Career decision making in undergraduate medical education.

BACKGROUND: It is unclear how medical students prioritize different factors when selecting a specialty. With rising under and unemployment rates a novel approach to career counselling is becoming increasingly important. A better understanding of specialty selection could lead to improved career satisfaction amongst graduates while also meeting the health care needs of Canadians. METHODS: Medical students from the University of Toronto participated in a two-phase study looking at factors impacting specialty selection. Phase I consisted of focus groups, conducted independently for each year, and Phase II was a 21-question electronic survey sent to all students. RESULTS: Twenty-one students participated in the focus group phase and 95 in the survey phase. Primary themes related to career selection identified in Phase I in order of frequency included personal life factors (36), professional life factors (36), passion/interest (20), changing interests (19) and hidden curriculum (15). The survey phase had similar results with passion (83), lifestyle (79), flexibility (75), employment opportunities (60) and family (50) being ranked as the factors most important in specialty selection. CONCLUSION: Personal factors, professional factors and passion/interest may be key themes for medical students when deciding which specialty to pursue. Targeting career counselling around these areas may be important.

CONTEXTE: On ne comprend pas bien comment les étudiants en médecine priorisent différents facteurs au moment de choisir une spécialité. Étant donné la hausse des taux de sous-emploi et de chômage, il devient de plus en plus important d'adopter une nouvelle approche d'orientation professionnelle. Une meilleure compréhension choix d'une spécialité pourrait accroître le niveau de satisfaction des diplômés en ce qui a trait à leur choix de carrière tout en satisfaisant aussi les besoins en soins de santé des Canadiens et Canadiennes. MÉTHODES: Les étudiants en médecine de l'Université de Toronto ont participé à une recherche comportant deux phases examinant les facteurs influençant le choix d'une spécialité. La Phase I comportait des groupes de discussion dirigés indépendamment pour chaque cohorte tandis que la Phase II consistait en un sondage électronique de 21 questions transmis à tous les étudiants. RÉSULTATS: Vingt et un étudiants ont participé à la phase des groupes de discussion et 95 à la phase du sondage. Les principaux thèmes liés au choix de carrière qui ont été identifiés durant la Phase I sont les suivants (en ordre de fréquence) : les facteurs de vie personnelle (36), les facteurs de vie professionnelle (36), la passion/l'intérêt (20), les champs d'intérêt changeants (19) et le curriculum caché (15). La phase de sondage a donné des résultats semblables. La passion (83), le style de vie (79), la souplesse (75), les possibilités d'emploi (60) et la famille (50) se sont révélés comme étant les facteurs les plus importants dans le choix d'une spécialité.Conclusion :Les facteurs personnels, les facteurs professionnels et la passion/l'intérêt pourraient être les principaux thèmes que partagent les étudiants en médecine au moment de décider à quelle spécialité ils aspirent. Il semble important de cibler les démarches d'orientation professionnelle sur ces thèmes.

Improvements in peripheral vascular function with vitamin D treatment in deficient adolescents with type 1 diabetes.

BACKGROUND: Vitamin D (VitD) deficiency is prevalent in adolescents with type 1 diabetes (T1D) and is associated with diabetes-related vascular complications in adulthood. The objective of this clinical trial was to assess VitD treatment on endothelial function (EF) and markers of renal inflammation, in this patient group. METHODS: Adolescents with T1D with suboptimal levels of VitD (<37.5 nmol/L) were treated for 12 to 24 weeks with a VitD analog (VitD3 ) at doses of 1000 or 2000 IU daily. The primary end-point assessed the change in reactive hyperemia index (lnRHI), a measure of EF. Secondary end-points included changes in blood pressure, lipid profile, HbA1c and albumin creatinine ratio (ACR). Urinary cytokine/chemokine inflammatory profile was also assessed in a subset of subjects posttreatment. RESULTS: Two hundred and seventy-one subjects were screened for VitD status and 31 VitD deficient subjects with a mean age of 15.7 ± 1.4 years were enrolled and completed the study. Mean 25-OH-VitD levels significantly increased (33.0 ± 12.8 vs 67.0 ± 23.2 nmol/L, P < .01) with a significant improvement in EF following VitD supplementation (lnRHI 0.58 ± 0.20 vs 0.68 ± 0.21, P = .03). VitD supplementation did not significantly impact systolic blood pressure/diastolic blood pressure (SBP/DBP), lipids, HbA1c and ACR and no adverse effects were seen. Several urinary inflammatory cytokines/chemokines: MCP-3 (P < .01), epidermal growth factor (EGF) (P < .01) tumor necrosis factor ß (TNFß) (P = .01), interleukin-10 (IL-10) (P = .01), also significantly decreased post-VitD-treatment. CONCLUSIONS: Treatment with VitD was associated with an improvement in EF and reduced expression of urinary inflammatory markers in adolescents with T1D. This data is suggestive of an additional benefit of VitD supplementation on early markers of microvascular complications.

Memory consolidation in children with epilepsy: does sleep matter?

