Evaluation of a sex education workshop

Thirty-two first year medical students who attended a 1 day sex education workshop and seven of their classmates who did not attend the workshop were given the Sex Knowledge and Attitude Test (SKAT) both 1 month before and 3 months after the workshop. The workshop group on retest had scores significantly higher than their pretest scores in the areas of sexual knowledge, autoeroticism and sexual myths. The scores of the no-workshop group did not change significantly on any of the parameters.Evidently, knowledge can be increased and attitudes liberalized by means of an intensive day-long workshop and such changes may persist beyong the immediate period of the workshop.     

The relationship among patient contemplation, early alliance, and continuation in psychotherapy.

The present study examined the relationship among contemplation stage of readiness to change, formation of an early therapeutic alliance, and psychological distress following the first session of psychotherapy. Significant correlations between the contemplation scores and the therapeutic alliance were found for patients in the contemplation stage. Although contemplation scores were not a factor in return for a second session of psychotherapy, the bond subscale of the alliance inventory did significantly contribute to whether patients returned for therapy. Patient psychological distress was not a significant factor in predicting the early alliance. Results indicate a need for further focus on contemplation with its inherent ambivalence, its relationship to alliance, and continuation in early psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unethical and unprofessional conduct observed by residents during their first year of training

PURPOSE: To present residents' personal observations of unethical and unprofessional conduct in medicine during their first year of training. METHOD: Eight hundred and fifty-seven second-year residents who had previously participated in a study of perceived mistreatment as senior medical students were resurveyed by a three-tiered mail process concerning their experiences during their first postgraduate year, including their personal observations of four types of unethical and unprofessional conduct. RESULTS: Surveys were returned by 571 residents, for a response rate of 67%. Personal observations of falsification of patient records by others on at least one occasion were reported by 44.5% of the responding residents, while 73.8% reported direct observations of mistreatment of patients. Nearly half of the residents (46.7%) reported that others had taken credit for their work, and 72.8% said they had observed colleagues working in an impaired condition at least once during their first year of training. Over one fourth of the residents (28.6%) stated that they had been required to do something during the year that they believed was immoral, unethical, or personally unacceptable. There was an inverse relationship between the residents' observations of unethical and unprofessional conduct and their overall satisfaction with their first year of training (p < .001). CONCLUSIONS: The residents reported observing several types of unethical and unprofessional conduct among their colleagues and superiors. These findings confirm similar reports among medical students and residents and raise questions about the possible effect of such observations on the ethical principles and behavior of physicians-in-training.     

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression.

This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Morphology and ultrastructure of the antennal chemoreceptors and mechanoreceptors of worker Coptotermes formosanus Shiraki

Data on respiratory symptoms and smoking for 2749 white American high school students from two linked surveys, separated by a one year lapse, are presented. There was a significantly higher likelihood of smoking at second survey among those who had initial symptoms. (There had been no educational efforts linking smoking and respiratory symptoms in the interim.) This difference was almost entirely contributed by those who had been ex-smokers and light (less than or equal to four cigarettes/day) smokers at first survey. Initial ex-smokers and light smokers also had, overall, least fixed smoking habits. Whatever the initial smoking or symptom status, symptoms at second survey were far more likely with current smoking. Controlling for initial symptom and smoking status, the gradient of symptoms between current smokers and non-smokers was over two and a half fold, except among those who had had symptoms and had not been smoking, and whose initial symptoms presumably arose from causes other than current cigarette smoking. Even among that group, symptoms at second survey were half as likely again among those who reported having become smokers (p less than-001). There were also strong linear trends of increased likelihood of symptoms with increased numbers of cigarettes smoked. Symptom rates at second survey of those who had symptoms a year earlier, and who stopped smoking during the year, were not as low as for those who also stopped smoking, but who had not had initial symptoms, suggesting that symptoms associated with smoking were not completely reversible in the time interval of this study. The difference, however, was not significant.     

Self-concept and peer acceptance in students with learning disabilities: A four- to five-year prospective study.

