Refugees and medical student training: results of a programme in primary care.

CONTEXT: Medical schools have responded to the increasing diversity of the population of the USA by incorporating cultural competency training into their curricula. This paper presents results from pre- and post-programme surveys of medical students who participated in a training programme that included evening clinical sessions for refugee patients and related educational workshops. METHODS: A self-assessment survey was administered at the beginning and end of the academic year to measure the cultural awareness of participating medical students. RESULTS: Over the 3 years of the programme, over 133 students participated and 95 (73%) completed pre- and post-programme surveys. Participants rated themselves significantly higher in all 3 domains of the cultural awareness survey after completion of the programme. CONCLUSIONS: The opportunity for medical students to work with refugees in the provision of health care presents many opportunities for students, including lessons in communication, and scope to learn about other cultures and practise basic health care skills. An important issue to consider is the power differential between those working in medicine and patients who are refugees. To avoid reinforcing stereotypes, medical programmes and medical school curricula can incorporate efforts to promote reflection on provider attitudes, beliefs and biases.

Effects of allocation of attention on habituation to olfactory and visual food stimuli in children.

Responding to food cues may be disrupted by allocating attention to other tasks. We report two experiments examining the effects of allocation of attention on salivary habituation to olfactory plus visual food cues in 8-12-year-old children. In Experiment 1, 42 children were presented with a series of 8 hamburger food stimulus presentations. During each intertrial interval, participants completed a controlled (hard), or automatic (easy) visual memory task, or no task (control). In Experiment 2, 22 children were presented with 10 presentations of a pizza food stimulus and either listened to an audiobook or no audiobook control. Results of Experiment 1 showed group differences in rate of change in salivation (p=0.014). Children in the controlled task did not habituate to repeated food cues, while children in the automatic (p<0.005) or no task (p<0.001) groups decreased responding over time. In Experiment 2, groups differed in the rate of change in salivation (p=0.004). Children in the no audiobook group habituated (p<0.001), while children in the audiobook group did not habituate. Changes in the rate of habituation when attending to non-food stimuli while eating may be a mechanism for increasing energy intake.

Relation between food reinforcement and dopamine genotypes and its effect on food intake in smokers.

BACKGROUND: Food reinforcement and dopaminergic activity may influence food consumption, but research on whether they interact has not been performed. OBJECTIVE: We assessed the effects of food reinforcement and the interaction of food reinforcement with the dopamine transporter (SLC6A3) genotype and the dopamine D(2) receptor (DRD(2)) genotype on energy consumption. DESIGN: We studied food-consumption and reinforcing-value-of-food tasks in 88 smokers of European ancestry before they enrolled in smoking-cessation treatment. In the food-consumption task, subjects tasted and consumed 8 snack foods ad libitum. The reinforcing-value-of-food task assessed how hard subjects would work for food. RESULTS: Significant interactions between dopamine genotypes and food reinforcement were observed. Subjects high in food reinforcement who lacked an SLC6A3*9 allele consumed significantly more calories (>150 kcal; P = 0.015) than did subjects low in food reinforcement or those high in food reinforcement who carried at least one SLC6A3*9 allele. Similarly, subjects high in food reinforcement who carried at least one DRD(2)*A1 allele consumed >130 kcal more (P = 0.021) than did subjects low in food reinforcement or those high in food reinforcement who lacked a DRD(2)*A1 allele. There was also a main effect of food reinforcement on energy intake (P = 0.005), with subjects high in food reinforcement consuming 104 kcal (or 30%) more than did subjects low in food reinforcement. CONCLUSIONS: Food reinforcement has a significant effect on energy intake, and the effect is moderated by the dopamine loci SLC6A3 and DRD(2).

Food hedonics and reinforcement as determinants of laboratory food intake in smokers.

