Social Belonging as a Predictor of Surgical Resident Well-being and Attrition

OBJECTIVE

In light of the predicted shortage of surgeons, attrition from surgical residency is a significant problem. Prior data have shown that those who are happier are more productive, and those who are less well have higher rates of absenteeism. This study sought to identify the role of social belonging and its relationship to well-being and risk of attrition.

DESIGN

Surgical residents were invited to participate in an online survey containing measures of social belonging (a 10-item scale adapted from previous studies), well-being (the Dupuy Psychological General Well-Being Scale, Beck Depression Inventory Short Form, and Maslach Burnout Inventory), and risk of attrition (indicated by frequency of thoughts of leaving the program).

SETTING

We surveyed residents at 2 tertiary care centers, Stanford Health Care (2010, 2011, and 2015) and Washington University in St. Louis (2017).

PARTICIPANTS

Categorical general surgery residents, designated preliminary residents going into 7 surgical subspecialties, and nondesignated preliminary residents were included.

RESULTS

One hundred sixty-nine residents responded to the survey for a response rate of 66%. Belonging was positively correlated with general psychological well-being (r = 0.56, p < 0.0001) and negatively correlated with depression (r = -0.57, p < 0.0001), emotional exhaustion (r = -0.58, p < 0.0001), and depersonalization (r = -0.36, p < 0.0001). Further, belonging was negatively correlated with frequency of thoughts of leaving residency (r = -0.45, p < 0.0001). In regression analysis controlling for demographic variables, belonging was a significant positive predictor of psychological well-being (B = 0.95, t = 8.18, p < 0.0001) and a significant negative predictor of thoughts of leaving (B = -1.04, t = -5.44, p < 0.0001).

CONCLUSIONS

Social belonging has a significant positive correlation with well-being and negative correlation with thoughts of leaving surgical training. Lack of social belonging appears to be a significant predictor of risk of attrition in surgical residency. Efforts to enhance social belonging may protect against resident attrition.

Reducing health disparities by removing cost, access, and knowledge barriers

BACKGROUND

While the rate of unintended pregnancy has declined in the United States in recent years, unintended pregnancy among teens in the United States is the highest among industrialized nations, and disproportionately affects minority teens.

OBJECTIVE

Our objective of this secondary analysis was to estimate the risk of unintended pregnancy for both Black and White teens age 15-19 years when barriers to access, cost, and knowledge are removed. Our hypothesis was that the Black-White disparities would be reduced when access, education, and cost barriers are removed.

STUDY DESIGN

We performed an analysis of the Contraceptive CHOICE Project database. CHOICE is a longitudinal cohort study of 9256 sexually active girls and women ages 14-45 years in the St Louis, MO, region from 2007 through 2013. Two measures of disparities were used to analyze teenage pregnancy rates and pregnancy risk from 2008 through 2013 among teens ages 15-19 years. These rates were then compared to the rates of pregnancy among all sexually active teens in the United States during the years 2008, 2009, 2010, and 2011. We estimated an absolute measure (rate difference) and a relative measure (rate ratio) to examine Black-White disparities in the rates of unintended pregnancy.

RESULTS

While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1000 in 2008 to 120.1 per 1000 in 2011; however, the relative ratio disparity decreased only from 2.6-2.5, suggesting that Black sexually active teens in the United States have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates among sexually active teens (age 15-19 years): 2008 through 2009 (rate difference, 18.2; rate ratio, 3.7), 2010 through 2011 (rate difference, 4.3; rate ratio, 1.2), and 2012 through 2013 (rate difference, -1.5; rate ratio, 1.0).

CONCLUSION

When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens were reduced on both absolute and relative scales. The rate of unintended pregnancy was almost equal between Black and White teens compared to large Black-White disparities on the national level.

Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population-based analysis

AIMS

Beyond single-institution case series, limited data are available to describe risks of performing a concurrent cystectomy at the time of urinary diversion for benign end-stage lower urinary tract dysfunction. Using a population-representative sample, this study aimed to analyze factors associated with perioperative complications in patients undergoing urinary diversion with or without cystectomy.

