The Diabetes Simulation Challenge: Enhancing Patient Perspective-Taking for Medical Students.

The Diabetes Simulation Challenge is a unique training tool to foster empathy, a key facet of patient-centered care, for medical students. Thirty-two medical students participated in a 24-hour perspective-taking activity as part of their curriculum, during which they simulated some common experiences of living with a chronic health condition, specifically type 1 diabetes. Students' written reflections were analyzed using a phenomenological qualitative approach to provide a composite description of the experience. An exhaustive, iterative method of thematic analysis that included manual coding was used to determine whether this activity led to expressions of empathy or thoughts and beliefs consistent with patient-centered health care. Nine unique themes emerged, six of which indicated that students adopted the perspective of an individual with a chronic illness. Most of the students' reflections illustrated an understanding of the behavioral, social, and emotional challenges related to living with type 1 diabetes, as well as increased empathy toward individuals with the disease. Medical students who aim to provide patient-centered care benefited from this perspective-taking exercise, and training programs should consider using such methods to extend learning beyond traditional didactic education.

Associations Between Multiple Health-Promoting Behaviors and Subjective Well-Being in High School Age Youth.

BACKGROUND: Conceptualizations of health have expanded to include indicators of adolescents' physical and mental wellness, rather than solely the absence of diseases or disorders. Although extensive research has identified links between mental and physical wellness, few studies have investigated the relationship between health promotion and happiness, particularly in adolescent populations who may be at particular risk for engaging in health-compromising behaviors, such as alcohol consumption. METHODS: This cross-sectional study examined the relationship between 12 health-promoting behaviors and subjective well-being in a sample of 450 high school students from 2 states. Participants reported on their diet, physical activity, sleep hygiene habits, as well as abstinence from tobacco and alcohol products, and completed a multidimensional assessment of subjective well-being. RESULTS: Findings demonstrated that 7 of the 12 health-promoting behaviors were significantly correlated with adolescents' subjective well-being. A sizeable portion of the variance in adolescents' subjective well-being (39.8%) was accounted for by the linear combination of the 12 health-promoting behaviors of interest. Increased physical activity, sleep hygiene cognitive/emotional factors, and bedtime routine all were identified as unique predictors of subjective well-being. CONCLUSIONS: These findings bring attention to the salience of daily physical activity and sleep hygiene and their associations with adolescents' happiness.

Health Knowledge and Adherence as Predictors of Viral Burden and CD4+ T-Cell Count in Youth and Young Adults Living With HIV.

Health literacy influences HIV treatment for youth and, thus, is a research priority. We explored health knowledge and self-reported adherence, as indicators of health literacy, among youth living with HIV (YLWH) and the association between health literacy and health outcomes. A total of 102 YLWH ages 13-25 years participated in the study. Participants completed the Brief Estimate of Health Knowledge and Action-HIV Version; CD4 T-cell counts and viral loads were extracted from participant medical records. Participants had a moderate amount of HIV knowledge, and most reported taking their medications under most conditions. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. Health literacy is an important factor that should be addressed by practitioners working with YLWH. More research is needed to determine the best way to measure and improve health literacy.

Depression, anxiety, and posttraumatic stress as predictors of immune functioning: differences between youth with behaviorally and perinatally acquired HIV.

Youth living with HIV (YLWH) face significant mental health problems, namely depression, anxiety, and PTSD with rates of these disorders higher than in the general population. This study explored the relationship between symptoms of depression, anxiety, and PTSD and biological markers among a sample of 145 YLWH ages 13-25 years. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 Item Scale (GAD-7), and Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD). Biological markers included CD4 count and viral load (VL) abstracted from medical records. Findings revealed a relationship between depression and anxiety and CD4 count as well as anxiety and VL. The relationship between depression and anxiety and CD4 count and anxiety and VL was moderated by transmission mode (i.e., behavioral versus perinatal). For youth perinatally infected, greater psychological symptoms of depression and anxiety were associated with a decline in CD4 count and increase in VL, but this was not true for youth with behaviorally acquired HIV. These findings point to the need for individualized mental health prevention and intervention services for YLWH.

Health-related quality of life and mental health indicators in adolescents with HIV compared to a community sample in the Southeastern US.

Although many studies have investigated the impact of HIV on cognitive, physical, academic, and psychosocial functioning, little is known about the self-perception of health-related quality of life (HRQOL), subjective well-being (SWB), social-emotional well-being, and psychopathology risks of adolescents with HIV. This study aimed to address gaps in the literature by exploring the psychosocial outcomes of adolescents with HIV from a strength-based assessment approach, as opposed to a traditional deficit-based approach. Specifically, we explored the relationship between HRQOL, SWB, social-emotional strengths, and psychopathology symptoms to develop a more comprehensive understanding of the physical and psychological well-being of adolescents with HIV (n = 42) compared to a community-based sample (n = 42) in the Southeastern US. Participants completed self-report measures, and data were analyzed for significant correlations, group differences between adolescents with HIV and a community-based sample, and social-emotional predictors of physical functioning and SWB. For adolescents with HIV, several HRQOL indicators were positively correlated with life satisfaction and social-emotional strengths indicators and negatively correlated with negative affect and psychopathology symptoms. Additionally, there was a significant main effect of parents' marital status on participants' perceptions of their social functioning and psychopathology symptoms. When differences in parents' marital status were controlled for, the overall mean ratings of participants' HRQOL, SWB, social-emotional strengths, and psychopathology risks did not significantly differ between groups. Furthermore, parents' marital status and self-rated empathy skills significantly predicted physical functioning of adolescents with HIV, but no significant or meaningful variables were found to predict their SWB. These findings highlight the need for further research on the use of a comprehensive assessment framework to enhance our understanding of the overall well-being of adolescents with HIV.

