Laura P. Chen

Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis

OBJECTIVE To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. PATIENTS AND METHODS We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity. RESULTS The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victims sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape. CONCLUSION A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.

Sexual Abuse and Lifetime Diagnosis of Somatic Disorders: A Systematic Review and Meta-analysis

CONTEXT Many patients presenting for general medical care have a history of sexual abuse. The literature suggests an association between a history of sexual abuse and somatic sequelae. OBJECTIVE To systematically assess the association between sexual abuse and a lifetime diagnosis of somatic disorders. Data Sources and Extraction A systematic literature search of electronic databases from January 1980 to December 2008. Pairs of reviewers extracted descriptive, quality, and outcome data from included studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity. STUDY SELECTION Eligible studies were longitudinal (case-control and cohort) and reported somatic outcomes in persons with and without history of sexual abuse. RESULTS The search identified 23 eligible studies describing 4640 subjects. There was a significant association between a history of sexual abuse and lifetime diagnosis of functional gastrointestinal disorders (OR, 2.43; 95% CI, 1.36-4.31; I(2) = 82%; 5 studies), nonspecific chronic pain (OR, 2.20; 95% CI, 1.54-3.15; 1 study), psychogenic seizures (OR, 2.96; 95% CI, 1.12-4.69, I(2) = 0%; 3 studies), and chronic pelvic pain (OR, 2.73; 95% CI, 1.73-4.30, I(2) = 40%; 10 studies). There was no statistically significant association between sexual abuse and a lifetime diagnosis of fibromyalgia (OR, 1.61; 95% CI, 0.85-3.07, I(2) = 0%; 4 studies), obesity (OR, 1.47; 95% CI, 0.88-2.46; I(2) = 71%; 2 studies), or headache (OR, 1.49; 95% CI, 0.96-2.31; 1 study). We found no studies that assessed syncope. When analysis was restricted to studies in which sexual abuse was defined as rape, significant associations were observed between rape and a lifetime diagnosis of fibromyalgia (OR, 3.35; 95% CI, 1.51-7.46), chronic pelvic pain (OR, 3.27; 95% CI, 1.02-10.53), and functional gastrointestinal disorders (OR, 4.01; 95% CI, 1.88-8.57). CONCLUSION Evidence suggests a history of sexual abuse is associated with lifetime diagnosis of multiple somatic disorders.

Restructuring a basic science course for core competencies: an example from anatomy teaching.

Medical schools revise their curricula in order to develop physicians best skilled to serve the publics needs. To ensure a smooth transition to residency programs, undergraduate medical education is often driven by the six core competencies endorsed by the Accreditation Council for Graduate Medical Education (ACGME): patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice. Recent curricular redesign at Mayo Medical School provided an opportunity to restructure anatomy education and integrate radiology with first-year gross and developmental anatomy. The resulting 6-week (120-contact-hour) human structure block provides students with opportunities to learn gross anatomy through dissection, radiologic imaging, and embryologic correlation. We report more than 20 educational interventions from the human structure block that may serve as a model for incorporating the ACGME core competencies into basic science and early medical education. The block emphasizes clinically-oriented anatomy, invites self- and peer-evaluation, provides daily formative feedback through an audience response system, and employs team-based learning. The course includes didactic briefing sessions and roles for students as teachers, leaders, and collaborators. Third-year medical students serve as teaching assistants. With its clinical focus and competency-based design, the human structure block connects basic science with best-practice clinical medicine.

Comparative Efficacy of Group and Individual Feedback in Gross Anatomy for Promoting Medical Student Professionalism.

Professionalism is a core competency of medical training that requires students to develop the skills of providing and receiving feedback. Our study evaluated the effectiveness of delivering feedback in a group setting compared with an individual setting. The first‐year class of Mayo medical students (n = 49) enrolled in gross anatomy (in dissection teams), completed weekly anonymous evaluations of themselves and their teammates regarding seven aspects of professionalism (altruism, compassion, respect, honesty/integrity, responsibility, commitment to excellence, and self‐reflection). Professionalism scores from these surveys were calculated using a six‐point Likert scale. Students were also asked to comment on strengths and possible areas for improvement on each peer. At the midpoint of the course, peer comments and professionalism scores were shared with students in debriefing sessions either individually or with their team. Analysis of preintervention and postintervention professionalism scores indicated that the students receiving feedback in a one‐on‐one setting (student and instructor) were more likely to demonstrate higher scores on subsequent evaluations as compared with those students receiving feedback in a group setting (all team members and one instructor). Our findings suggest that providing feedback to first‐year medical students on an individual basis is the best way to improve professional attitudes and behaviors. Anat Sci Educ 3: 64–72, 2010.