METHODS

A representative sample of patients undergoing urinary diversion for benign indications was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2011. Perioperative complications of urinary diversion with and without concomitant cystectomy were identified and coded using the International Classification of Diseases, version 9. Multivariate logistic regression models identified hospital and patient-level characteristics associated with complications of concomitant cystectomy with urinary diversion.

RESULTS

There were 15,717 records for urinary diversion identified, of which 31.8% demonstrated perioperative complications: urinary diversion with concurrent cystectomy (35.0%) and urinary diversion without concomitant cystectomy (30.6%). Comparing the two groups, a concomitant cystectomy at the time of urinary diversion was significantly associated with a complication (OR = 1.23, 95%CI: 1.03-1.48). Comorbid conditions of obesity, pulmonary circulation disease, drug abuse, weight loss, and electrolyte disorders were positively associated with a complication, while private insurance and southern geographic region were negatively associated.

CONCLUSIONS

A concomitant cystectomy with urinary diversion for refractory lower urinary tract dysfunction elevates risk in this population-representative sample, particularly in those with certain comorbid conditions. This analysis provides critical information for preoperative patient counseling.

Descriptive Analysis of the 2014 Race-Based Healthcare Disparities Measurement Literature

IMPORTANCE

There are more than 500 articles in the 2014 race-based healthcare disparities literature across a broad array of diseases and outcomes. However, unlike many other forms of research (e.g., clinical trials and systematic reviews), there are no required reporting guidelines when submitting results of disparities studies to journals.

OBJECTIVE

This study describes the race-based healthcare disparities measurement literature in terms of study design, journal characteristics, generation of health disparities research, type of disparity measure used, and adherence to disparities measurement guidelines.

METHODS

We searched three databases of peer-reviewed literature, PubMed, Ovid Medline, and JSTOR, for English language articles published in 2014 on racial/ethnic healthcare disparities. Studies must have quantitatively measured the difference in health outcomes between two racial/ethnic groups in order to be included. Our final sample included 266 studies from 167 medical and public health journals.

FINDINGS

Only 7 % (n = 19) of articles reported both an absolute and relative measure of disparity; the majority of studies (64 %, n = 171) reported only a relative measure of effect. Most studies were published in clinical journals (74 %, n = 198), used secondary data (86 %, n = 229), and calculated black-white disparities (82 %, n = 218). The most common condition studied was cancer (25 %, n = 67), followed by a surgical procedure (18 %, n = 48). On average, articles in the sample only met 61 % of the applicable guidelines on reporting of disparities.

CONCLUSIONS AND RELEVANCE

To be able to synthesize findings in the racial disparities literature (meta-analysis), there is a need for the use of consistent methods for quantifying disparities and reporting in the literature. A more consistent battery of measures and consistent reporting across studies may help speed our understanding of the origins and development of solutions to address healthcare disparities. Despite guidelines for best practices in reporting disparities, there is a lack of adherence in the current literature.

Temporal Trends in Conduit Urinary Diversion With Concomitant Cystectomy for Benign Indications: A Population-based Analysis

OBJECTIVE

To describe national trends in cystectomy at the time of urinary diversion for benign indications. Multiple practice patterns exist regarding the necessity for concomitant cystectomy with urinary diversion for benign end-stage lower urinary tract dysfunction. Beyond single-institution reports, limited data are available to describe how concurrent cystectomy is employed on a national level.

MATERIALS AND METHODS

A representative sample of patients undergoing urinary diversion for benign indications with or without concurrent cystectomy was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2011. Using multivariate logistic regression models, we identified hospital- and patient-level characteristics associated with concomitant cystectomy with urinary diversion.

RESULTS

There was an increase in the proportion of concomitant cystectomy at the time of urinary diversion from 20% to 35% (P < .001) between 1998 and 2011. The increase in simultaneous cystectomy over time occurred at teaching hospitals (vs community hospitals), in older patients, in male patients, in the Medicare population (vs private insurance and Medicaid), and in those with certain diagnoses.

CONCLUSION

There has been an overall increase in the use of cystectomy at the time of urinary diversion for benign indications on a national level, although the indications driving this clinical decision appear inconsistent.

