Modeling the social determinants of resilience in health professions students: impact on psychological adjustment.

Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.

Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students.

OBJECTIVE: Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. METHODS: Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. RESULTS: Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM); n = 31, 76% School of Nursing (SON); n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM; n = 28, 68% SON; n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). CONCLUSIONS: Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.

Patient-Centered Team-Based Learning in Pre-Clinical Curriculum Supporting the Application of Knowledge to Real-World Clinical Experience.

We report an active learning session which effectively supported 1st year medical students applying their learning experience in a clinical setting. A team-based learning (TBL) on familial hypercholesterolemia (FH) with a live patient was given to deliver basic genetics knowledge in a clinically relevant context. Subsequently, two participating students applied their learning experience by presenting a differential diagnosis of homozygous FH in a patient at a medical mission in Central America. We propose that combining active learning with clinically relevant scenarios effectively fosters student's clinical reasoning skills and can bridge the perceived gap between basic science and clinical education.

A Commercially Available Thermogenic Dietary Supplement Increases Resting Metabolic Rate in Physically Active Males: A Randomized, Double-Blind, Placebo-Controlled Investigation.

Males seeking to improve body composition may ingest thermogenic dietary supplements with the goal of elevating resting metabolic rate. The purpose of this study was to examine the effects of a commercially available dietary supplement (containing ingredients that promote thermogenesis) on resting metabolic rate (RMR) in a randomized, double-blind, placebo-controlled cross-over study. Ten healthy, physically active males (age: 26.5 ± 6.4 years; height: 177.6 ± 7.2 cm; body weight: 80.5 ± 10.8 kg) underwent two testing sessions separated by approximately 7 days. Following baseline assessments of RMR, heart rate (HR), and blood pressure (BP), each participant ingested a thermogenic dietary supplement or a placebo. Assessments were repeated at 60, 120, and 180 minutes postingestion. Approximately 1 week later, participants ingested the alternative supplement and the assessments were repeated. Post hoc analyses revealed that the dietary supplement treatment demonstrated significant elevations in RMR during the postingestion period (p < 0.05) from 1,859 ± 266 kcal to 2,027 ± 288 kcal (increase of 9%) to 2,072 ± 292 kcal (increase of 11.5%) and to 2,040 ± 271 kcal (increase of 9.7%) at 60, 120, and 180 minutes postingestion, respectfully. No significant elevations were observed in the placebo treatment at any time point. HR and BP measures were within normal clinical values throughout the intervention.

Factors affecting patient valuations of caries prevention: Using and validating the willingness to pay method.

OBJECTIVES: Determining the value of, or strength of preference for health care interventions is useful for policy makers in planning health care services. Willingness to pay (WTP) is an established economic technique to determine the strength of preferences for interventions by eliciting monetary valuations from individuals in hypothetical situations. The objective of this study was to elicit WTP values for a dental preventive intervention and to analyze the factors affecting these as well as investigating the validity of the WTP method. METHODS: Patients aged 40 years plus attending dental practices in the UK and Germany were recruited on a consecutive basis over one month. Participants received information about a novel root caries prevention intervention. They then completed a questionnaire including a WTP task. Where the coating was indicated, patients were offered this for a payment and acceptance was recorded. Analysis included econometric modelling and comparison of expected (based on stated WTP) versus actual behaviour. RESULTS: The mean WTP for the coating was £96.41 (standard deviation 60.61). Econometric models showed that no demographic or dental history factors were significant predictors of WTP. 63% of the sample behaved as expected when using stated WTP to predict whether they would buy the coating. The remainder were split almost equally between those expected to pay but who did not and those who were expected to refuse but paid. CONCLUSIONS: Values for a caries preventive intervention had a large and unpredictable variance. In comparing hypothetical versus real preferences both under- and over-valuation occurs. CLINICAL SIGNIFICANCE: Wide and unpredictable variation in valuations for prevention may mean that there are difficult policy questions around what resource should be allocated to dental prevention and how to target this resource.

Efficacy of a 10% chlorhexidine coating to prevent caries in at-risk community-dwelling adults.

OBJECTIVE: The purpose of the study was to determine the efficacy of a 10% chlorhexidine tooth coating in reducing the incidence of cavitated carious lesions in adults. MATERIALS AND METHODS: The trial was a randomized, double-blind, multi-center, placebo controlled study with 983 participants, receiving the application of either the active or the placebo coatings to the entire dentition. Four applications were made in the first month and one at the 7th month. The final examination was performed at 13 months. RESULTS: Coronal caries showed a statistical reduction (p = 0.02). Examination of the results by site showed that the highest risk participants experienced the most significant preventive effect (p = 0.003). When two sites (uninsured and public health) are pooled the treatment p-value is 0.0009, interaction term has a p-value of 0.0001. CONCLUSION: 10% Chlorhexidine was highly effective in high risk participants with more than two cavities at the initial examination. This trial in conjunction with other published trials of this topical medication indicates that chlorhexidine exerts its action by preventing the transition of D1 lesions to cavitated lesions, not on sound to D1 lesions.

Identification of a novel circovirus in Australian ravens (Corvus coronoides) with feather disease.

The complete genome of a novel Circovirus isolated from an Australian raven (Corvus coronoides) with feather lesions similar to those that occur in psittacine beak and feather disease is reported. Degenerate polymerase chain reaction primers were designed to amplify and sequence novel Circovirus DNA from affected feathers. Sequence analysis indicated that the tentatively named raven circovirus (RaCV) was 1898 nucleotides in size with two major open reading frames synonymous with other avian circoviruses, ORF C1 and ORF V1, likely to encode a putative capsid protein (Cap) and replicase-associated protein (Rep), respectively. In common with other circoviruses was the conservation of several nucleotide structures and amino acid motifs implicated in virus replication. Comparison with other members of the Circoviridae demonstrated that RaCV shares the greatest sequence homology with canary circovirus (CaCV) and pigeon circovirus (PiCV) and was more distantly related to the beak and feather disease virus, goose circovirus, duck circovirus and the two porcine circoviruses, PCV1 and PCV2. Phylogenetic analysis of the genome and the putative Cap and Rep proteins provided further evidence of the close relationship of RaCV with CaCV and PiCV.