Pia Thiemann

Oxytocin increases eye contact during a real-time, naturalistic social interaction in males with and without autism

Autism spectrum conditions (autism) affect ~1% of the population and are characterized by deficits in social communication. Oxytocin has been widely reported to affect social-communicative function and its neural underpinnings. Here we report the first evidence that intranasal oxytocin administration improves a core problem that individuals with autism have in using eye contact appropriately in real-world social settings. A randomized double-blind, placebo-controlled, within-subjects design is used to examine how intranasal administration of 24 IU of oxytocin affects gaze behavior for 32 adult males with autism and 34 controls in a real-time interaction with a researcher. This interactive paradigm bypasses many of the limitations encountered with conventional static or computer-based stimuli. Eye movements are recorded using eye tracking, providing an objective measurement of looking patterns. The measure is shown to be sensitive to the reduced eye contact commonly reported in autism, with the autism group spending less time looking to the eye region of the face than controls. Oxytocin administration selectively enhanced gaze to the eyes in both the autism and control groups (transformed mean eye-fixation difference per second=0.082; 95% CI:0.025–0.14, P=0.006). Within the autism group, oxytocin has the most effect on fixation duration in individuals with impaired levels of eye contact at baseline (Cohen’s d=0.86). These findings demonstrate that the potential benefits of oxytocin in autism extend to a real-time interaction, providing evidence of a therapeutic effect in a key aspect of social communication.

Body image disturbance in children and adolescents with eating disorders. Current evidence and future directions.

Body image is multifaceted and incorporates perceptual, affective, and cognitive components as well as behavioral features. Only few studies have examined the character of body-image disturbance in children/adolescents with eating disorders. It is unknown whether body-image disturbances in children/adolescent with eating disturbances are comparable to those of adult patients with eating disorders. Body-image disturbance might differ quantitatively and qualitatively according to the cognitive developmental status and the age of the individual. This paper provides an overview of the current evidence for body-image disturbance in children/adolescents with eating disorders, and how they compare with those adults with eating disorders. Current evidence indicates that older adolescent patients show similar deficits as adult patients with eating disorders, in particular for the attitudinal body-image component. However, evidence for a perceptual body-image disturbance in adolescent patients, in particular anorexia nervosa, is not conclusive. Reliable statements for childhood can hardly be made because clinical studies are not available. Investigations of body-image disturbance in children have focused on the predictive value for eating disorders. Limitations of the current evidence are discussed, and future directions for research and therapy are indicated.

Measuring medical students' empathy: exploring the underlying constructs of and associations between two widely used self-report instruments in five countries

Purpose Understanding medical student empathy is important to future patient care; however, the definition and development of clinical empathy remain unclear. The authors sought to examine the underlying constructs of two of the most widely used self-report instruments—Davis’s Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy version for medical students (JSE-S)—plus, the distinctions and associations between these instruments. Method Between 2007 and 2014, the authors administered the IRI and JSE-S in three separate studies in five countries, (Brazil, Ireland, New Zealand, Portugal, and the United Kingdom). They collected data from 3,069 undergraduate medical students and performed exploratory factor analyses, correlation analyses, and multiple linear regression analyses. Results Exploratory factor analysis yielded identical results in each country, confirming the subscale structures of each instrument. Results of correlation analyses indicated significant but weak correlations (r = 0.313) between the total IRI and JSE-S scores. All intercorrelations of IRI and JSE-S subscale scores were statistically significant but weak (range r = −0.040 to 0.306). Multiple linear regression models revealed that the IRI subscales were weak predictors of all JSE-S subscale and total scores. The IRI subscales explained between 9.0% and 15.3% of variance for JSE-S subscales and 19.5% for JSE-S total score. Conclusions The IRI and JSE-S are only weakly related, suggesting that they may measure different constructs. To better understand this distinction, more studies using both instruments and involving students at different stages in their medical education, as well as more longitudinal and qualitative studies, are needed.

Undergraduate medical students' empathy: current perspectives.

Empathy is important to patient care. It enhances patients’ satisfaction, comfort, self-efficacy, and trust which in turn may facilitate better diagnosis, shared decision making, and therapy adherence. Empathetic doctors experience greater job satisfaction and psychological well-being. Understanding the development of empathy of tomorrow’s health care professionals is important. However, clinical empathy is poorly defined and difficult to measure, while ways to enhance it remain unclear. This review examines empathy among undergraduate medical students, focusing upon three main questions: How is empathy measured? This section discusses the problems of assessing empathy and outlines the utility of the Jefferson Scale of Empathy – Student Version and Davis’s Interpersonal Reactivity Index. Both have been used widely to assess medical students’ empathy. Does empathy change during undergraduate medical education? The trajectory of empathy during undergraduate medical education has been and continues to be debated. Potential reasons for contrasting results of studies are outlined. What factors may influence the development of empathy? Although the influence of sex is widely recognized, the impact of culture, psychological well-being, and aspects of undergraduate curricula are less well understood. This review identifies three interrelated issues for future research into undergraduate medical students’ empathy. First, the need for greater clarity of definition, recognizing that empathy is multidimensional. Second, the need to develop meaningful ways of measuring empathy which include its component dimensions and which are relevant to patients’ experiences. Medical education research has generally relied upon single, self-report instruments, which have utility across large populations but are limited. Finally, there is a need for greater methodological rigor in investigating the possible determinants of clinical empathy in medical education. Greater specificity of context and the incorporation of work from other disciplines may facilitate this.