Examined the peer relations and self-concepts of students prior to and following their identification by the school district as learning disabled (LD) in a 4- to 5-yr prospective study. Self-concept ratings (kindergarten–4th grade) and peer acceptance ratings (kindergarten–3rd grade), as well as academic achievement scores, were compared across 3 groups: LD students who were placed in resource special education programs during 2nd grade, low-achieving (LA) students, and average-achieving/high-achieving (AA/HA) students. For peer acceptance, AA/HA students' scores were higher than LA students' scores only. No between-groups differences were obtained during any school year on the self-concept measure. Findings suggest that LD students' self-perceptions are not negatively affected by academic and social difficulties in the early grades or by the identification and labeling process. Though generalization is limited by the small sample size, few studies have examined students with learning disabilities longitudinally or prior to and following their identification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Potentiation of 5-fluorouracil-leucovorin activity by alpha2a-interferon in colon adenocarcinoma xenografts

The present study examined the effect of received support on adjustment by foreign students, with data from 33 Chinese students who completed questionnaires at three occasions: three months (the first period), nine months (the second period), and one year and nine months (the third period) after they arrived in Japan. The Social Support Scale for Chinese Students in Japan (Jou, 1993a) and items for measurement of adjustment were used in the questionnaires. Analysis of Variance results revealed no differences among the amounts of support received during the three periods, but compared with the first or second, adjustment was better during the third period. Results from path analysis indicated that support in the first period was positively related to adjustment in the first period, the first period adjustment and second period support positively to the second period adjustment, and only the second period adjustment positively to the third period adjustment. Thus, the present study suggests that it is especially necessary to provide more support to foreign students during the critical early period in order to facilitate their adjustment.     

What do students find attractive about the practice of medicine? A pattern of stability over time

There is little consensus about the stability or instability of medical students career preferences during their time in college. These two studies found little change in their perception of the attractiveness of aspects of medical work which may be related to their final career choice. In the first study three successive cohorts of students in a London medical school completed questionnaires about the attractiveness of various medical job-attributes. Each cohort was tested twice such that the pattern of testing covered the entire course. Only data from students who were present at both test sessions were used for the longitudinal study. Comparisons with students in other London schools indicated that the study groups were representative of all London medical students. The second study was cross-sectional comparing final year data from 1983 and 1991 at three London medical schools. The first study results suggest that students enter medical school with values and opinions about their work which remain, on the whole, unchanged until they leave. There were significant decreases in the attractiveness of four attributes, but none became significantly more attractive. The second study revealed little change, five attributes were significantly less attractive 8 years later. In both studies most of the changes related to organisational rather than patient-related attributes. This may reflect greater realism about doctors' work. Comparison of final years students' data with published data from the mid-seventies confirms the overall stability of these values. It is suggested that specialists could use this information to highlight the desirable aspects of their work and so 'sell' their discipline to students and newly qualified doctors.     

Survival and functional status after resection of recurrent glioblastoma multiforme

OBJECTIVE: To determine the selection factors for and results of second resections performed to treat recurrent glioblastoma multiforme (GM), we studied 301 patients with GM who were treated from the time of diagnosis using two prospective clinical protocols. METHODS: The patients were prospectively followed from the time of diagnosis, using clinical and radiographic criteria after maximal surgical resection and external beam radiotherapy with or without adjuvant chemotherapy. Resection of recurrent GM was performed at the recommendation of the treating clinicians. The results of the second resections were retrospectively reviewed and analyzed using multivariate logistic regression, Kaplan-Meier-Turnbull survival analysis, Cox regression, and propensity score stratification. RESULTS: Forty-six patients underwent second resections during the study period. The actuarial rate of the second resections was 15% of the patients 1 year after diagnosis and 31% 2 years after diagnosis. Younger age (P = 0.01) and more extensive initial resection (P = 0.02), but not Karnofsky Performance Scale (KPS) score at the time of diagnosis or recurrence, predicted a higher chance of selection for reoperation after initial tumor recurrence. Twenty-eight percent of the patients had improved KPS scores after undergoing reoperation, 49% were stable, and 23% had declines in KPS scores of 10 to 30 points. There was no operative mortality. After reoperation, 85% of the patients received chemotherapy, 11% received brachytherapy or underwent stereotactic radiosurgery, and 17% underwent third resections. The median survival period after reoperation was 36 weeks. Higher preoperative KPS scores predicted longer survival periods after reoperation (P = 0.03). Age and interval since diagnosis were not significant prognostic factors. The median high-quality survival period (KPS score, > or =70) was 18 weeks. The median survival period after first tumor progression was 23 weeks for 130 patients treated using the same protocols who did not undergo reoperations. Patients who did undergo reoperations experienced clinically and statistically significantly longer survival periods. However, this was determined to be partially because of selection bias. CONCLUSION: Survival after resection of recurrent GM remains poor despite advances in imaging, operative technique, and adjuvant therapies. High-quality survival after resection of recurrence to treat GM seems to have increased significantly since an earlier report from our institution.     

