Steven R. Daugherty

Prevalence and burden of illness for asthma and related symptoms among kindergartners in Chicago public schools

BACKGROUND Asthma mortality rates in poor communities of Chicago are among the highest in the country. Possible explanations include increased asthma prevalence, increased severity, and suboptimal health care. OBJECTIVE To estimate the prevalence of asthma and asthma-related symptoms among inner-city kindergarten children, and to characterize their burden of illness, asthma-related health care access, and pharmacologic treatment. METHODS Cross-sectional survey of parents of kindergartners was conducted in 11 randomly selected Chicago elementary schools. A self-administered 16-item questionnaire was given to parents of kindergartners. Parents who reported doctor-diagnosed asthma or at least one of several key asthma-related symptoms were then interviewed with a supplemental questionnaire examining asthma-related health care and medication use. RESULTS Based on data from 638 children [mean age 5.7 (SD = 0.6) years], the prevalence of diagnosed asthma was 10.8%. Sixteen percent of the respondents reported that their child had wheezed in the past year. The prevalence of asthma-related symptoms unassociated with a diagnosis of asthma was 30.1%. The children with diagnosed asthma had evidence of a high burden of illness: over 40% were reported to have had sleep disturbance due to wheezing > or =1 to 2 nights/week and 86.6% reported acute care visits for respiratory symptoms in the past year. Self-reported access to medical care was high. Over 40% of the children with doctor diagnosed asthma were reported to have used a beta2-agonist in the preceding 2 weeks, and 12.2% used an inhaled anti-inflammatory. CONCLUSIONS These data suggest that asthma prevalence in school-aged children in inner-city communities may be higher than US estimates. The burden of illness experienced by these children is substantial. Also, a large proportion of children were reported to have respiratory symptoms consistent with asthma, and no asthma diagnosis, suggesting possible undiagnosed asthma. While measures of health care access appear to indicate that the majority of children with asthma experience no identified barriers to health care, there is evidence to suggest undertreatment.

Interprofessional conflict and medical errors: Results of a national multi-specialty survey of hospital residents in the US

Clear communication is considered the sine qua non of effective teamwork. Breakdowns in communication resulting from interprofessional conflict are believed to potentiate errors in the care of patients, although there is little supportive empirical evidence. In 1999, we surveyed a national, multi-specialty sample of 6,106 residents (64.2% response rate). Three questions inquired about “serious conflict” with another staff member. Residents were also asked whether they had made a “significant medical error” (SME) during their current year of training, and whether this resulted in an “adverse patient outcome” (APO). Just over 20% (n = 722) reported “serious conflict” with another staff member. Ten percent involved another resident, 8.3% supervisory faculty, and 8.9% nursing staff. Of the 2,813 residents reporting no conflict with other professional colleagues, 669, or 23.8%, recorded having made an SME, with 3.4% APOs. By contrast, the 523 residents who reported conflict with at least one other professional had 36.4% SMEs and 8.3% APOs. For the 187 reporting conflict with two or more other professionals, the SME rate was 51%, with 16% APOs. The empirical association between interprofessional conflict and medical errors is both alarming and intriguing, although the exact nature of this relationship cannot currently be determined from these data. Several theoretical constructs are advanced to assist our thinking about this complex issue.

Masculinity, femininity, type A behavior, and psychosocial adjustment in medical students.

The freshman class of a midwestern medical school completed measures of masculinity and femininity, Type A behavior, and a variety of dependent variables concerning psychological well-being, adjustment, and interpersonal satisfaction. Appropriate statistical treatment of the data revealed strong and consistent masculinity effects on neuroticism, depression, self-esteem, confidence, hedonic capacity, locus of control, and relationship satisfaction. Femininity main effects varied in number as a function of the statistical method employed and involved a more diverse group of variables than is typically reported. Additive androgyny formulations of mental health were supported; balance androgyny formulations were not. No evidence for a Type A X Masculinity effect on adjustment was found. Discussion focuses on the correct interpretation of masculinity and femininity scales, comparability of analysis of variance (ANOVA) and multiple regression statistical analyses, and the viability of the concept of androgyny.

Presenteeism Among Resident Physicians

individuals for leading healthy lifestyles is currently the subject of policy experiments in Europe. The Dutch Council for Public Health, like the British National Health Service and the GermanStatutoryHealth Insurance, is experimentingwith incentives to encourage healthy lifestyles in health insurance. What can be learned from these European policy experiments? First, it is questionable whether prevention programs and incentives work at the individual level. There is a great deal of evidence that these policies fail to change people’s lifestyles in the long run because unhealthy living habits are strongly predicted by a person’s socioeconomic position and social circumstances. Certain social contexts make it harder for people to make the “right” individual choices with regard to exercise, diet, and other health habits. In some cases, what seems like a personal choice to adopt an unhealthy lifestyle might not be; the choice may be driven by the fact that realistic options do not exist. Second, there is a danger that focusing on individual responsibility reinforces existing socioeconomic health inequalities. By rewarding healthy lifestyles and punishing unhealthy behaviors, the initial advantage of the well educated and well paid may tend to beget further advantage, and disadvantage those most in need of health improvements, creating widening gaps between haves and have-nots. Strikingafairbalanceinhealthcareismorecomplicatedthan moralizingriskybehavior.For individuals tobeable to take individual responsibility for their health, they first and foremost need adequate opportunities to achieve good health, such as affordableandaccessiblehealthcare—nottheotherwayround.