Racial and Ethnic Heterogeneity in Self-Reported Diabetes Prevalence Trends Across Hispanic Subgroups, National Health Interview Survey, 1997-2012

Introduction

We examined racial/ethnic heterogeneity in self-reported diabetes prevalence over 15 years.

Methods

We used National Health Interview Survey data for 1997 through 2012 on 452,845 adults aged 18 years or older. Annual self-reported diabetes prevalence was estimated by race/ethnicity and education. We tested for trends over time by education and race/ethnicity. We also analyzed racial/ethnic and education trends in average annual prevalence.

Results

During the 15 years studied, diabetes prevalence differed significantly by race/ethnicity (P < .001) and by Hispanic subgroup (P < .001). Among participants with less than a high school education, the 5-year trend in diabetes prevalence was highest among Cubans and Cuban Americans (β_5YR = 4.8, P = .002), Puerto Ricans (β_5YR = 2.2, P = .06), non-Hispanic blacks (β_5YR = 2.2, P < .001), and non-Hispanic whites (β_5YR = 2.1, P < .001). Among participants with more than a high school education, non-Hispanic blacks had the highest average annual prevalence (5.5%) and Puerto Ricans had the highest 5-year trend in annual diabetes prevalence (β_5YR = 2.6, P = .001).

Conclusions

In this representative sample of US adults, results show ethnic variations in diabetes prevalence. The prevalence of diabetes is higher among Hispanics than among non-Hispanic whites, unevenly distributed across Hispanic subgroups, and more pronounced over time and by education. Findings support disaggregation of data for racial/ethnic populations in the United States to monitor trends in diabetes disparities and the use of targeted, culturally appropriate interventions to prevent diabetes.

Relationships Between Health Literacy and Genomics-Related Knowledge, Self-Efficacy, Perceived Importance, and Communication in a Medically Underserved Population

The increasing importance of genomic information in clinical care heightens the need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and family health history (FHH) and communication about FHH in a medically underserved population. The analytic sample was composed of 624 patients at a primary care clinic in a large urban hospital. About half of the participants (47%) had limited health literacy; 55% had no education beyond high school, and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β = -0.55, SE = 0.10, p < .0001), lower awareness of FHH (odds ratio [OR] = 0.50, 95% confidence interval [CI; 0.28, 0.90], p = .020), and greater perceived importance of genetic information (OR = 1.95, 95% CI [1.27, 3.00], p = .0022) but lower perceived importance of FHH information (OR = 0.47, 95% CI [0.26, 0.86], p = .013) and more frequent communication with a doctor about FHH (OR = 2.02, 95% CI [1.27, 3.23], p = .0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients.

Structural characteristics of the desmin protofilament

Biochemical investigations of intermediate filaments in soluble or partially assembled forms are often difficult to perform due to the unusual insolubility of most types of intermediate filaments. However, desmin is soluble in 10 mM Tris. The structure of partially soluble native desmin was studied by gel-filtration chromatography and electron microscopy. The lowest molecular weight species of soluble desmin is a flexible rod averaging 53 nm in length. Calculations of f/fmin values from a previously published sedimentation value allowed comparisons with other elongated proteins. These values and the dimensions obtained from electron microscopy suggest that the desmin protofilament contains three or four protein subunits.

Visualization of a 21-nm axial periodicity in shadowed keratin filaments and neurofilaments

Unidirectional and rotary shadowing techniques have been applied in studying the surface structure of two types of intermediate filaments. Keratin filaments and neurofilaments demonstrate a approximately 21-nm axial periodicity which probably indicates the helical pitch of the outer shell of the filament. Analysis of unidirectionally shadowed keratin showed that the helix is left-handed. The observation of a left-handed helix of 21-nm pitch supports the three-stranded protofilament model of Fraser, Macrae, and Suzuki (1976, J. Mol. Biol. 108:435-452), and indicates that keratin filaments probably consist of 10 three-stranded protofilaments surrounding a core of three such protofilaments, as predicted by models based on x-ray diffraction of hard keratin filaments. Neurofilaments do not demonstrate an easily identifiable hand, so their consistency with the model is, as yet, uncertain.