Learning to Lead: Self- and Peer Evaluation of Team Leaders in the Human Structure Didactic Block.

Increasing emphasis on leadership in medical education has created a need for developing accurate evaluations of team leaders. Our study aimed to compare the accuracy of self‐ and peer evaluation of student leaders in the first‐year Human Structure block (integrated gross anatomy, embryology, and radiology). Forty‐nine first‐year medical students at Mayo Medical School were assigned to learning teams of three or four members. Teams worked together on daily laboratory dissection, clinical projects, embryology presentations, and daily group quizzes. Student team leaders were responsible for leading laboratory dissection, reviewing radiographic findings, and organizing group assignments. Weekly electronic surveys were administered to evaluate team leaders on altruism, compassion, respect, integrity, responsibility, commitment to excellence, and self‐reflection. Results demonstrated that team leaders rated themselves lower than their peers rated them in multiple aspects of leadership. Peer evaluation of team leaders was statistically higher than self‐evaluation in all traits measured except respect. Female leaders were rated higher by their peers in the areas of responsibility and self‐reflection compared to male leaders. This study demonstrates the need for increased communication between team leaders and members, along with creation of a mutually respectful environment, to improve leader awareness of their abilities and foster team success. Anat Sci Educ 2:210–217, 2009.

Pediatric Obesity and Self-Reported Health Behavior Information:

Childhood obesity is a growing epidemic in the United States. According to the 2003-2006 National Health and Nutrition Examination Surveys, 24.4% of 2to 5-yearolds and 33.3% of 6to 11-year-olds are overweight or obese. As overweight and obesity are related to a myriad of health problems and are amenable to intervention, they have become the focus of many clinicians and researchers. Several studies have demonstrated how sedentary behaviors such as increased TV watching, playing electronic games, and lack of physical activity, along with poor dietary patterns such as restaurant eating and excessive portion size are significantly associated with childhood obesity. However, much of the existing research is restricted by methodological limitations such as small sample size, unvalidated measurement tools, statistical issues, inappropriate follow-up, and lack of practice-relevant information. These shortcomings, coupled with the lack of formal research in this area and conflicting results provided, strongly suggest that further research is warranted. The purpose of this investigation is to offer new information regarding the association of self-reported sedentary lifestyle and poor dietary habits with childhood obesity in a large population, using a unique data set that merged self-reported data with measured clinical data (height and weight). To our knowledge, no previous studies have investigated this topic on such a large primary care population of children using both selfreported and biometric data.

Misperceptions of weight status among adolescents: sociodemographic and behavioral correlates.

Objective Accurate perceptions of weight status are important motivational triggers for weight loss among overweight or obese individuals, yet weight misperception is prevalent. To identify and characterize individuals holding misperceptions around their weight status, it may be informative for clinicians to assess self-reported body mass index (BMI) classification (ie, underweight, normal, overweight, obese) in addition to clinical weight measurement. Methods Self-reported weight classification data from the 2007 Current Visit Information – Child and Adolescent Survey collected at Mayo Clinic in Rochester, MN, were compared with measured clinical height and weight for 2,993 adolescents. Results While, overall, 74.2% of adolescents accurately reported their weight status, females, younger adolescents, and proxy (vs self) reporters were more accurate. Controlling for demographic and behavioral characteristics, the higher an individual’s BMI percentile, the less likely there was agreement between self-report and measured BMI percentile. Those with high BMI who misperceive their weight status were less likely than accurate perceivers to attempt weight loss. Conclusion Adolescents’ and proxies’ misperception of weight status increases with BMI percentile. Obtaining an adolescent’s self-perceived weight status in addition to measured height and weight offers clinicians valuable baseline information to discuss motivation for weight loss.