Time: an underestimated variable in minimizing the gender gap in medical college admission scores.

BACKGROUND: Results of medical college admission tests in Austria demonstrate the slightly worse performance of women, and are the basis for discussions around fairness and a basic science knowledge gap among female applicants. PURPOSE: The purpose of this article was to investigate a basic science knowledge gap among female candidates of the admission test at the Medical University of Graz, and to evaluate whether the point of time of taking the examination has an influence on the test results. METHODS: Observational investigations of the results of the admission test at the Medical University of Graz were performed. A total of 3405 applicants were included in the study. Statistical analyses were performed by routine methods. RESULTS: Male Austrian applicants are invariably more successful than female Austrian applicants when they pass the admission test immediately after completing secondary education. When female as well as male candidates pass the admission test 1 year after completion of secondary education, the differences in the results are no longer statistically significant. CONCLUSIONS: A basic science knowledge gap in the Austrian applicants can be confirmed. The variable time can be interpreted as an opportunity for the reduction of a basic science knowledge gap.

Have "new" methods in medical education reached German-speaking Central Europe: a survey.

BACKGROUND: Simulation-based-training (SBT) in the education of health professionals is discussed as an effective alternative for knowledge and skills enhancement as well as for the establishment of a secure learning environment, for learners and patients. In the Anglo-American region, SBT and simulation and training centers (STC) are numbered as standard for medical training. In German-speaking Central Europe, priority is still given to the establishment of SBT and STC. The purpose of this study was (i) to survey the status quo relating to the existence and facilities of simulation and training centers at medical universities in German-speaking Central Europe and (ii) the evaluation of training methods, especially in the area of emergency medicine skills. METHODS: All public and private medical universities or medical faculties in Germany (36), Austria (4) and German-speaking Switzerland (3) were interviewed. In the survey, information regarding the existence and facilities of STCs and information with regards to the use of SBT in the area of emergency medicine was requested. The questions were partly posed in a closed-ended-, in an open-ended- and in a multiple choice format (with the possibility of selecting more than one answer). RESULTS: Of a total of 43 contacted medical universities/medical faculties, 40 ultimately participated in the survey. As decisive for the establishment of a STC the potential to improve the clinical-practical training and the demand by students were listed. Obligatory training in a STC during the first and sixth academic year was confirmed only by 12 institutions, before the first invasive procedure on patients by 17 institutions. 13 institutions confirmed the use of the STC for the further training of physicians and care-staff. Training for the acute care and emergency medicine skills in the field of pediatrics, for the most part, occurs decentralized. CONCLUSIONS: New methods in medical training have reached German-speaking Central Europe, but the simulation and training centers vary in size, equipment or regarding their integration into the obligatory curriculum as much as the number and variety of the offering to be trained voluntarily or on an obligatory basis.

Oral information about side effects of endocrine therapy for early breast cancer patients at initial consultation and first follow-up visit: an online survey.

This study was initiated to identify how physicians inform women about specific side effects of endocrine therapy for early breast cancer. It is recommended that women with early breast cancer receive endocrine treatment for at least 5 years. Although this medication is an important step in curing breast cancer, continued application by patients is far below 100%; 30-50% of all women prematurely end their prescribed therapy. In an online survey, physicians specializing in treating breast cancer (members of the Austrian Breast and Colorectal Cancer Study Group, ABCSG) were asked about their practice of informing patients about potential side effects of endocrine therapy for breast cancer. Two hundred and five members of the ABCSG completed the online questionnaire. The physicians indicated that patients were primarily informed regarding joint pain/muscle pain and flushes/sleep disturbances during the initial consultation as well as during the first follow-up visit. Patients were informed considerably less regarding side effects that influence quality-of-life areas, such as pain during intercourse, reduced orgasm capability, and hair loss. During the initial consultation, and during first follow-up visit, patients are not uniformly and are insufficiently informed about substantial side effects of endocrine therapy.

Insecurities of women regarding breast cancer research: a qualitative study.