INTRODUCTION: Children with epilepsy have frequent sleep disturbance and challenges in learning and memory. There is little research on the consolidation of memory during sleep in this population. The goal of this pilot study was to determine whether children with epilepsy are able to consolidate memories better after a sleep versus wake period as has been demonstrated in typically developing children. METHODS: This study was a prospective evaluation of children with epilepsy to determine if sleep improved episodic memory (using word lists) as compared with memory following a wake period of similar duration. The study was conducted in patients in the Epilepsy Monitoring Unit at a single academic health science center. In the sleep recall condition, the learning trials were presented in the evening, and delayed recall of the words was tested in the morning. In the wake condition, the learning took place in the morning, and the delayed recall took place later in the day. Subjects wore an actigraph to evaluate sleep/wake patterns. Data regarding the children's epilepsy, antiepileptic medications, and frequency of interictal epileptiform discharges were also documented. RESULTS: Ten children (agd 8-17years) participated in the study. For the entire sample, recall after sleep was better than recall after awake (p=0.03), and 7 of the 10 children showed this effect. However, reanalyses removing an outlier showed no difference between the two recall conditions. The mean number of interictal epileptiform discharges was 8.8 during the recall after sleep and 7.8 during the recall after awake. Three children had seizures during the evaluation. CONCLUSION: In this pilot study, we demonstrated that a small cohort of children with epilepsy, with similar interictal epileptiform discharges during sleep and wake, showed no advantage in memory for a word list after a period of sleep than after a period of being awake. This finding requires further study in a larger cohort. Poor memory consolidation during sleep may contribute to the cognitive deficits in children with epilepsy.

Quality of life in children with diabetes and celiac disease: minimal impact of the 'double diagnosis'.

BACKGROUND: Despite the advent of sensitive testing to detect celiac disease (CD), screening in type 1 diabetes (T1D) remains controversial. Many diabetes clinics are apprehensive about the prospect of introducing a second illness requiring intensive lifestyle changes in patients and families already managing a chronic condition, especially in asymptomatic patients. OBJECTIVE: To determine the impact of managing CD + T1D on quality of life in families, with attention to the effect of adherence with a gluten-free diet (GFD) and metabolic control. PATIENTS AND METHODS: Cross-sectional assessment using a validated self-reported quality of life measure: 28 children with biopsy-proven CD + T1D were compared with 40 subjects with T1D aged 8-18 yr. Parental and child reports were assessed as well as symptoms at the time of CD diagnosis and adherence with a GFD at the quality of life assessment. RESULTS: No significant differences in quality of life were observed between subjects with established CD + T1D and subjects with T1D alone. Parents of children with CD + T1D reported lower social functioning scores than parents of children with T1D (p = 0.03). In the CD + T1D group no differences in quality of life were observed with regard to age at CD diagnosis, CD duration, or on the basis of adherence with a GFD. CONCLUSIONS: The additional diagnosis of CD has minimal impact on quality of life in children with T1D; however, parents of CD + T1D children did express greater concern about their child's social functioning.

Celiac disease and pediatric type 1 diabetes: diagnostic and treatment dilemmas.

Despite the advent of sensitive and specific serologic testing, routine screening for celiac disease (CD) in diabetic populations may not be universal practice, and many clinicians struggle to find the optimal approach to managing CD in pediatric Type 1 diabetes (T1D) patients. While some clinicians advocate screening for CD in all patients with T1D, others are unsure whether this is warranted. The diagnosis of patients who present with symptomatic CD, including malabsorption and obvious pathology upon biopsy, remains straightforward, with improvements noted on a gluten-free diet. Many patients identified by screening, however, tend to be asymptomatic. Evidence is inconclusive as to whether the benefits of screening and potentially treating asymptomatic individuals outweigh the harms of managing a population already burdened with a serious illness. This review focuses on current knowledge of CD in children and youth with T1D, highlighting important elements of the disease's pathophysiology, epidemiology, clinical presentation, and diagnostic challenges.

Increased restrictive feeding practices are associated with reduced energy density in 4-6-year-old, multi-ethnic children at ad libitum laboratory test-meals.

Increased reports of restrictive feeding have shown positive relationships to child obesity, however, the mechanism between the two has not been elucidated. This study examined the relationship between reported use of restrictive feeding practices and 4-6-year-old children's self-selected energy density (ED) and total energy intake from an ad libitum, laboratory dinner including macaroni and cheese, string beans, grapes, baby carrots, cheese sticks, pudding, milks, and a variety of sweetened beverages. A second objective explored the relationship between ED and child body mass index (BMI) z-score. Seventy (n=70) healthy children from primarily non-Caucasian and lower socioeconomic status families participated. Mothers completed the Child Feeding Questionnaire (CFQ) to assess restrictive feeding practices. Energy density (kcal/g) values for both foods and drinks (ED(food+drink)) and ED for foods only (ED(foods)) were calculated by dividing the average number of calories consumed by the average weight eaten across 4 meals. Higher maternal restriction was associated with lower ED(food+drink). In overweight and obese children only, higher maternal restriction was associated with lower ED(food). There was a non-significant trend for both ED measures to be negatively associated with child BMI z-score. Overall, restrictive feeding practices were not associated with child BMI z-score. However, when analyzing separate aspects of restriction, parents reported higher use of restricting access to palatable foods but lower use of using palatable foods as rewards with heavier children. Previous reports of positive associations between child obesity and restrictive feeding practices may not apply in predominantly non-Caucasian, lower socioeconomic status cohorts of children.