Understanding resident wellness: A path analysis of the clinical learning environment at three institutions

PURPOSE

The clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout.

MATERIALS AND METHODS

Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout.

RESULTS

Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= -0.12, p=.025; PS: B= -0.37, p<.001). The relationship between stress and residents' level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout.

CONCLUSIONS

Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors.

Serving on a Graduate Medical Education Diversity, Equity, Inclusion, and Justice Committee: Lessons Learned From a Journey of Growth and Healing

Efforts toward achieving diversity, equity, inclusion, and justice (DEIJ) within graduate medical education (GME) often begin with the formation of a DEIJ committee that steers the work. Little is known about the experiences and the challenges faced by those serving on such committees. We sought to describe the experiences of members of our institutional GME DEIJ committee to gain knowledge that would propel this work forward. An open-ended survey was electronically administered to members of our institutional GME DEIJ committee. Responses were analyzed using a rapid qualitative analytical approach. Eighteen members (58%) responded. Of these, (67%) were women and five (28%) were Black. Six domains emerged: “motivation,” “challenges,” “emotional response,” “highs,” “facilitators,” and “advice.” Black respondents more often cited the need to increase diversity as a motivator to join this work. Women and Black respondents more often identified time constraints as a challenge to participation. Some members found the work emotionally draining; others described it as uplifting. Two themes emerged as high points of participation-pride and achievement around the work completed and the personal benefits of building a community with a shared purpose. Three themes emerged as facilitators: effective leadership, support, and establishing psychological safety during the meetings. Many arrived at the realization that change would take time and advocated for patience and perseverance. Protected time and DEIJ expertise were identified as integral to successful committee work. Our findings provide novel insights into the experience of serving on a GME DEIJ committee and highlights infrastructural and institutional prerequisites for success.

Characteristics of Intimate Partner Violence Incidents and the Environments in Which They Occur: Victim Reports to Responding Law Enforcement Officers

The objectives of this study were to identify intimate partner violence (IPV) incidence rates, to quantify specific risks and characteristics of these incidents and the environments in which they occur, to identify how often children are present for or injured during these incidents, and to identify differences in victim reports of IPV to law enforcement officers at the scene of the incident compared with previously published reports of IPV from retropsective, anonymous surveys and domestic violence shelter interviews. Data gathered by responding law enforcement officers at the scene of the IPV incident were used to determine the prevalence of IPV incident characteristics and outcomes. Females aged 20 to 39 years, unmarried adults, and African Americans were disproportionately represented as victims of IPV in this study. IPV incidents were significantly more likely to occur on Saturdays and Sundays and during the months of May through August. Relationship durations for suspect-victim pairs were most often less than 12 months at the time of the incident. Weapon use and/or strangulation was common, occurring in 44% of all incidents. Minors (under age 18 years) were frequently present in the home during the IPV incident or a member of the household (59%). This study provides a unique perspective of IPV by utilizing data collected directly from the scene of the incident by first responders. Previously published characteristics of IPV were confirmed, but this study also brings to light new and critical information concerning this prevalent form of violence. Study findings relating to incidence, seasonality, severity, disproportionately affected populations, and child exposure are discussed.

Consultations in Child Abuse Pediatrics

This study describes a hospital-based child abuse pediatrics consultation service. Medical records for all child abuse pediatrics consultations during 2006 to 2009 were reviewed. Descriptive statistics were used for data analysis. Of 2495 consultations, 13 were excluded due to insufficient information, 1682 were examinations for suspected sexual abuse, and 800 were examinations for nonsexual abuse concerns. Among the latter group of 800 patients, the most common reasons for consultation were fracture (33.5%), nonburn skin injury (16.8%), burn (15.4%), and intracranial injury (13.2%). Median patient age was 11 months (range = 3 days to 16 years). Case fatality rate was 3.9%. Final diagnosis was classified as definite/likely abuse in 40.0%, questionable/unknown in 24.5%, definite/likely accident in 23.6%, no injury in 4.6%, neglect in 4.0%, and a medical condition in 3.2%. Therefore, among consultations requested for suspected child maltreatment, a child abuse pediatrician concluded that abuse was definite or likely in less than half of patients.

Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

BACKGROUND

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality.

OBJECTIVE

The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital.

MATERIALS AND METHODS

A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER™ scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma.

RESULTS

There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma patients (41% vs 23%, P=0.02; 26% vs. 12%, P=0.03). The most common findings resulting in major radiologic interpretation errors were fractures and subdural hemorrhage. Differences in the age of the patient and the percentage of patients with hemorrhage were statistically significant between the abusive head trauma versus non-abusive head trauma groups, while no statistical difference was identified for skull fractures, ischemia, head CT radiation dose, or presence of multiplanar or 3-D reformatted images. The second interpretation more frequently indicated potential for abusive head trauma compared to the primary interpretation (P=0.0001). MRI and/or surgical findings were in agreement with the second interpretation in 29/29 (100%) of patients with discrepancies.

CONCLUSION

A high incidence of radiologic interpretation errors may occur in pediatric trauma patients at risk for abusive head trauma who are referred from a community hospital. This suggests value for second interpretations of head CTs at a tertiary pediatric hospital for this patient population.

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

BACKGROUND AND PURPOSE

MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma.

MATERIALS AND METHODS

A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma. All patients received noncontrast head CT, ultrafast brain MR imaging without sedation, and standard MR imaging with general anesthesia or an immobilizer, sequentially. Two pediatric neuroradiologists independently reviewed each technique blinded to other modalities for intracranial trauma. We performed interreader agreement and consensus interpretation for standard MR imaging as the criterion standard. Diagnostic accuracy was calculated for ultrafast MR imaging, noncontrast head CT, and combined ultrafast MR imaging and noncontrast head CT.

RESULTS

Interreader agreement was moderate for ultrafast MR imaging (κ = 0.42), substantial for noncontrast head CT (κ = 0.63), and nearly perfect for standard MR imaging (κ = 0.86). Forty-two percent of patients had discrepancies between ultrafast MR imaging and standard MR imaging, which included detection of subarachnoid hemorrhage and subdural hemorrhage. Sensitivity, specificity, and positive and negative predictive values were obtained for any traumatic pathology for each examination: ultrafast MR imaging (50%, 100%, 100%, 31%), noncontrast head CT (25%, 100%, 100%, 21%), and a combination of ultrafast MR imaging and noncontrast head CT (60%, 100%, 100%, 33%). Ultrafast MR imaging was more sensitive than noncontrast head CT for the detection of intraparenchymal hemorrhage (P = .03), and the combination of ultrafast MR imaging and noncontrast head CT was more sensitive than noncontrast head CT alone for intracranial trauma (P = .02).

CONCLUSIONS

In abusive head trauma, ultrafast MR imaging, even combined with noncontrast head CT, demonstrated low sensitivity compared with standard MR imaging for intracranial traumatic pathology, which may limit its utility in this patient population.

Stress, Coping, and Injuries in Male and Female High School Basketball Players

Past research has identified a positive relationship between life-event stress and football injuries, but research in other sports has yielded more ambiguous results. It seems, then, that the relation of life stress and injury may be sport-specific and that different sports must be studied separately before such a relationship is assumed. The present investigation examined the relationships among life-event stress, coping skills, social support, and injuries of male and female high school basketball players. Contrary to the hypothesis, the number of days missed due to injury was not significantly related to life-event stress. As expected, the injury measure was negatively correlated with both the coping-skills and social-support variables, but these correlations did not reach statistical significance. Recommendations for research are discussed.

Yield of skeletal surveys in children ≤ 18 months of age presenting with isolated skull fractures

OBJECTIVE

To measure the yield of a skeletal survey in children ≤ 18 months old presenting with isolated skull fractures without significant intracranial injury.