OBJECTIVES: Only 1.2%-11% of all potential study participants participate in cancer studies. Low participation rates can result in bias or in a failure to obtain data saturation. Subject-scientific psychology assumes that reasons for acting are based on individual premises. The objective of this study was to render reproducible individual reasons of female breast cancer patients to participate or not participate in breast cancer studies using a qualitative approach. METHODS: Problem-based interviews were conducted with female breast cancer patients. The selection of interview partners continued until theoretical data saturation was achieved. RESULTS: As main arguments against participation emotional overload and too many medication side-effects were stated. Improvement of health-related values, long-term protection and comprehensive follow-up exams were stated as arguments for participation. Trust in the attending physician was mentioned as influencing both participation and non-participation. CONCLUSIONS: A significant influential factor determining willingness to participate in studies was one's contentment with patient-physician communication. In order to guarantee an adequate patient decision-making process, keeping existing standards for patient briefings is absolutely mandatory.

WHO-definition of health must be enforced by national law: a debate.

BACKGROUND: On its establishment, the World Health Organization (WHO) defined health as a fundamental human right deserving legal protection. Subsequently, the Ottawa Charter reaffirmed health as a fundamental right, and emphasized health promotion as the most appropriate response to global health issues. Here we suggest that the WHO definition of health as more than simply the absence of illness is not normative, and therefore requires standardization. To date such standardization unfortunately is lacking. DISCUSSION: National legislatures must actively ensure fair access to health care, both nationally and internationally, and also must reduce social inequality. To achieve this requires practical action, not statements of intentions, commitments or targets. Protecting fundamental rights to health care can be a fruitful focus for legislatures. Legislative action can build an objective legal framework for health care law, and guide its interpretation and application. Additionally, it is important to ensure the law is appropriate, useful and sustainable. SUMMARY: Action is needed to protect the fundamental right to health care. Legislators should appropriately incorporate the WHO recommendations regarding this right into national law. Additionally, professional experts should help interpret and codify concepts of health and join the interdisciplinary discussion of a variable health standard.

Reasons for and against participation in studies of medicinal therapies for women with breast cancer: a debate.

BACKGROUND: A special challenge for research studies of breast cancer among females is low patient participation rates. We compiled this systematic review to identify reasons why women with, or at high risk of, breast cancer do or do not participate in medicinal studies of breast cancer. METHOD: A systematic literature search in the databases Cochrane Library, EMBASE, Medline, Pascal Biomed, ACP Journal Club and CINAHL, as well as searches through reference lists of relevant texts, was performed. RESULTS: Of 39 relevant full texts, ultimately, nine studies (1 qualitative, 8 quantitative) were included after applying the inclusion criteria. Despite a lack of data material, it was possible to identify various factors influencing women's willingness to participate in medicinal studies and group them into three categories: person-related, study-related, and physician-related. CONCLUSION: Reasons for or against participation in studies of medicinal therapies by women with, or at high risk of, breast cancer are multi-dimensional, and should be considered when planning such studies to garner higher participation rates. For a more comprehensive picture of factors that affect participation, further studies in this field are recommended.

Pregnancy associated hormones modulate the cytokine production but not the phenotype of PBMC-derived human dendritic cells.

OBJECTIVE: Dendritic cells (DC) play a central role in initiating and polarizing immune responses. As effects of pregnancy associated hormones on phenotype and function of DC are unknown, our objective was to test the influence of progesterone, beta-estradiol and betaHCG on immature (iDC) and mature (mDC) DC. STUDY DESIGN: DC generated from peripheral-blood-monocytes were exposed to different doses of hormones. DC phenotype was determined by FACS-analysis of surface marker expression (CD40, CD86, CD83 and HLA-DR). Modifications in the secretion of cytokines (IL12p70, IL-18, IL-10, IL-6, TNFalpha) and chemokines (MDC, IL-8) were analysed by ELISA. T cell stimulatory capacity of mDC was assessed by mixed lymphocyte reaction. RESULTS: Incubation with progesterone or estradiol resulted in a significant upregulation of IL-10 production by iDC and mDC. Combinations of progesterone and betaHCG or estradiol respectively induced a significant decrease in production of IL-18 by mDC. No significant changes could be observed in surface marker expression or T cell stimulatory capacity, neither in cultures of DC matured under influence of progesterone, estradiol nor betaHCG. CONCLUSIONS: PBMC-derived DC seem to be relatively stable against the influence of pregnancy associated hormones apart from particular effects on cytokine production which partly could contribute to the modification of immune responses observed in normal early pregnancy.