Self-Reported Preferences for Help-Seeking and Barriers to Using Mental Health Supports Among Internal Medicine Residents: Exploratory Use of an Econometric Best-Worst Scaling Framework for Gathering Physician Wellness Preferences.

BACKGROUND: Burnout interventions are limited by low use. Understanding resident physician preferences for burnout interventions may increase utilization and improve the assessment of these interventions. OBJECTIVE: This study aims to use an econometric best-worst scaling (BWS) framework to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to using wellness supports by quantifying selections for 7 wellness support options and 7 barriers. METHODS: Internal medicine resident physicians at our institution completed an anonymous web-based BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine the relative rank ordering of factors for seeking support for burnout and barriers to using wellness supports. Analysis of variance with Tukey honest significant difference posthoc test was used to analyze differences in mean utility scores representing choice for barriers and support options. RESULTS: Of the 163 invited residents, 77 (47.2% response rate) completed the survey. Top-ranking factors for seeking wellness supports included seeking informal peer support (best: 71%; worst: 0.6%) and support from friends and family (best: 70%; worst: 1.6%). Top-ranking barriers to seeking counseling included time (best: 75%; worst: 5%) and money (best: 35%; worst: 21%). CONCLUSIONS: Overall, our findings suggest that low utilization of formal mental health support is reflective of resident preferences to seek help informally and that increasing utilization will require addressing pragmatic barriers of time and cost. Assessing physician preferences for wellness-related initiatives may contribute to understanding the low utilization of formal mental health services among physicians, which can be determined using a BWS framework.

Impact of Collateral on Emergency Department Length of Stay in College-Aged Patients.

This study evaluated the efficacy of a collaborative intervention between hospitals and universities to decrease the length of stay (LOS) in the Emergency Department (ED) for college students. The hypothesis was that university collateral would decrease LOS in the ED. A retrospective chart review was performed for 834 consults in patients aged 18-25 regarding presence of collateral, disposition, and LOS. Of those hospitalized, LOS in the ED was 15.7 h for students with collateral, 14.6 h for students without collateral, and 19.5 h for unenrolled peers. There was a statistically significant difference in LOS for patients hospitalized in enrolled versus unenrolled patients (t = 2.17, p = 0.031). Of those discharged home, students with collateral, students without collateral, and unenrolled peers spent 9.7 h, 11.6 h, and 13.6 h in the ED respectively. LOS of enrolled versus unenrolled patients discharged home trended towards significance (t = 1.80, p = 0.073), but no significance was found in relation to collateral (t = 1.21,p = 0.23). This study found that college students had decreased LOS in the ED regardless of collateral when compared to unenrolled peers.

Gender, Headaches, and Sleep Health in High School Students.

BACKGROUND: The effects of gender, headaches, and their interaction on sleep health (sleep duration, sleep onset and continuity, and indications of hypersomnolence) have not been well studied. MATERIALS AND METHODS: For American adolescents, we contrasted sleep health variables between males (n = 378) and females (n = 372) and between individuals with chronic headaches (n = 102 females and 60 males) and without chronic headaches (n = 270 females and 318 males) using data from surveys. RESULTS: Not all measures of sleep health differed between groups, but the following patterns were observed for the measures that did differ. Females reported shorter sleep durations on school nights (p = 0.001), increased likelihood of sleepiness on school days (p < 0.05), and higher hypersomnolence scores compared with males (p = 0.005). Individuals with headaches reported shorter sleep durations on weekends (p = 0.009) and higher hypersomnolence scores (p = 0.009) than individuals without headaches. Interestingly, females with headaches reported worse sleep health than females without headaches for multiple measures. Males with headaches did not differ from males without headaches, except for greater waking at night (p = 0.04). CONCLUSIONS: These results are consistent with other studies of gender-based differences in sleep health and emphasize the importance of recognizing the risk of headache in female adolescents and treating that condition to prevent additional sleep health issues.

Sleep health, messaging, headaches, and academic performance in high school students.

AIM: We tested for associations of bedtime, sleep duration, instant messaging, and chronic headaches with hypersomnolence and academic performance in a sample of high school students in New Jersey, USA. METHODS: Students were surveyed anonymously and asked to report their sleep and messaging habits, headache status, and overall grades. RESULTS: We found that greater hypersomnolence was associated with later bedtimes, shorter sleep durations, and the presence of chronic headaches, but not with messaging after lights out. Also, we found that academic performance was lower in students who messaged after lights out, but it was not affected by headache status, bedtime, or sleep duration. CONCLUSIONS: These results are consistent with other studies that have demonstrated associations between headaches and hypersomnolence and between instant messaging habits and academic performance. They also add to a growing literature on the relationships among use of electronic devices, sleep health, and academic performance by adolescents.

Uptake of 3H-cAMP by retinal pigment epithelium isolated from bluegill sunfish (Lepomis macrochirus).

BACKGROUND: In bluegill sunfish, the melanin-containing pigment granules of the retinal pigment epithelium undergo cyclic movements in response both to ambient lighting and circadian cues. Pigment granules aggregate into the cell body at night (in the dark), and disperse into apical processes during the day (in the light). Regulation of pigment granule aggregation in a number of fishes depends on modulating the intracellular levels of cyclic adenosine monophosphate. RESULTS: Here we show isolated RPE takes up cyclic adenosine monophosphate (cAMP) in a saturable manner, exogenously applied cAMP induces pigment granule aggregation in retinal pigment epithelium isolated from bluegill, and aggregation induced in this manner is inhibited by treatment with probenecid, an organic anion transport inhibitor. CONCLUSION: Our results raise the possibility that cAMP functions as a messenger secreted from the neural retina to signal darkness to the RPE, which takes it up. It further suggests that organic anion transport systems are the route by which cAMP crosses RPE cell membranes since probenecid inhibits extracellular cAMP from causing pigment granule aggregation.