STUDY DESIGN

A retrospective chart review was conducted on all children ≤ 18 months old presenting with an isolated skull fracture not associated with a motor vehicle crash or shopping cart fall between January 1, 2004 and December 31, 2010. An institutional protocol requires a skeletal survey and social work consult on all such children. We analyzed the association of mechanism of injury, type of skull fracture, and presence of "red flags" with a positive skeletal survey using χ(2) and Fisher exact tests.

RESULTS

Of 175 eligible patients, 150 (86%) underwent a skeletal survey. Of the 9 patients (6%) who had another fracture in addition to the presenting one, only 1 child was older than 6 months. Eight patients with additional fractures had a simple skull fracture (not complex) and 7 patients with other fractures had at least 1 red flag. Regarding skull fractures, the majority of long falls (81%) resulted in a simple skull fracture.

CONCLUSION

The skeletal survey in patients with isolated skull fractures revealed additional fractures in 6% of patients. Thus, a skeletal survey may yield clinically and forensically relevant data in such patients. However, it may be possible to restrict the window for obtaining a skeletal survey to younger infants, particularly those who are premobile.

Bio-monitoring for uranium using stream-side terrestrial plants and macrophytes

This study evaluated the abilities of various plant species to act as bio-monitors for environmental uranium (U) contamination. Vegetation and soil samples were collected from a U processing facility. The water-way fed from facility storm and processing effluents was the focal sample site as it represented a primary U transport mechanism. Soils and sediments from areas exposed to contamination possessed U concentrations that averaged 630 mg U kg(-1). Aquatic mosses proved to be exceptional accumulators of U with dry weight (dw) concentrations measuring as high as 12,500 mg U kg(-1) (approximately 1% of the dw mass was attributable to U). The macrophytes (Phragmites communis, Scripus fontinalis and Sagittaria latifolia) were also effective accumulators of U. In general, plant roots possessed higher concentrations of U than associated upper portions of plants. For terrestrial plants, the roots of Impatiens capensis had the highest observed levels of U accumulation (1030 mg kg(-1)), followed by the roots of Cyperus esculentus and Solidago speciosa. The concentration ratio (CR) characterized dry weight (dw) vegetative U levels relative to that in associated dw soil. The plant species that accumulated U at levels in excess of that found in the soil were: P. communis root (CR, 17.4), I. capensis root (CR, 3.1) and S. fontinalis whole plant (CR, 1.4). Seven of the highest ten CR values were found in the roots. Correlations with concentrations of other metals with U were performed, which revealed that U concentrations in the plant were strongly correlated with nickel (Ni) concentrations (correlation: 0.992; r-squared: 0.984). Uranium in plant tissue was also strongly correlated with strontium (Sr) (correlation: 0.948; r-squared: 0.899). Strontium is chemically and physically similar to calcium (Ca) and magnesium (Mg), which were also positively-correlated with U. The correlation with U and these plant nutrient minerals, including iron (Fe), suggests that active uptake mechanisms may influence plant U accumulation.

Incidence of fractures among children with burns with concern regarding abuse

OBJECTIVE

Consensus recommendations state that a radiographic skeletal survey is mandatory for all children <2 years of age with concern for physical abuse. It has been suggested that patients with burns may represent a special subgroup at lower risk for occult fractures, compared with other abused children. Our objective was to determine the prevalence of fractures in children referred for subspecialty abuse evaluations because of burns.

METHODS

We performed retrospective analyses of data collected as part of the Using Liver Transaminases to Recognize Abuse (ULTRA) research network. Data were collected for all children <5 years of age who were referred to 19 child protection teams for subspecialty child abuse evaluations over 1 year (N = 1676). We compared the rate of fractures in children presenting with burns with that in other children evaluated for abuse.

RESULTS

Of 97 children <24 months of age with burns, 18 (18.6%) were also found to have fractures. Among all 1203 children <24 months of age, 649 (53.9%) had fractures. Eleven children had multiple fractures, and 12 children had fractures with radiographic evidence of healing. Two children were noted to have classic metaphyseal fractures.

CONCLUSION

The rate of fractures in children who present with burns and concerns regarding physical abuse is sufficient to support the recommendation for routinely performing skeletal surveys for children <2 years of age.