Cross-tolerance between inhaled cannabis and intraperitoneal injections of delta9-THC

Male and female rats were exposed to Cannabis smoke or placebo once every second day for 32 days. Following these 16 trials all animals were injected once intraperitoneally with 4 mg/kg THC. After every third inhalation trial and after the injection the rats were placed on a movement sensor for 3 min. Cannabis smoke significantly reduced activity, relative to baseline scores, during the first 10 inhalation trials but by the thirteenth exposure, tolerance was evident. When the animals were injected with THC, the male rats who had been exposed to Cannabis smoke significantly increased their activity whereas the females did not alter their activity relative to the last inhalation trial. In contrast rats of both sexes that had been exposed to placebo smoke significantly decreased their activity following the injection. This intermodal cross-tolerance is discussed in terms of the role of conditioning in the development of tolerance.     

Does Clinical Psychology Education Enhance the Clinical Competence of Practitioners?

Until now there has been little evidence that graduate programs in clinical psychology make any difference to practitioners' abilities. The authors present a quasi-experimental study designed to evaluate the effectiveness of postgraduate education in clinical psychology. Clinical psychology students from Australian universities were compared with psychology graduates who had elected to practice under Australian provisional registration rules (i.e., without a postgraduate education). Results showed that after 1 extra year of education, postgraduate trainees performed better than those with no postgraduate training, but only to a modest degree. The authors explore the implications of these results for trainers, trainees, and professional organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elimination and biochemical responses to intravenous alendronate in postmenopausal osteoporosis

Postmenopausal women with established vertebral osteoporosis were studied for 2 years to determine the terminal elimination half-life and the duration of response to treatment with intravenous alendronate (30 mg) given over 4 days. The urinary excretion of alendronate followed a multiexponential decline. Approximately 50% of the total dose was excreted over the first 5 days, and a further 17% was excreted in the succeeding 6 months. Thereafter, there was a much slower elimination phase with an estimated mean terminal half-life of greater than 10 years (n = 11). Urinary excretion of hydroxyproline and calcium decreased significantly from pretreatment values by day 3, reaching a nadir by 1 week (40% and 67% decrease, respectively). Thereafter, hydroxyproline remained suppressed for the following 2 years. In contrast, urinary calcium excretion returned gradually toward pretreatment values over the first year and during the second year was comparable to pretreatment values. Serum activity of alkaline phosphatase activity decreased over 3 months (23% reduction), increased gradually thereafter, and returned to pretreatment values at month 24. Bone mineral density measured at the spine increased by approximately 5% during the first year and remained significantly higher than pretreatment values at 2 years. We conclude that a short course of high doses of intravenous alendronate is associated with a prolonged skeletal retention of the agent. This open study also suggests that this regimen has a sustained effect on bone turnover persisting for at least 1 year.     

Quality-of-life following thoracotomy for lung cancer

Contrary to the issues of perioperative morbidity and survival following surgery for lung cancer, little attention has been given to quality-of-life. To address this, quality-of-life was assessed preoperatively and 1, 3, 6 and 9 months postoperatively in a cohort of 117 consecutive subjects who underwent thoracotomy with a certain or presumptive diagnosis of lung cancer. Those with cancer (n = 91) confirmed at thoracotomy were contrasted to those without (n = 26). Moderate to severe dyspnea, reported in 14% preoperatively, increased to 34% at 1 and 3 months (p < 0.005) but returned to approximately 10% at 6 and 9 months. Similarly, activities of daily living were impaired in 11% preoperatively; this disability increased to 21% at 1 month (p < 0.005), and returned to baseline at 6 and 9 months. Those with cancer compared to those without a postoperative diagnosis of cancer had similar quality-of-life preoperatively but deteriorated more in the postoperative period. This study demonstrates that important deterioration in quality-of-life occurs during the first 3 months postoperatively in those with a final diagnosis of cancer but improvement back to baseline can be expected thereafter.     