Student and resident perspectives on professionalism: beliefs, challenges, and suggested teaching strategies.

OBJECTIVE: The purpose of this study was to investigate the views of medical students and residents regarding the practice of professionalism, their perceived challenges, and ideas for the development of a new curriculum in medical professionalism. METHODS: Data were collected from four focus groups comprised of 27 residents and medical students recruited from the University of South Florida Morsani School of Medicine and Residency Programs between January and March 2012. A questioning protocol was used to guide the focus group discussion. Data were transcribed for thematic analysis. RESULTS: Learners expressed beliefs regarding key attributes of professional behaviors, factors perceived to be associated with lapses of professional behavior, skills that need to be taught, and strategies to teach professionalism from the learners' perspective. Learners perceived that the values of professionalism are often disconnected from the reality evidenced in clinical training due to a myriad of personal and contextual challenges. CONCLUSIONS: Residents and students need help in negotiating some of the challenges to medical professionalism that are encountered in clinical settings. We recommend a learner's centered model of curriculum development in medical professionalism that takes into consideration perceived challenges and strategies for modeling and reinforcing medical professionalism.

Student perceptions of a patient- centered medical training curriculum.

OBJECTIVE: To evaluate a patient-centered medical training curriculum, the SELECT program, through perceptions of the inaugural student cohort. METHODS: Data were collected from two focus groups conducted in the university setting, comprised of fifteen first-year medical students who participated in the SELECT program during its inaugural year. A questioning protocol was used to guide the focus group discussion, which was transcribed and hand-coded through thematic analyses. RESULTS: Various themes related to patient-centered care were identified. Students noted changes in their attitudes towards interacting with patients in an empowering and educative manner as a result of communication and motivational interviewing exercises. Additionally, they recognized certain external, structural barriers as well as internal conflict between pragmatism and emotional intelligence that could potentially hinder patient-centered care. The impact of family dynamics and social support on quality of life and health outcomes was acknowledged. Students also emphasized the value of collaborating with multiple health professionals. Lastly, students provided suggestions for program improvement, namely additional simulations, more education regarding other healthcare professionals' roles, more standardized experiences, and application of principles to acute and primary care. CONCLUSIONS: Upon completion of the first year of the SELECT program, students gained an appreciation for patient-centered care and various factors and skills that facilitate such care. Additionally, they experienced a dissonance between didactic concepts from the curriculum and observed medical practices. This study highlights the educational benefits of a patient-centered medical curriculum and provides suggestions for future improvement.

Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature.

PURPOSE: The knowledge that cancer treatment may impair fertility in pediatric populations is an emerging aspect of quality of life in this population. However, decision making and use of fertility preservation (FP) among adolescent cancer patients and their families has not been well studied. This review summarizes the available published data on aspects of decision making and FP in adolescent cancer patients. METHODS: An electronic search was performed to identify peer-reviewed studies published between 1999 and 2009 using key Medical Subject Heading terms and inclusion criteria. Inclusion criteria limited eligible studies to those that focused on adolescent decision making in cancer treatment or FP, fertility concerns in pediatric oncology, capacity for decision making, and health decision making in pediatrics. Studies that did not meet at least one of these criteria were excluded. RESULTS: A total of 29 articles were reviewed and summarized. Three categories of results were seen: a focus on adolescent decision making in oncology, decision making in chronic illness, and decision making in cancer-related infertility and preservation. CONCLUSION: Most of the studies showed that adolescents have a strong desire to participate in decisions related to their cancer treatment and many have concerns regarding their future fertility, although barriers often prevented these discussions. More research is needed to explore the role of teenagers and parents in decisions about fertility in relation to cancer treatment.

Health savings accounts: back to the future.

Health savings accounts (HSAs) have altered the health care landscape in ways no one might have predicted. HSAs have emerged as a valuable tool in the quest to change consumers' health care spending behaviors and better manage health care costs. This article compares and contrasts HSAs to other health care spending accounts, addresses various HSA topics in the context of HSAs' first six years, and speculates on the future of HSAs. The authors identify policy changes that could help expand HSAs, drive further employer savings, make HSAs more user-friendly, impact employee satisfaction and increase adoption rates.

BMI and physical activity among at-risk sixth- and ninth-grade students, Hillsborough County, Florida, 2005-2006.

INTRODUCTION: During the past 3 decades, the number of overweight adolescents increased while adolescent engagement in physical activity decreased. We investigated the prevalence of overweight and physical activity levels among economically disadvantaged and minority middle- and high-school students in a school district in Florida. In particular, data on physical activity levels of middle-school students are limited and needed for prevention and intervention planning. In addition, because of state education policies, students in Florida are less likely than students nationally to enroll in physical education, placing them at a higher risk for decreased physical activity levels. METHODS: We used multivariate methodology to analyze physical activity levels among 526 students from 3 middle and 2 high schools in southwest Florida. RESULTS: Forty percent of students met criteria for overweight or obesity. Overall, less than 45% of students reported engaging in daily physical activity. Boys reported higher levels of physical activity than did girls, and a decline in physical activity levels was observed between grades 6 and 9, especially among minority girls (ie, African American and Latino). Lack of time was identified as the greatest barrier to engaging in physical activity. CONCLUSION: This study documents health disparities among minority students from economically disadvantaged backgrounds in an urban school district. Participation in daily physical activity was below recommended guidelines across grades. We found numerous barriers to engaging in physical activity, which will enable local education agencies to evaluate their current physical activity policies and identify alternative physical activities for these youth.