More Than a Joke: The Intersection of Gender-Based Humor and Gender Inequities Experienced by Women Department Chairs in Academic Medicine.

Purpose: The purpose of this qualitative descriptive study is to describe how women academic department chairs in emergency medicine, surgery, and anesthesiology experience humor in the workplace. Method: Interviews were conducted with 35 women department chairs in academic medicine from 27 institutions that aimed to describe women's leadership emergence. The data from the primary study yielded rich and revealing themes involving participants' experiences with humor in the context of their leadership roles, justifying a secondary analysis focusing specifically on these experiences. Relevant remarks were extracted, coded, and summarized. Results: Participants discussed two broad types of humor-related experiences. First, they described how they responded to aggressive gender-based humor directed at themselves or their colleagues by tolerating it or expressing disapproval. This humor includes demeaning quips, insulting monikers, sexist jokes, and derogatory stories. Participants often did not confront this humor directly as they feared being rejected or ostracized by colleagues. Second, they described how they initiated humor to address gender-related workplace issues by highlighting gender inequalities, coping with sexual harassment and assault, and managing gender-based leadership challenges. Participants felt constrained in their own use of humor because of the need to be taken seriously as women leaders. Conclusion: Women leaders in academic medicine use humor to confront gender-related issues and experience aggressive gender-based humor in the workplace. The constraints placed on women leaders discourage them from effectively confronting this aggressive gender-based humor and perpetuating gender inequities. Eliminating aggressive gender-based humor is needed to create safe and equitable work environments in academic medicine.

Updates in SJS/TEN: collaboration, innovation, and community.

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a predominantly drug-induced disease, with a mortality rate of 15-20%, that engages the expertise of multiple disciplines: dermatology, allergy, immunology, clinical pharmacology, burn surgery, ophthalmology, urogynecology, and psychiatry. SJS/TEN has an incidence of 1-5/million persons per year in the United States, with even higher rates globally. One of the challenges of SJS/TEN has been developing the research infrastructure and coordination to answer questions capable of transforming clinical care and leading to improved patient outcomes. SJS/TEN 2021, the third research meeting of its kind, was held as a virtual meeting on August 28-29, 2021. The meeting brought together 428 international scientists, in addition to a community of 140 SJS/TEN survivors and family members. The goal of the meeting was to brainstorm strategies to support the continued growth of an international SJS/TEN research network, bridging science and the community. The community workshop section of the meeting focused on eight primary themes: mental health, eye care, SJS/TEN in children, non-drug induced SJS/TEN, long-term health complications, new advances in mechanisms and basic science, managing long-term scarring, considerations for skin of color, and COVID-19 vaccines. The meeting featured several important updates and identified areas of unmet research and clinical need that will be highlighted in this white paper.

Treatment Patterns of Anxiety and Posttraumatic Stress Disorder Following Traumatic Brain Injury.

OBJECTIVE: Symptoms of mental disorders are common, are underrecognized, and contribute to worse outcomes after traumatic brain injury (TBI). Post-TBI, prevalence of anxiety disorders and prevalence of posttraumatic stress disorder (PTSD) are comparable with that of depression, but evidence-based treatment guidelines are lacking. The investigators examined psychotropic medication use and psychotherapy patterns among individuals diagnosed with anxiety disorders and PTSD post-TBI. METHODS: Administrative claims data were used to compare the prevalence and patterns of pharmacotherapy and psychotherapy utilization among individuals diagnosed with an anxiety disorder or PTSD post-TBI. RESULTS: Among 207,354 adults with TBI, prevalence of anxiety disorders was 20.5%, and prevalence of PTSD was 0.6% post-TBI. Receipt of pharmacotherapy pre- and post-TBI (anxiety: pre-TBI=58.4%, post-TBI=76.2%; PTSD: pre-TBI=53.7%, post-TBI=75.2%) was considerably more common than receipt of psychotherapy (anxiety: pre-TBI=5.8%, post-TBI=19.1%; PTSD: pre-TBI=11.2%, post-TBI=36.0%). Individuals diagnosed with anxiety were 66% less likely to receive psychotherapy compared with individuals diagnosed with PTSD, although engagement in psychotherapy decreased faster over time among those with PTSD. Overall, psychotropic medication use and rates of antidepressant prescription use in the anxiety group were higher compared with those in the PTSD group. Benzodiazepines were the second most commonly prescribed medication class in the anxiety group, even though judicious use is warranted post-TBI. CONCLUSIONS: Further exploration of differences and risks associated with pharmacotherapy for anxiety and PTSD post-TBI is warranted to refine treatment guidelines. The low level of psychotherapy engagement suggests that barriers and facilitators to psychotherapy utilization post-TBI should be examined in future studies.

Here for My Peer: The Future of First Responder Mental Health.

Workplace interventions that leverage social tactics to improve health and well-being are becoming more common. As an example, peer mental health support interventions aim to reduce stigma and promote treatment seeking in first responder populations. Given the social nature of these interventions, it is important to consider how the preexisting social context influences intervention outcomes. A peer mental health support intervention was delivered among first responders, and self-efficacy and intention to have supportive peer conversations were measured pre-and post-intervention. Trust in peers was measured prior to the intervention. Results suggest a floor effect may exist for self-efficacy, in which a foundational level of trust and pre-intervention self-efficacy may be needed to maximize intervention effectiveness. As the future of work brings complex safety and health challenges, collaborative solutions that engage multiple stakeholders (employees, their peers, and their organization) will be needed. This study suggests that more frequent attention to pre-existing intervention context, particularly social context in peer-focused intervention, will enhance intervention outcomes.

REACT: A paraprofessional training program for first responders-A pilot study.

The purpose of this study was to evaluate a newly designed peer support training program for first responders titled Recognize, Evaluate, Advocate, Coordinate, and Track (REACT). REACT was developed in partnership with public safety agencies to address the need for promoting psychological health. This resulted in the development of a program that uses train-the-trainer methodology to address primary prevention of stress injuries. REACT was an all-day training that consisted of four modules, each featuring instruction and practice. Six public safety agencies totaling 30 individuals (76.9% from four fire departments, 23.1% from two emergency communication centers) participated in REACT. The primary outcomes were knowledge and training-related self-efficacy; secondary outcomes included general self-efficacy, resilience, and improved attitudes and expectations. A peer-support model, using a train-the-trainer methodology, is a promising approach for addressing the promotion of psychological health.