An exploration of sexual knowledge, attitudes and behavior in aboriginal elementary school students in the Ping-Tung area

The purpose of this study was to investigate sexual knowledge, attitudes and behavior of fifth and sixth grade students in aboriginal elementary schools in the Ping-Tung area. A structured questionnaire was administered to 1091 students who were selected by cluster sampling. The results showed: (1) The sexual knowledge score was low but sexual attitudes showed a positive trend. (2) 64.7% and 67.4% of students had at some time seen pictures of male or female sexual organs. (3) About 61% of students had seen sexual magazines or videotapes. (4) 66.2% of male and 88.1% of female students had heard about wet dreams or menstruation before their first experience; more than half of the students thought that wet dreams need treatment. (5) 17.8% of students had masturbation experience, and after that 59.3% of students had fear or guilt feeling. (6) Female students had significantly higher knowledge and attitude scores than male students, Demographic variables produced no significant difference in the above scores. (7) 42.4% of students most desired to know what phenomena indicate sexual maturity. (8) Sex knowledge had significantly positive correlation with sex attitude.     

Elevated soluble fas production in SLE correlates with HLA status not with disease activity

CONTEXT: Medical educators have had a growing sense that proficiency in physical diagnostic skills is waning, but few data have examined the question critically. OBJECTIVE, DESIGN, AND SETTING: To compare the cardiac auscultatory proficiency of medical students and physicians in training. A multicenter cross-sectional assessment of students and house staff. A total of 8 internal medicine and 23 family practice programs of the mid-Atlantic area. PARTICIPANTS: A total of 453 physicians in training and 88 medical students. INTERVENTIONS: All participants listened to 12 cardiac events directly recorded from patients, which they identified by completing a multiple-choice questionnaire. MAIN OUTCOME MEASURES: scores were expressed as the percentage of participants, for year and type of training, who correctly identified each event. Cumulative scores were expressed as the total number of events correctly recognized. An adjusted score was calculated whenever participants selected not only the correct finding but also findings that are acoustically similar and yet absent. RESULTS: Trainees' cumulative scores ranged between 0 and 7 for both internal medicine and family practice residents (median, 2.5 and 2.0, respectively). Internal medicine residents had the highest cumulative adjusted scores for the 6 extra sounds and for all 12 cardiac events tested (P=.01 and .02, respectively). On average, internal medicine and family practice residents recognized 20% of all cardiac events; the number of correct identifications improved little with year of training and was not significantly higher than the number identified by medical students. CONCLUSIONS: Both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events. This study suggests a need to improve the teaching and assessment of cardiac auscultation during generalists' training, particularly with the advent of managed care and its search for more cost-effective uses of technology.     

Inactivation of coliphage Q beta by potassium ferrate

The study looked at palpitations in relation to the prevalence of arrhythmia, as assessed by 24-h ambulatory electrocardiography (ECG) in a population sample. The subjects were randomly drawn from among those involved in a cardiovascular survey. Forty-three of those who answered 'Yes' and 54 of those who answered 'No' (84% of those eligible) to the following question, participated: 'Have you observed sudden changes in your heart rate or heart rhythm during the preceding year?' In both groups mean age was 49 years and 58% were men. There was no relationship between recorded arrhythmia and perceived palpitations during monitoring. The prevalence of at least one arrhythmic episode (ventricular or supraventricular arrhythmia or pauses > = 1.5 s) was significantly higher in those who had perceived palpitations during the previous year (98%) than in those who had not (74%) (P < 0.0014). Through a simple question about palpitations during the preceding year we were able to identify significantly a population with true arrhythmias. However, the question could not be used to define a population entirely without arrhythmia. The high prevalence of arrhythmia in subjects without reported palpitations indicates that it is a normal finding which alone should not demand further clinical investigations.     

Effect of ageing on pancreatic hyperplasia after 90% proximal small bowel resection