Skeletal surveys in children with burns caused by child abuse

OBJECTIVE

To determine the frequency of occult fractures in children with suspicious burns compared with children with other types of physical abuse.

METHODS

Child abuse outpatient clinic reports and inpatient consultations from a midwest urban children's hospital for 1989 to 2000 were reviewed. Demographic and clinical data were abstracted for patients seen because of suspected physical abuse. Patients were classified based on reason seen (burns vs other physical injuries), whether they were diagnosed as abused, and whether they had at least 1 skeletal survey. Positive skeletal surveys were defined as having a fracture that was unexplained, highly specific for abuse, or with a perpetrator confession.

RESULTS

Of 335 patients evaluated, the mean age (+/-SD) was 1.5 +/- 1.9 years, 63% were boys, 64% were white, and 80% had skeletal surveys performed. Reasons for evaluation included 69 (21%) for burns and 266 (79%) for other injuries. After excluding patients without a final diagnosis of abuse and those presenting with obvious fractures, 5 (14%) of 36 burn patients had positive skeletal surveys compared with 45 (34%) of 133 with nonburn injuries (P = 0.02). Burn patients were older compared with those with nonburn injuries (mean ages, 1.8 +/- 1.5 vs. 1.1 +/- 1.6 years; P = 0.03) and were more likely to be nonwhite (69% vs. 32%; P < 0.001).

CONCLUSIONS

Although young children with abusive burns have fewer occult fractures compared with those with other abusive injuries, the frequency of occult fractures is still high enough to warrant the consideration of skeletal surveys in these cases.

Handedness and anxiety

The anxiety scores of 23 left-handed, 12 mixed-handed and 35 right-handed college students were compared with the result that right-handers were significantly less anxious then both the left and the mixed-handed groups (which did not differ statistically). Since these data appear to be unique, generalizations from them was thought to be premature.

Striking changes in the sleep satisfaction of university students over the last two decades

Over two decades, our data document a substantial linear increase in the percentage of university students who self-reported dissatisfaction with their sleep, i.e., 24% in 1978, 53% in 1988, and 71% in 2000.

The changing sleep habits of university students: an update

Using data collected from 9,543 university undergraduates, we noted that over three decades, the median hours of sleep reported by these students has decreased by more than one hour.

Self-reported sleep durations of college students: normative data for 1978-79, 1988-89, and 2000-01

In 2000-2001 academic year the frequency distribution of hours slept per night was not significantly different from distributions of 1978-79 and 1988-89.

"You are hereby commanded to appear": pediatrician subpoena and court appearance in child maltreatment

OBJECTIVE

To determine the frequency of court appearance by pediatricians evaluating child abuse and neglect cases and to identify case characteristics associated with actual court appearance or case adjournment.

DESIGN

Retrospective review of subpoenas received between 1995 and 1999 for child maltreatment cases personally evaluated by 2 pediatricians during the years 1995 to 1998. Information was collected regarding patient age, gender, race/ethnicity, type of suspected maltreatment, date of evaluation, date of subpoena, type of court hearing, whether the pediatrician actually testified in court, and legal outcomes. Case characteristics were compared between pediatricians and were used to predict physician appearance and case continuance or adjournment in logistic regression models.

RESULTS

Four hundred forty-five subpoenas concerning 260 patients were received. Although significant differences were noted between the pediatricians in type of abuse, no differences were found in patient age, gender, ethnicity or legal outcomes. The pediatricians received subpoenas in <15% of child maltreatment cases, and <5% of children seen resulted in the physician being required to actually appear in court. No case characteristics significantly predicted court appearance or case continuance or adjournment.

CONCLUSIONS

Although pediatricians are sometimes subpoenaed to appear in court to explain the medical evaluation and the needs of the child in cases of child abuse and neglect, most court cases were continued, adjourned, or settled before physician testimony. Most subpoenas did not result in the pediatrician going to court, and it is unclear which child factors may predict court involvement. Pediatricians can take steps to minimize (but not eliminate) the potential dissatisfaction and inconvenience associated with receiving and responding to subpoenas in child maltreatment cases.

