Do you think it's a disease? a survey of medical students

Obesity Education in Medical School Curricula in Korea

Obesity is one of the three most common diseases, affecting about one-third of adults. Obesity also increases vulnerability to metabolic disorders, psychological disorders, and various cancers and decreases quality of life. Therefore, obesity must be adequately addressed in medical school. Here, I will review how obesity education is implemented in medical school curricula in Korea. Many studies have shown that students who are well educated about obesity through various educational methods reduce their prejudice toward obese patients. The Korean Society for the Study of Obesity is an interdisciplinary academy, including experts from fields such as general research, clinical practice, nutrition, nursing, exercise, and rehabilitation. They aim to identify the core competencies of obesity education necessary for medical students, develop curricula of obesity education, and present examples of lectures and discussions. In the future, health professionals who receive such education will be able to take better care of obese patients without bias.

Words do matter: a systematic review on how different terminology for the same condition influences management preferences

OBJECTIVES

Changing terminology for low-risk, screen-detected conditions has now been recommended by several expert groups in order to prevent overdiagnosis and reduce the associated harms of overtreatment. However, the effect of terminology on patients' preferences for management is not well understood. This review aims to synthesise existing studies on terminology and its impact on management decision making.

DESIGN

Systematic review.

METHODS

Studies were included that compared two or more terminologies to describe the same condition and measured the effect on treatment or management preferences and/or choices. Studies were identified via database searches from inception to April 2017, and from reference lists. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias of included studies.

RESULTS

Of the 1399 titles identified, seven studies, all of which included hypothetical scenarios, met the inclusion criteria. Six studies were quantitative and one was qualitative. Six of the studies were of high quality. Studies covered a diverse range of conditions: ductal carcinoma in situ (3), gastro-oesophageal reflux disease (1), conjunctivitis (1), polycystic ovary syndrome (1) and a bony fracture (1). The terminologies compared in each study varied based on the condition assessed. Based on a narrative synthesis of the data, when a more medicalised or precise term was used to describe the condition, it generally resulted in a shift in preference towards more invasive managements, and/or higher ratings of anxiety and perceived severity of the condition.

CONCLUSIONS

Different terminology given for the same condition influenced management preferences and psychological outcomes in a consistent pattern in these studies. Changing the terminology may be one strategy to reduce patient preferences for aggressive management responses to low-risk conditions.

TRIAL REGISTRATION NUMBER

PROSPERO: CRD42016035643.

The Obesities: An Overview of Convergent and Divergent Paradigms

The study of obesity lends itself to difficulties not only due to our imprecise ability to measure body composition, food consumption, and physical activity but also, even more important, due to complexities involved in defining and conceptualizing obesity. For centuries, obesity has been considered a disease, although researchers and clinicians cannot agree on definitions of "disease" or, if it is one, whether obesity is a disease of metabolism, inflammation, brown fat, chronobiology, the blood-brain barrier, the right brain, or even of infectious origin. The concept of "obesity" as a disease remains controversial to some because not everyone who has excess adipose tissue has any evidence of disease. Obesity, though, has also been considered a sin, a crime against society, an aesthetic crime, a self-inflicted disability, an example of body diversity, a failure in the regulation of energy balance, an appropriate or even inappropriate adaptation to our increasingly obesogenic environment, a genetic disorder, and a psychological/behavioral disorder of overeating involving self-regulation or even addiction. Five major paradigms-medical, sociocultural, evolutionary, environmental, and psychological/behavioral, all with their own subcategorical models-have been identified. All 5 paradigms are required because we are dealing not with "obesity" but with a plurality, the "obesities."

Examining the relationship between fatigue and cognition after stroke: A systematic review

Many stroke survivors experience fatigue, which is associated with a variety of factors including cognitive impairment. A few studies have examined the relationship between fatigue and cognition and have obtained conflicting results. The aim of the current study was to review the literature on the relationship between fatigue and cognition post-stroke. The following databases were searched: EMBASE (1980-February, 2014), PsycInfo (1806-February, 2014), CINAHL (1937-February, 2014), MEDLINE (1946-February, 2014), Ethos (1600-February, 2014) and DART (1999-February, 2014). Reference lists of relevant papers were screened and the citation indices of the included papers were searched using Web of Science. Studies were considered if they were on adult stroke patients and assessed the following: fatigue with quantitative measurements (≥ 3 response categories), cognition using objective measurements, and the relationship between fatigue and cognition. Overall, 413 papers were identified, of which 11 were included. Four studies found significant correlations between fatigue and memory, attention, speed of information processing and reading speed (r = -.36 to .46) whereas seven studies did not. Most studies had limitations; quality scores ranged from 9 to 14 on the Critical Appraisal Skills Programme Checklists. There was insufficient evidence to support or refute a relationship between fatigue and cognition post-stroke. More robust studies are needed.