgilio, MD
LA BioMed lead researcher and corresponding author for the study
He also is the former director of the general surgery residency program
Harbor-UCLA Medical Center and the recipient of several teaching awards.

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

Response: Recent forecasts have predicted the United States will have a deficit of as many as 29,000 surgeons by 2030 because of the expected growth in the nation’s population and the aging of the Baby Boomers. This expected shortfall in surgeons has made the successful training of the next generation of surgeons even more important than it was before. Yet recent studies have shown that as many as one in five general surgery residents leave their training programs before completion to pursue other specialties.

Our team of researchers studied 21 training programs for general surgeons and published our findings in the Journal of the American Medical Association Surgery (JAMA Surgery) on August 16, 2017. What we found was the attrition rate among residents training in general surgery was lower than previously determined – just 8.8% instead of 20% – in the 21 programs we surveyed. Our study also found that program directors’ attitudes and support for struggling residents and resident education were significantly different when the authors compared high- and low-attrition programs.

General surgeons specialize in the most common surgical procedures, including abdominal, trauma, gastrointestinal, breast, cancer, endocrine and skin and soft tissue surgeries. General surgery residency training follows medical school and generally requires five to seven years. The programs are offered through universities, university affiliated hospitals and independent programs.

In this study, the research team surveyed 12 university-based programs, three program affiliated with a university and six independent programs. In those programs, 85 of the 966 general surgery residents failed to complete their training during the five-year period the research team studied, July 1, 2010 to June 30, 2015. Of those who failed to complete their general surgery training, 15 left during the first year of training; 34 during the second year, and 36 during the third year or later.

Notably, we found a nearly seven-fold difference between the training program with the lowest attrition rate, 2.2%, and the one with the highest rate, 14.3%, over the five-year period surveyed. In the programs with lower attrition rates, we found about one in five residents received some support or remediation to help ensure they would complete their https://medicalresearch.com/author-interviews/reduction_in_surgical_residents_work_hours/4475/ In the programs with higher attrition rates, the research team reported that only about one in 15 residents received such remediation. Continue reading

Despite Sleep Benefits To Teens, Only Half of Parents Support Later School Start Times

MedicalResearch.com Interview with:

Galit Dunietz, Ph.D., MPH Doctor of Philosophy Department of Neurology University of Michigan  Ann Arbor MI

Dr. Dunietz

Galit Dunietz, Ph.D., MPH
Epidemiologist, Sleep Disorders Center
Department of Neurology
University of Michigan
Ann Arbor MI

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

Response: Insufficient sleep has a negative impact on health, cognition and mood and is linked to motor vehicle accidents. However, sleep loss in adolescents has become an epidemic and arises in part from biological processes that delay sleep and wake timing at the onset of puberty. This biology does not fit well with early school start times (before 8:30 a.m.). Despite recommendations from the American Academy of Pediatrics and the American Academy of Sleep Medicine to delay school start times, most schools in the U.S. have current start times before 8:30 a.m.

In this nationally representative study of US parents of teens, we examined whether parents supported or opposed later school start times (after 8:30 a.m.). We also examined what may have influenced their opinions.

We found that only about half of surveyed parents of teens with early school start times supported later school start times. Opinions appeared to depend in part on what challenges and benefits were expected to result from the change.

For example, parents who expected an improvement in their teen’s academic performance or sleep quantity tended to support the change, whereas parents that expected negative impact on afterschool activities or transportation opposed delays in school start times.  We also found that parents had misconception about sleep needs of their adolescents, as the majority perceived 7-7.5 hours of sleep as sufficient, or possibly sufficient even at this young age when 8-10 hours are typically recommended.

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Neonatal Hypoglycemia Linked To Neurodevelopmental Outcomes at 4.5 Years

MedicalResearch.com Interview with:

Jane E. Harding, DPhil Liggins Institute The University of Auckland Auckland, New Zealand

Prof. Harding

Jane E. Harding, DPhil
Liggins Institute
The University of Auckland
Auckland, New Zealand

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

Response: Neonatal hypoglycaemia – low blood sugars in newborns – affects up to one in six babies born. It involves a sustained dip in blood sugar levels following birth. Blood glucose is the only fuel for babies’ brains (adults have alternative, back-up sources). So, if left untreated, this condition can cause developmental brain damage and lowered education outcomes later in life.