Stamina in adults: is attachment style a factor?

The study was designed to extend inquiry on adult attachment style to include the variable of personal stamina. The data were derived from an anonymous survey administered to 163 college students (82 women and 81 men) in introductory psychology classes. Attachment style was measured by the Close Relationship Questionnaire, based on a four-category scheme suggested by Bartholomew. Stamina was evaluated with a self-report scale developed by R. A. Hicks. The pattern of statistically significant differences (p < .001) in the relative frequency with which respondents self-identified with descriptions of each of the four attachment styles on the questionnaire diverged somewhat from those reported previously. Respondents who identified themselves as most accurately described by the questionnaire's alternative defined as characterizing secure attachment had significantly higher stamina scores than did those who self-endorsed the fearful or preoccupied alternatives in that categorical measure. No other pairwise comparisons of stamina scores were statistically significant. The results provide preliminary support for the hypothesis that secure attachment is more facilitative of personal stamina than are insecure styles. Methodological limits on inferences and corresponding alternative interpretations, the potential effectiveness of defensive suppression of the attachment system in dismissing-avoidant adults, and directions for research are discussed.

Consistency of hand use and frequency of colds among college students

The self reported annual frequencies of colds were assessed for two groups of 37 students each who were either consistent or inconsistent in the use of their hands. These data indicated that the inconsistent hand use group reported significantly more colds than their consistent hand use peers.

Boundaries and level of experience with six types of dreams

The self-reported levels of experience to six types of dreams were compared for groups of students who classified as having either thin (n = 30) or thick (n = 86) boundaries. Consistent with predictions drawn from the literature, the thin-boundary group scored significantly higher on level of experience for each dream type than the thick-boundary group. These data provide additional validation for Hartmann's Boundary Questionnaire.

Nightmare distress and stress-related health problems

Responses of 289 university students to Belicki's Nightmare Distress Questionnaire and the Stress-related Health Problems Scale were used to test the hypothesis that persons who score high on nightmare distress are more likely to report psychological problems. Since relative to the Low Nightmare Distress group, the High Nightmare Distress group scored significantly higher on all seven of the sets of symptoms that are measured by the Stress-related Health Problems Scale, this hypothesis was supported.

Consistency of hand use and sleep problems

In this study, we measured the relationship between the consistency of hand use and three symptoms of insomnia, i.e., delayed sleep onset, frequent awakenings during sleep, and trouble returning to sleep after an awakening. For each of these insomnia-related symptoms, university students who were classified as inconsistent in the use of their hands (n = 30) were significantly more likely to report problems than their consistent hand-use peers (n = 30). These data were discussed both in relation to the literature on handedness classification and sleep problems and the emerging literature on consistency of hand use and health-related problems.

Consistency of hand use and frequent falls

We examined relationships between consistency of hand use and falling in groups of right-handed university undergraduates who were either consistent (n = 45) or inconsistent (n = 32) in the use of their hands. A scoring procedure developed for the Briggs-Nebes Handedness Scale permitted us to classify individuals as consistent or inconsistent in the use of their hands. The inconsistent group was 2.81 times more likely to have experienced frequent falls during the last 12-mo. period and was 1.64 times more likely to rate themselves higher on proneness to falling. These data suggest that inconsistent hand use may be a sign of a developmental inconsistency in motor coordination.

Consistency of hand use, exercise, and sports-related injuries

In this study, we examined the relationships between the consistency of hand use, exercise, and sports-related injuries as an indirect test of the hypothesis that the consistency of hand use is a reflection of general motor coordination. As we predicted, the consistent hand-use group (n = 23) exercised more, were more likely to follow a regular exercise schedule, and reported having experienced more sports-related accidents than their inconsistent hand-use peers (n = 23).

