Decreased bone mineral density and reproductive axis dysfunction: more than oestrogen.

Decreased bone mineral density (BMD) in oestrogendeficient states has long been thought to be a direct outcome of the reduction in oestrogen. In physiologic and many pathologic hypo-oestrogenic states, oestrogen supplementation improves BMD. However, the relationship between oestrogen replacement and BMD is less clear in the case of reproductive axis dysfunction secondary to decreased caloric intake or increased energy expenditure, such as in female athletes or anorexia nervosa. This decrease in oestrogen is associated with decreased BMD, but oestrogen replacement in these states fails to conclusively improve BMD. This suggests that the decrease in BMD in these states is not driven solely by low oestrogen. Cortisol and other markers of inflammation may play a role in BMD reduction but further research is needed. What is clear is that increased caloric consumption and restoration of menses and the reproductive axis are essential to improving BMD, while pharmacologic therapy, including oestrogen replacement through hormone therapy or contraceptives, does not provide conclusive benefit.

Physician race and specialty influence Press Ganey survey results.

BACKGROUND: The Press Ganey survey is widely used to evaluate physician and institution quality and performance, with some institutions making their survey results publicly available. However, given its subjective nature, the survey results may be subject to bias regarding physician characteristics, such as race, sex, and specialty, that are unrelated to competence. The goal of this study was to determine if and what physician characteristics influence Press Ganey results. METHODS: In this study, publicly-available information on sex, race, specialty, and Press Ganey results for all physicians with a photograph and a Press Ganey rating at two institutions was collected in June 2018 and compared for difference. RESULTS: The average Press Ganey rating for the 678 physicians included in the study was 4.73 out of 5. Female physicians had fewer negative comments (0.49 female vs. 0.67 male, p = 0.04) and there was no difference in positive comments or ratings. White physicians had higher ratings (4.74 white vs. 4.71 non-white, p = 0.01), greater number of positive comments (12.3 vs. 10.0, p = 0.008), and fewer negative comments (0.55 vs. 0.80, p = 0.03). Paediatric physicians had lower ratings (4.66 paediatric vs. 4.75 adult, p < 0.001) and fewer positive comments (9.07 paediatric vs. 12.21 adult, p = 0.004). CONCLUSIONS: These results suggest that physician race and specialty choice impact Press Ganey results. Given that neither race nor specialty influence physician competence, this data suggests that the Press Ganey survey is a biased measure of physician quality and should not be used to evaluate physician skill or ability.