In developed economies, as many as a third of babies born are at risk. Risk factors include being born smaller or larger than usual, preterm babies and babies whose mothers have any form of diabetes – this last a growing group, with the rising incidence of gestational (pregnancy-related) diabetes.

We wanted to systematically track a cohort of babies to see if hypoglycaemia in babies affects their long-term health and development. So we designed the CHYLD study – Children with Hypoglycaemia and their Later Development. We are following 614 New Zealand babies born at risk of low blood sugar levels (neonatal hypoglycemia) into childhood to see if the condition affects their later growth and development. Our team includes researchers from the Liggins Institute, the University of Auckland, Waikato Hospital, the University of Canterbury and the University of Waterloo.

Half of the babies in the study were diagnosed with, and treated for low blood sugars. Seventy percent received extra, continuous monitoring of their blood sugar levels, which detected in some babies low levels that were not diagnosed by the heel-prick tests.

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“Positive Manifold” : Vocabulary and Reasoning Skills Reinforce Each Other In Adolescents

MedicalResearch.com Interview with:

Dr Rogier Kievit PhD Cambridge Neuroscience

Dr. Kievit

Dr Rogier Kievit PhD
Cambridge Neuroscience

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

Response: One of the most robust findings in psychology is the so-called ‘positive manifold’ – The fact that people who are better at cognitive task A are, on average, also better at task B (and C, D etcetera). Despite over a hundred years of empirical investigations, we don’t really know why this is the case. Here, we aimed to investigate the mechanisms that underlie the positive manifold. To do so, we studied almost 800 adolescents and young adults from Cambridge and London (the NSPN study; Www.nspn.org

We measured both their abstract reasoning skills (e.g. solving a puzzle) and vocabulary knowledge (e.g. example) on two occasions, about 1.5 years apart.

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

Response: Our main finding was that abstract reasoning skills and vocabulary knowledge seem to reinforce each other during development. In other words, the adolescents who started out with higher vocabulary abilities had largest increases in reasoning skills, and those with better reasoning skills gained more vocabulary knowledge. This is exciting as we know mathematically that such a process can (at least partially) help explain the emergence of the positive manifold.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: That cognitive abilities interact with each other during development. It is tempting (also for scientists!) to think about skills like memory, reading and as separate domains. However, in reality they are part of a larger network of cognitive, mental and emotional processes that interact throughout the lifespan. We simple can’t fully understand humans as psychological agents by taking only ‘snapshots’.

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

Response: The field of psychology has recently realized it needs to increase sample sizes to gain robust knowledge about human behaviour and mental processes. I think the next step is realizing the importance of studying development (i.e. testing people on multiple occasions) as a way to look at longstanding questions in new and exciting ways. Secondly, we find that that mathematical models are a very exciting way to translate theories into directly testable propositions – Although such models are always oversimplifications, they often move scientific debates forward.

MedicalResearch.com: Is there anything else you would like to add?

Response: With the emergence of experience sampling methods (e.g. performing cognitive tests on smartphones), ideally combined with longitudinal brain imaging, I think the next two decades will prove an incredibly exciting time for understanding human cognition.

Disclosures: The Medical Research Council Cognition and Brain Sciences Unit is part of the University of Cambridge, funded through a strategic partnership between the MRC and the University.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Rogier A. Kievit et al, Mutualistic Coupling Between Vocabulary and Reasoning Supports Cognitive Development During Late Adolescence and Early Adulthood, Psychological Science (2017). DOI: 10.1177/0956797617710785

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

Medical School Curriculum Aims To Overcome Physician Bias Against Obese Patients

MedicalResearch.com Interview with:

Gregory Gayer, PhD Associate Professor Chair of Basic Science Department TUCOM California

Dr. Gayer

Gregory Gayer, PhD
Associate Professor
Chair of Basic Science Department
TUCOM California 

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

Response: The prevalence of obesity in the United States continues to be a growing and remains a major health concern.  Closely associated with obesity is an extensive list of chronic diseases, including hypertension, dyslipidemia, and type 2 diabetes.  Unfortunately, physician bias against obese people may create a self-defeating environment that can produce less effective communication in a manner that could reduce the patient’s willingness to participate in their own health. Our overall goal is to prepare future physicians to appropriately engage the obese patient in order to optimize health care delivery.