Ethnicity, Sleep Hygiene Knowledge, and Sleep Hygiene Practices

We tested the mean differences in scores on Sleep Hygiene Knowledge and on Sleep Hygiene Practices among four ethnic groups of university students (N = 963). We computed significant main effects for ethnicity for both of these variables. Primarily the results reflect that the Euro-American students scored significantly higher on both scales than each of the other three groups.

Boundaries and handedness

The responses of 116 university students were used to assess a possible relation between scores on Hartmann's Boundary Questionnaire and the Briggs-Nebes Handedness Scale. Consistent with our prediction, the mean handedness score of the students with thin boundaries was significantly skewed in the direction of mixed-handedness.

Time perspective and sleep problems

In this study of 137 university students, we examined the relationships among the five dimensions of the Zimbardo Time Perspective Inventory and three scales that measure aspects of sleep problems. All of the Zimbardo Inventory dimensions correlated significantly with each of the sleep problem-related scales. These data suggest that concern about time, regardless of the specific nature of individuals' time perspective, and certain sleep problems are significantly related.

Ethnicity and bruxism

Distributions of students of four ethnic groups were statistically significantly different. 106 African-American students reported the lowest incidence of self-reported bruxism (9.4%), 452 Asian students the highest incidence (24.6%); 312 Euro-American and 225 Hispanic students' incidence was intermediate.

Ethnicity, sleep duration, and sleep satisfaction

Analysis of responses of 1100 students from four ethnic groups to questions about the quantity and quality of their sleep indicated that ethnicity was modestly but significantly related.

Cigarette smoking and bruxism

Responses of 18 smokers and 165 nonsmokers to two items which assessed experience with symptoms of bruxism were compared. Smokers were about three times more likely to experience symptoms of bruxism but not over-all stressful experience.

Consistency of hand use and accidents with injury

In this study, we examined the relationship between the consistency of hand use and the self-reported incidence of accidents with injuries which required medical care in groups of university students (n = 23 for each group). To do this, we adopted a scoring procedure for the Briggs-Nebes Handedness Scale that permitted us to classify individuals as consistent or inconsistent in the use of their hands. We observed that the inconsistent group was 6.12 times more likely to have experienced accidents with injury that required medical care than the consistent group. These data have implications for the literature on handedness classification and accidents. Collectively, these limited data underscore the need to pay attention to the consistency of hand use in research on handedness, health, and longevity.

Handedness and stress-related health problems

Response of groups of 163 right-, 22 mixed-, and 20 left-handed university students to the seven symptom subscales of a 48-item Stress-related Health Problems Scale were used to test the hypothesis that left-handedness is associated with an increased risk of stress-related health problems. Since only one of the 21 possible statistical tests computed barely reached statistical significance, there is no meaningful relationship between handedness and stress-related health problems.

Fatal alcohol-related traffic crashes increase subsequent to changes to and from daylight savings time

On the hypothesis that sleepiness and alcohol interact to increase the risk of alcohol-related traffic fatalities, the percentages of alcohol-related fatal traffic crashes were assessed for the entire state of New Mexico for the years 1989-1992, for each of the seven days that preceded the changes to and from Daylight Savings Time and for each of the 14 days which followed the changes to and from Daylight Savings Time. Consistent with our hypothesis the percentage of alcohol-related fatal crashes increased significantly during the first seven days after these changes in Daylight Savings Time.

Ethnicity, sex and snoring

The associations of the incidence of snoring with ethnicity and sex were measured using self-report data collected from 1098 university undergraduates. Both the relationships were significant. The unique feature of these data is that for the first time, a significant relationship between ethnicity and snoring has been reported.

Stress, coping, and injuries in male and female high school basketball players

Past research has identified a positive relationship between life-event stress and football injuries, but research in other sports has yielded more ambiguous results. It seems, then, that the relation of life stress and injury may be sport-specific and that different sports must be studied separately before such a relationship is assumed. The present investigation examined the relationships among life-event stress, coping skills, social support, and injuries of male and female high school basketball players. Contrary to the hypothesis, the number of days missed due to injury was not significantly related to life-event stress. As expected, the injury measure was negatively correlated with both the coping-skills and social-support variables, but these correlations did not reach statistical significance. Recommendations for research are discussed.