Both the hedonic ratings and the reinforcing value of food have been considered to be determinants of food intake. The objective of this study was to compare the pleasurable ratings and the reinforcing value of food as determinants of energy intake. Seventy-four smokers were studied in food consumption and reinforcing value of food tasks prior to enrolling in a smoking-cessation treatment program. For the food consumption task, the participants tasted and consumed food ad lib from eight snack foods. The reinforcing value of the food task assessed how hard subjects would work for a preferred snack food. Results showed that food reinforcement was related to laboratory food intake, with those high in food reinforcement consuming significantly more calories (+114.4 kcal, P<.01) than did the participants low in food reinforcement. Food reinforcement was related to food intake for the preferred food as well as to total energy intake. Hedonics for the preferred food was related to food reinforcement but not to either measure of laboratory energy intake. In multiple-regression models, food reinforcement and the interaction of food reinforcement by sex were significant predictors of energy intake for the preferred food and for total energy intake, along with baseline hunger. In conclusion, energy intake in smokers in a laboratory setting is more strongly related to food reinforcement than to the hedonic ratings of food.

The value of sedentary alternatives influences child physical activity choice.

The choice to be physically active or sedentary depends in part on the value of the alternatives that are available. The shift from sedentary to active alternatives may be a function of the value of the sedentary alternatives. To evaluate the influence of the value of the sedentary alternatives on the choice to be physically active or sedentary, 30 nonobese 8-12-year-old youth were randomized in groups that provided a choice between 4 active alternatives or 4 sedentary alternatives (Group 1), their least valued sedentary activity (Group 2), or their most valued sedentary activity (Group 3), on computerized and questionnaire versions of a behavioral choice task. The computer task required participants to work for access to the alternatives. The work required to obtain access to the active alternatives remained constant for all choices, while the work required to gain access to the sedentary alternatives progressively increased. Compared to Groups 1 and 3, participants in Group 2 chose to be sedentary less often as they had to make a choice between being physically active or sedentary on the computerized (p < .005) and the questionnaire version (p < .05) of the behavioral choice task, which correlated r = .54, p < .01. These results suggest interventions designed to increase physical activity by reducing access to sedentary behaviors may need to consider the value of the targeted sedentary behavior and the extent to which the sedentary behaviors compete with physical activity.

Habituation of salivation and motivated responding for food in children.

Repeated presentation of food cues results in habituation in adults, as demonstrated by a decrement in salivary responding that is reversed by presenting a new food cue in adults. Food reinforced behavior in animals shows the same pattern of responding, with a decrease in responding to obtain the food, followed by a recovery of responding when a new food is presented. The present study assessed whether children would show the same pattern of a decrement of food reinforced responding followed by recovery of responding when a new food is presented for both salivation and food reinforcement tasks. Subjects were assigned to one of two groups that differed in the trial that the new food stimulus was presented to ensure recovery was specific to the introduction of the new food stimulus. In the salivation task, subjects were provided repeated olfactory presentations of a cheeseburger with apple pie as the new food stimulus, while in the food reinforcement task subjects worked for the opportunity to consume a cheeseburger, followed by the opportunity to work for consumption of apple pie. Subjects in both groups showed a decrement in salivary and food reinforced responding to repeated food cues followed by immediate recovery of responding on the trial when a new food was presented. Subjects increased their energy intake by over 30% in the food reinforcement task when a new food was presented. These results are consistent with the general process theory of motivation that suggests that changes in food reinforced responding may be due in part to habituation.

Comparison between two measures of delay discounting in smokers.

Agreement between computer and questionnaire measures of delay discounting in smokers was compared. Correlations between measures for small, medium, or large rewards were significant. Log k values decreased as the reward delay increased, with values lower for the computer task than the questionnaire, with significant differences for small rewards. The 2 measures were related to smoking rate but not to age, gender, or obesity. The Bland-Altman test of agreement indicated large within-subject differences in k values between the 2 measures. The size of the difference between the log k values and magnitude of the log k values were positively related. Results suggest k values from the 2 measures are related but may not be used interchangeably.