Intimacy, power, and psychological well-being in medical students

Numerous reports suggest that medical school has adverse psychological effects on medical students, although not all students are affected equally. The authors examined the effects of two social motives, the need for power and the need for intimacy, on measures of well-being and distress obtained throughout the undergraduate years. Medical students high in both power and intimacy motivation were more depressed, neurotic, fatalistic, and self-doubting than were their classmates. These effects began at the end of year 1, peaked in year 2, and disappeared by the end of clerkships. High intimacy-low power students had the highest levels of well-being. These effects were equally true in men and women and both support and render more precise prior role conflict explanations.

Reduction of Sexual Activities in Females Taking Antiepileptic Drugs

Studies of male or sexually unspecified populations have revealed loss of libido and decreased sexual function in patients with epilepsy taking antiepileptic drugs. The relative contributions of antiepileptic drugs, seizures, brain injury, and social factors have not been clearly delineated. We studied sexual activity in a group of females taking antiepileptic drugs, and defined a subgroup with pronounced hyposexuality.

Personality indicators of psychosocial adjustment in first-year medical students

One aspect of the Rush Medical College Longitudinal Study is concerned with the identification of personality traits that predict various kinds of psychosocial adjustments and impairments among medical students and physicians. Two orthogonal traits, masculinity and femininity, were selected for study as independent variables because of their implications for mental health and their relevance to the work of physicians. Ninety percent (N = 106) of a class of first-year medical students completed measures of masculinity and femininity during orientation and, 8 months later, completed a broad array of dependent measures of psychological well-being, interpersonal satisfaction, humanistic attitudes and alcohol consumption. Analyses of the data revealed strong and consistent main effects of masculinity on depression, confidence, pleasure capacity, extraversion, locus of control, neuroticism and interpersonal satisfaction. Femininity was associated with depression, pleasure capacity, extraversion, neuroticism, interpersonal satisfaction, concern for the opinion of others and humane attitudes toward patient care. Low femininity was also associated with high alcohol consumption. These results suggest that masculinity and femininity scores may help to identify at the outset medical students at risk for impairment, and that androgynous individuals (who are high in both masculinity and femininity) may be especially well-suited to assume the demanding and varied roles that physicians are called on to play.

The relationship between academic performance and severity of depressed mood during medical school

We employ a structural equation model to examine the relationship between academic performance and depressed mood over 4 years for a single medical school class. Academic performance measures included undergraduate gradepoint average, first- and second-year medical school gradepoint average, full Medical College Admissions Test (MCAT) and total National Boards Part I (NB) scores. Severity of depressed mood was assessed by administering the Beck Depression Inventory two times per year during the first 2 years, and once per year during the last 2 years. Overall there is little reason to think that depressive mood states compromise academic performance during the first 2 years of medical school for the class as a whole. Medical school grades had no direct impact on depressed mood, and mood had no direct impact on grades. There was a non-significant tendency for mood in the months preceding National Boards Part I to influence Board scores, which in turn influenced mood. Students with higher college gradepoint averages consistently reported fewer depressive symptoms throughout medical school. The latter result directs attention to a subgroup of medical students less susceptible to depression, or less prone to admit distress or symptoms. The non-susceptible and/or minimizing qualities of this subgroup merit further investigation.

Racial and ethnic discrimination during residency: results of a national survey.

No abstract available.

Distinguishing sexual harassment from discrimination: a factor-analytic study of residents' reports.

The problem of sexual harassment and discrimination in medical education received little attention until relatively recently. The first empirical data documenting such behavior involving medical students were presented at the Association of American Medical Colleges (AAMC) meeting in 1988. This was followed by a spate of reports over the following dozen years, both here and abroad, including our own involving a national sample of PGY1 residents. While documenting the ubiquity of the problem, most of these studies have failed to distinguish clearly between sexual harassment and discrimination, frequently linking the two terms in their inquiries. Some have asked specifically about ‘‘sexual abuse,’’ ‘‘sexual mistreatment,’’ ‘‘sexual slurs,’’ ‘‘sexist teaching materials,’’ or ‘‘sexual advances,’’ while others have included such items as ‘‘poor evaluations,’’ being ‘‘denied opportunities,’’ and being subjected to ‘‘favoritism,’’ terms that are clearly different from each other. Studies of sexual harassment and discrimination in graduate medical education have exhibited a similar lack of clarity. Although sexual harassment and discrimination frequently coexist, it seems clear that they are not the same, and, when explicitly asked, most people perceive the difference. At the same time, there has been a tendency on the part of researchers and respondents alike to refer to them together, perhaps with the desire to include all possibilities. A thorough review of the medical and legal aspects of sexual harassment by Nora in 1996 defined gender discrimination and two major forms of sexual harassment from the legal standpoint, but reported no empirical data to support the differences. In another report, using scenarios describing different forms of sexual harassment and discrimination, the same author found that most medical students failed to distinguish between the two terms and frequently included them under the general category of mistreatment or abuse. She concluded that ‘‘lack of clarity in definition creates problems in data interpretation and solution development.’’ In the hope of further clarifying the differences and encouraging a better standard of data gathering on this important issue, we conducted a factor analysis of the various behaviors usually included under the terms sexual harassment and discrimination, using data from a national survey of residents’ reported experiences during their 1998–1999 PGY1 and PGY2 years.