Type A-B behavior and nightmare types among college students

To consider the relationships among Type A-B behavior, gender, and specific types of nightmares, 780 university undergraduates were tested with Glass' version of the Jenkins Activity Survey and the Spadafora and Hunt Dream Types Survey which included the critical nightmares (fantastic nightmares, posttraumatic nightmares, and night terrors). Relative to students classified as Type B, those classified as Type A were significantly more likely to report experiencing certain types of nightmares, i.e., fantastic and posttraumatic nightmares. We also observed that women reported significantly greater frequencies of all types of nightmares than men. Possible reasons for these differences were discussed.

Understanding fatal child abuse

Medical, social service and coroner reports were reviewed for 14 cases of fatal child abuse and neglect identified at a children's hospital from 1988-1992. Twelve cases involved physical abuse and two neglect. The median age was 6.5 months (range 24 days to 3 years). Six families (43%) had prior protective service involvement; however, four of the referrals involved a sibling. Only two of 12 physical abuse victims had a history of a prior suspicious injury. Clinical and postmortem findings are presented. The cause of death in all physically abused patients was blunt impact head injury; one also had contributing intraabdominal injuries. Ten cases were ruled due to homicide; 12 have come to legal closure resulting in nine felony convictions. These findings emphasize the role of blunt impact brain injury in fatal child abuse cases. Two findings have significant implications for prevention: (a) the paucity of injuries recognized prior to the fatal event, and (b) among families known to child protection agencies the focus was not the fatally injured child.

Relationship of response-set differences on Beck Depression Inventory scores of undergraduate students

The relationship of a ruminating and a distracting response style upon severity of depression and on gender were investigated. The Ways of Coping Questionnaire was modified to include ruminating and distracting scales and administered to 91 undergraduate students who also completed the Beck Depression Inventory. It was hypothesized that (a) regardless of gender, people who ruminate would have greater rated severity of depression than people who distract themselves; (b) women ruminators would show higher rated severity of depression than women distractors; and (c) female and male ruminators would show the same ratings on severity of depression. A set of t ratios was computed for mean differences between the groups. An analysis of variance for response style x gender was also done with the women and men classified as ruminators. The results conformed to the predictions for women but not for men.

Do right-handers live longer? An updated assessment of baseball player data

In support of the argument that left-handedness is a marker for decreased survival fitness, in 1991 Coren and Halpern gave considerable weight to the results of their 1988 study in which right-handed baseball players were described as having lived about eight months longer than their left-handed peers. In their 1993 unsuccessful attempt to replicate this study, Fudin and colleagues cited certain difficulties with the sources of these data that led them to recommend a comprehensive third study which included only reliable data from the two current editions of the major sources of information on Major League baseball players, i.e., the 1993 editions of The Baseball Encyclopedia and Total Baseball. Following this suggestion, we measured the life spans of all baseball players, i.e., right-, left-, and mixed-handed players, for whom reliable data were available (N = 5441) and found that the relationship between handedness and longevity was not significant. Unlike Halpern and Coren we noted that right-handed players could be described as having lived about eight months less than their left-handed peers.

Arousability and eye color: a test of Worthy's hypothesis

As a test of the hypothesis that eye color is related to reactivity, we measured the relationships between scores on the Arousal Predisposition Scale and two measures of eye color. Our data did not support this hypothesis.

Snoring may be linked to culture

The estimates of the incidence of snoring in adults that have been provided by four epidemiological studies vary from 16-89% of the population. Collectively, these data are completely confounded by country of origin and thus may reflect cultural differences that contribute to snoring. While the etiology of snoring is not fully known, speculation has focused on gender and age as primary factors that contribute to this behavior. Within the limitations imposed by the designs of these four studies, we compared the relative strength of the relationships between snoring and gender, age, and culture. These analyses suggest that certain variables associated with cultures appear to be more salient than both gender and age, as determinants of snoring.