This study was initiated in response to the ever increasing demand on the medical profession to properly care for the obese patient. We demonstrated that medical students have the same inherent bias as other health care providers and this bias can be sustainably reduced by education. We hope that this reduction in bias shown in medical school will enable students to be better prepared to address the concerns of their obese patients and ultimately translate into better clinical outcomes for them.

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USPSTF: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors

MedicalResearch.com Interview with:

Carol M. Mangione, MD, MSPH, FACP Barbara A. Levey, MD, and Gerald S. Levey, MD Endowed chair in medicine David Geffen School of Medicine University of California, Los Angeles Professor of public health at the UCLA Fielding School of Public Health

Dr. Mangione

Carol M. Mangione, MD, MSPH, FACP
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine
David Geffen School of Medicine
University of California, Los Angeles
Professor of public health at the UCLA Fielding School of Public Health

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

Response: Americans can experience several health benefits from consuming healthy foods and engaging in physical activity. The Task Force recommends that primary care professionals work together with their patients when making the decision to offer or refer adults who are not obese and do not have hypertension, high cholesterol, high blood sugar, or diabetes to behavior counseling to promote healthful diet and physical activity. Our focus was on the impact of a healthful diet and physical activity on cardiovascular risk because this condition is the leading cause of premature morbidity and mortality. The Task Force evaluates what the science tells us surrounding the potential benefits and harms of a particular preventive service. In this case, the Task Force found high quality evidence focusing on the impact a healthful diet and physical activity can have on a patient’s risk of cardiovascular disease. Relying on this evidence, the Task Force was able to conclude that there is a positive but small benefit of behavioral counseling to prevent cardiovascular disease.

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How To Evaluate Cognitive Function in the Aging Physician?

MedicalResearch.com Interview with:

E. Patchen Dellinger, M.D. Professor, Department of Surgery University of Washington, Box 356410 Seattle, Washington 98195-6410

Dr. Dellinger

E. Patchen Dellinger, M.D.
Professor, Department of Surgery
University of Washington, Box 356410
Seattle, Washington 98195-6410 

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

Response: As I passed the age of 70 myself and began considering when to slow down and/or retire I decided to examine the literature about age and physician competence.  I have had a wonderful, rewarding time in surgery but have always wanted to provide the best possible care for my patients.  On my review of an extensive literature on this topic I found examples of physicians who had become dangerous to their patients with age but persisted because of their eminence and also of physicians who continued to deliver high quality care well into old age.

In medicine, unlike most other safety conscious industries, we have not really taken a systematic approach to the issue of policies related to the aging physician.

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Transgender Actors Effective in Teaching Residents to Provide Respectful and Effective Health Care

MedicalResearch.com Interview with:

Richard E. Greene, MD, FACP Medical Director, Bellevue Adult Primary Care Center Assistant Professor, NYU School of Medicine Associate Program Director, Primary Care Residency Program Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality 

Dr. Greene

Richard E. Greene, MD, FACP
Medical Director, Bellevue Adult Primary Care Center
Assistant Professor, NYU School of Medicine
Associate Program Director, Primary Care Residency Program
Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList
Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies
VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality 

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

Response: Transgender individuals face complex health disparities and have historically been mistreated and even denied care in medical settings. As a provider in New York City, I saw how this affected my trans patients, resulting in mistrust of the health care system, resulting in negative health outcomes. This sparked my interest in improving medical education to serve the needs of trans patients. It’s important to teach medical students and residents that they are not just treating a set of symptoms, they are working with a individuals with complex lived experiences who deserve compassionate care.

I found with traditional didactic methods, like lectures, learners smiled and nodded in agreement, but when faced with a patient who was transgender, they would stammer and feel uncomfortable with aspects of the cases that were specific to transgender patients, from pronouns to hormones.

Residents should be prepared to treat transgender patients not only with dignity, but also in medically appropriate ways. Without exposure to the transgender community, it’s difficult for providers to decipher their trans patients’ health care needs and contextualize them within a care plan.

In order to provide a low stakes environment for residents to practice these skills, we developed an OSCE focused on a transgender woman with health care needs specific to her transition. The goal of the case was to discuss the patient’s medical concerns while also taking into consideration her goals around her hormone therapy and surgical interests.

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