PURPOSE: A longitudinal study to ascertain the attitudes toward, and habits of, substance use among a single class of medical students. METHOD: A single class from a northeastern medical school was surveyed in both its first year (February 1991, 176 students) and its third year (May 1993, 170 students). The students were asked to report how frequently during the prior year they had used drugs or alcohol, and whether their use of each substance had increased, decreased, or remained the same since entering medical school; to identify any family members with histories of alcohol or drug problems; and to report any incidence during the prior year of ten behaviors associated with substance dependence. The students were also asked to indicate their agreement or disagreement with 11 attitudinal statements. Additional attitudinal items asked the students to identify three major deterrents to the abuse of drugs and alcohol, and what they had done if they had become aware of a classmate with a drug or alcohol problem. Chi-square analysis and two-tailed t-tests were used to compare data from the two surveys. RESULTS: The response rates in the first and second surveys were 96.9% and 81.8%, respectively. Use of licit and illicit substances was comparable to that of chronological peers and prior national studies of medical trainees. Most of the students admitted to using alcohol at least once in the prior year (91.8% and 95%, respectively). In both years marijuana was the illicit drug used most often. Although there was a slight increase over time in the use of benzodiazepines (2.4% to 5.8%) and a decrease in the use of marijuana (29.4% to 21.7%), these changes were not significant. Few of the students in their third year reported using any substance other than alcohol more than once a month. In general, a greater percentage of the students reported a decrease rather than an increase in the use of a substance since entering medical school; the primary exception was for wine. As they progressed in their training, the students became less concerned about the effect of substance use on their performance and more likely to be embarrassed about admitting to an addiction. Although in each year a few of the students appeared to be at risk for substance dependence (8.9% and 3.5%, respectively), no student came to the attention of the administration because of problems related to substance use. While most of the students were unaware of any classmate who had a problem, half of those who were aware had done nothing, and the balance had rarely sought assistance from the faculty or administration. CONCLUSION: Although there was no evidence that substance use was a major problem, a few of the students appeared to be at risk for drug or alcohol dependence. Appropriate intervention, support, and referral systems should be identified for the few who may be at risk, and increased educational efforts are needed to help all students address this issue with their peers and, ultimately, with their patients.     

The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour

Maternal and foetal acid-base balance, PaO2, lactate, potassium and creatine phosphokinase (CPK) were studied during the course of 28 induced labours. Every second mother received segmental epidural analgesia during the first stage of labour (epidural group), while the remaining mothers (who were given pethidine for pain relief, if necessary) acted as a control group. In the epidural group the patients had only minimal changes in acid-base balance and lactate concentration during the first stage. During the second stage lactate concentration increased. In the control group, on the other hand, the acid-base balance showed signs of hyperventilation and lactic acid accumulation during the first stage. The potassium changes were quite minimal and were not significantly different between the groups. The CPK level did not change during labour, but 2 and 4 h after delivery it was significantly elevated in both groups. The foetal acid-base balance, potassium, lactate and PaO2 values revealed no differences between the groups at any time. The CPK level in umbilical venous blood was significantly higher in the epidural group.     

Assessment at one school of students' abilities and confidence in diabetic patients' education

PURPOSE: To determine medical students' experiences in working with diabetic patients, their cognitive competence and their confidence in meeting diabetic patients' educational needs, and changes in their expertise with advancing education. METHOD: The study was conducted in March 1994 at the University of Illinois College of Medicine, where students work with ambulatory patients in a longitudinal primary care experience from their second year through graduation. A combined questionnaire and objective quiz was developed and distributed to 138 second-, third-, and fourth-year students. The students were asked whether they had had experience in seeing a newly diagnosed diabetic patient, in what setting, and whether they felt confident in educating such patients on various common topics. They were also asked about their interests in and preferences for learning about diabetic patients' education. A 50-item objective quiz on the management of diabetes followed the questionnaire. Data were analyzed with several statistical methods. RESULTS: In all, 65 of the students (47%) responded; the majority were third- or fourth-year students. The percentages of students who felt confident ranged from 83% who felt confident about counseling about exercise to only 16% who felt confident about pre-conception counseling. All of the students but one felt that diabetic patients' education was an important topic, and all but two were interested in it. The students' quiz scores showed no significant difference by year of training; for all the students the average score was 39.6% correct, with no increase in score for increased training. Also, the students who were more confident about their abilities to provide patient education on a certain topic were no more likely to have accurate information about that topic than were those who were not confident. CONCLUSION: Although they were clearly interested in diabetic patients' education, the students did not feel confident in providing it, nor did they have the cognitive competence to do so. Medical schools have a responsibility to students and to their patients to formally address the issues of patient education.     

From top dog to bottom half: Social comparison strategies in response to poor performance.

Although the hypothesis that people will alter comparison behavior in response to threat is consistent with the formulation of social comparison theory, the empirical evidence for the natural occurrence of such shifts is weak. Two studies were conducted to examine this hypothesis. In the 1st study, adolescents' perceptions were assessed before, during, and 6 mo after their participation in an academic program for gifted students. Male students who performed poorly, and also worse than they had expected in the program, demonstrated self-protective strategies by lowering the amount and level of academic comparison they reported engaging in and by lowering their perception of the importance of academics. Female students, who generally performed as well as expected, reported relatively little change. By follow-up, most of the male students' perceptions had returned to baseline. A 2nd study found that both male and female college students who thought they had performed poorly academically also demonstrated these shifts in comparison. Motivations behind the strategies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)