Cancer-Related Fatigue in Adolescents and Young Adults After Cancer Treatment: Persistent and Poorly Managed

Cancer-related fatigue is the most prevalent and distressing symptom experienced by adolescents and young adults (AYAs). An electronic survey was undertaken to ascertain current fatigue management and perceptions of its effectiveness. Eighty-five percent of responders (68/80) experienced fatigue, and it was worse more than 1 year after cancer treatment ended, compared to <1 year (p = 0.007). Forty-one percent received no fatigue management. Although advice to exercise was the most frequent intervention, the greatest impact of fatigue was on the ability to exercise and most did not find exercise advice helpful. Early intervention is warranted, supporting AYAs to persevere with increasing activity.

Palliative care in medical practice: medical students' expectations.

Objectives During their careers, all doctors will be involved in the care of the dying, and this is likely to increase with current demographic trends. Future doctors need to be well-prepared for this. Little is known about medical students’ expectations about providing palliative care. Our aim was to investigate how satisfying students expect palliative care to be, and any attitudes towards palliative care associated with a negative expectation. Methods Fifteen UK medical schools participated in the study, with 1898 first and final year students completing an online questionnaire which investigated how satisfying they expect providing palliative care to be and their attitudes towards palliative care. Results At both the beginning and end of their training, a significant proportion of students expect palliative care to be less satisfying than other care (19.3% first year, 16% final year). Students expecting palliative care to be less satisfying were more likely to be men, and their attitudes suggest that while they understand the importance of providing palliative care they are concerned about the potential impact of this kind of work on them personally. Conclusions Medical student education needs to address why palliative care is important and how to deliver it effectively, and the strategies for dealing positively with the impact of this work on future clinicians.

1 A novel recruitment method for a study of recently bereaved people in the community

Background NICE guidelines state that ‘everyone should be given bereavement support according to their needs and preferences’. The few existing studies on the bereaved persons perspective of Primary Care bereavement support are often limited by recruitment biases, low participant numbers and recall bias. We assessed the feasibility and acceptability of a new recruitment method for recently bereaved people in the community. Methods Recently bereaved people were invited to take part in a questionnaire study when registering a death. Registry Officers handed out study packs over a 12 week period. On receipt of reply slip indicating interest in participation, participants were sent further study information and after 6 weeks a postal questionnaire concerning bereavement support. Questionnaires could also be completed online. Qualitative interviews with a subsample of Registry Officers (n=6) and bereaved people (n=14) investigated their views of the recruitment approach. Results Between 25/07/2016 and 14/10/2016, 1726 deaths were registered and 1069 study packs were distributed: 72 reply slips and 6 online-questionnaires were returned (response rate 7%). Over 50% of reply slips were returned within a week of registering the death. The questionnaire response rate was 83% (60/72). Interviews highlighted that the bereaved and Registry Officers felt comfortable with the study recruitment approach. Data on reasons for refusal, collected from Registry Officers and reply slips declining participation did not reveal ethical concerns or distress caused by the recruitment approach. Conclusions The response rate was lower than previous bereavement studies, possibly related to the early timing of recruitment. Nevertheless, novel data were obtained from early in bereavement and the recruitment timing was found to be acceptable by all consulted participants. We conclude that a sensitive recruitment approach even shortly after the death can be acceptable to the (newly) bereaved, although the low response rate calls into question the feasibility of the Registry Officers approach.

20 Negative personal emotional impact of caring for the dying – expectations of future doctors. a multicentre study

Background End of life care (EOLC) is a large part of junior doctors’ workload. Negative attitudes may impact on care provided and may be shaped during undergraduate medical training. Aims We investigated: whether medical students expect EOLC to have a negative emotional impact on themselves demographic and psychological factors associated with such expectations. Methods Multicentre cross-sectional online study of 1520 first and 954 final year medical students from 18 universities, (16 UK, 1 New Zealand, 1 Ireland). We assessed attitudes towards EOLC (Sullivan’s statements), age, gender, course year, course type (standard or graduate), spirituality and experience of bereavement as well as psychological variables: death anxiety (Collett Lester Fear of Death Scale, COLFD), empathy (Davis’s Interpersonal Reactivity Index, IRI) and depression (Hospital Depression Scale HADS-D). Factor analysis suggested 3 Sullivan statements formed a ‘negative personal emotional impact score’ (Impact Score, −6 to +6). Students with low/neutral (−6 to +3) and high (+3 to+6) Impact Score were compared (χ2-tests and ANOVA) and regression analyses undertaken. Results Respondents were neutral overall (mean Impact Score=0.3), although with substantial variations. Participants with high Impact Score were likely to be younger, standard course, first-year students, and to have higher depression and distress scores (HADS-D and IRI-Personal-Distress-scale), lower cognitive empathy scores (IRI-Perspective-Taking) and to score more highly on all COLFD sub-scales. Regression analysis showed psychological factors were strongly associated with the Impact Score: COLFD others-dying (1.29;CI: 1.08 to 1.50;p=0.001), IRI-Personal-Distress-scale (0.97;CI: 0.77 to 1.17;p=0.001), HADS-D (0.45;CI: 0.17 to 0.74;p=0.002), and COLFD others-death (0.31;CI: 0.09 to 0.54;p=0.006) scales were the strongest predictors. Conclusions Medical students worry about the possible negative personal emotional impact of EOLC when doctors. While medical education may mitigate such concerns, negative expectations appear related to distress, death anxiety and depression. Measures to improve and support psychological well-being may have a positive impact on medical students’ attitudes toward EOLC.