Type A-B scores and insomnia among college students: a replication and extension of earlier studies

In an attempt to rationalize conflicting sets of data from earlier studies, groups of Type A- and Type B-classified university students were asked to respond to a sleep habits questionnaire that included the items of the Coren Insomnia Scale. As was the case in two earlier studies, we found significant but weak evidence from the Coren scale only that Type A-scoring students experience more sleep problems than Type B scorers. We also found, as in a recent study, a sharp increase in sleep problems among all the students sampled from the frequencies reported by similar groups in 1982.

Handedness and accidents with injury

As evidence for the hypothesis on the claim of reduced longevity for left-handers, Coren in 1989 reported data which suggested that left-handers were 1.89 times more likely to report injuries which required medical attention. This left-handed group included both left- and mixed-handed individuals. To clarify the results of his study, we repeated in part Coren's study but defined handedness so that groups of right-, mixed-, and left-handed individuals were considered. In contrast to Coren's data, we found that right- and left-handers did not differ significantly in the frequency with which they reported having experienced accidents with injury and that mixed-handers reported being significantly more likely to have had an injury-accident than either right- or left-handers. These data underscore the need to consider mixed-handedness as a separate group in studies of this type.

Empiric therapy of perianal lesions in a sexually abused child: medical and forensic implications

A two-year, eight-month-old boy was diagnosed clinically with perianal warts and treated with topical 5-Fluorouracil, with subsequent resolution of the lesions. The child disclosed sexual abuse, and subsequent physical abuse was also documented. Attempts to identify the perpetrator have been hampered by the child's young age and resolution of the skin lesions. The forensic implications of this case are discussed.

Snoring and nightmares

To test the conclusion of a recent study that snoring and disturbing dreams are strongly associated, 199 university undergraduates responded to a questionnaire that assessed their level of snoring and the frequency with which they experienced fantastic nightmares. Contrary to data provided by this recent study, we did not find a significant relationship between snoring and disturbing dreams. Some possible reasons for the discrepancy between these data sets were considered.

Does cigarette smoking increase sleep problems

Cigarette smoking has been associated with delayed sleep onset and diminished sleep duration, primarily on the bases of responses to one-shot questionnaires. This study used a survey format of daily diaries to observe sleep quality. 29 smokers were matched for age, ethnicity, and gender with 29 nonsmokers. Both groups recorded information on cigarette, alcohol, caffeine consumption, daily stress, and sleep quality. While the results showed that smokers were more likely to experience poor sleep than nonsmokers, these data are difficult to interpret because smokers also used significantly greater amounts of alcohol and caffeine.

The incidence of sleep problems among type A and type B college students: changes over a ten-year period (1982-1992)

Ten years ago we reported that Type A scoring students were twice as likely as their Type B peers to report sleep problems. In an exact 1992 replication of that study, no Type A-B differences in the frequency of self-reported sleep problems were observed; however, the over-all incidence of sleep problems among the 753 college students had increased substantially.

Arousability and bruxism in male and female college students

The relationship between arousability, as measured by the Arousal Predisposition Scale, and bruxism was computed for groups of 41 male and 75 female university undergraduates as a further test of the hypothesis that bruxism is a stress-linked disorder. Contrary to our prediction, arousability was not related to bruxism in men and the relationship between these variables for women was significant but relatively weak. When considered with other studies, these data provide a clearer focus for further study of the stress-bruxism hypothesis.

Changes in the self-reported consistency of normal habitual sleep duration of college students (1978 and 1992)

Changes in the consistency of self-reported sleep habits within two large samples of 763 and 782 college students were assessed for 1978 and 1992. Noteworthy changes over the 14-yr. period included significant decreases in the percentage of students who claimed stable (> or = 5-year) sleep-duration habits and the percentage reporting satisfaction with their sleep.

Arousability and eating problems of college women

A significant relationship between arousability and abnormal eating patterns, computed from the responses of 184 college women to the Arousability Predisposition Scale and the Eating Attitudes Test, provided a constructive replication of earlier results by Mehrabian and his colleagues.