A longitudinal study of empathy in preclinical and clinical medical students and clinical supervisors

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Although appropriate empathy in health professionals is essential, a loss of empathy can occur during medical education. The structure of clinical learning may be one factor that is implicated in a loss of empathy. This study examines student and doctor empathy, and possible associations between empathy and the structure of clinical learning. Methods: There were three groups of participants: medical students (n = 281), who completed a longitudinal survey consisting of the Jefferson Scale of Empathy and an open question about empathy at the beginning and end of the 2013 academic year; private doctors (medical practitioners) in South Australia (n = 78) who completed a survey consisting of the Jefferson Scale of Empathy and an open question about empathy at the end of the students’ academic year; and doctors (medical practitioners) from public teaching hospitals (n = 72) in southern Adelaide, South Australia who completed a survey consisting of the Jefferson Scale of Empathy at the end of the students’ academic year. Results: Year one students’ empathy scores at the end of the year (102.8 ± 17.7) were significantly lower than at the start of the year (112.3 ± 9.6) p < .05). There were no other significant differences in students’ empathy scores by year groups or across the two time points. Empathy scores were almost identical for private and hospital clinicians and higher than average scores for students. Free-text comments highlighted the importance students and doctors place on empathy. Students described issues that adversely affected their empathy, including specific incidents, systemic issues, and course structure, but also described some positive role models. Doctors’ comments focused on the importance of empathy but qualified its meaning in the therapeutic setting. Conclusion: Medical students and practitioners alike ascribe importance to empathy in clinical practice, yet its developmental course remains poorly understood with possible decrement across the course of medical education. A more sophisticated understanding of empathy in medical students is needed, with attention to issues that might adversely impact on this crucial aspect of their development

The effects of maternal obesity on neonatal anthropometry and placental regulation of cytokine production

Introduction: The prevalence of obesity is rising and maternal obesity has been implicated as a perpetuating factor. Maternal obesity has been linked to the development of macrosomic neonates who are at increased risk of becoming obese themselves. Current understanding of the mechanisms instigating this are unknown, however the pro-inflammatory status associated with obesity has been suggested. Method: Anthropometric estimation of fat mass and percentage body fat was conducted on neonates of lean and obese women and their placentae analysed for morphological changes by light microscopy. Placental explants from both cohorts of women were incubated in order to determine the regulatory role of glucose, leptin, tumour-necrosis factor-α (TNF-α), and insulin on the production of interleukin-1 (IL-1β), interleukin-6 (IL-6), and TNF-α. Results: Neonates of obese mothers were found to have increased birth weight, fat mass, fat free mass, and percentage body fat in comparison to neonates of lean mothers. The rise in birth weight, fat mass, fat free mass, and percentage body fat were not shown to significantly correlate to maternal booking BMI on univariate analysis. Placentae of obese women were shown to produce more IL-6 under basal conditions and in response to TNF-α stimulation. Glucose was shown to reduce placental production of IL-1β, IL-6, and TNF-α in both cohorts, and leptin and insulin stimulation had no effect on cytokine production. There was no evidence of placental inflammation on examination by light microscopy. Conclusion: Maternal obesity is associated with neonates of increased birth weight and adiposity, and increased production of inflammatory mediators by the placenta which is not evidenced in overall placental appearance. It is hoped that by elucidating the mechanisms by which obesity may be perpetuated, via the in-utero environment for example, foundations for future research can be established which are aimed at tackling the epidemic of obesity

Deciduous enamel 3D microwear texture analysis as an indicator of childhood diet in medieval Canterbury, England

This study conducted the first three dimensional microwear texture analysis of human deciduous teeth to reconstruct the physical properties of medieval childhood diet (age 1-8yrs) at St Gregory's Priory and Cemetery (11th to 16th century AD) in Canterbury, England. Occlusal texture complexity surfaces of maxillary molars from juvenile skeletons (n=44) were examined to assess dietary hardness. Anisotropy values were calculated to reconstruct dietary toughness, as well as jaw movements during chewing. Evidence of weaning was sought, and variation in the physical properties of food was assessed against age and socio-economic status. Results indicate that weaning had already commenced in the youngest children. Diet became tougher from four years of age, and harder from age six. Variation in microwear texture surfaces was related to historical textual evidence that refers to lifestyle developments for these age groups. Diet did not vary with socio-economic status, which differs to previously reported patterns for adults. We conclude, microwear texture analyses can provide a non-destructive tool for revealing subtle aspects of childhood diet in the past

Parenting Styles and Disordered Eating Among Youths: A Rapid Scoping Review

Youth is a critical period in the development of maladaptive eating behaviors. Previous systematic reviews suggest the etiological significance of parent-child relationships for the onset of disordered eating in youth, but less is known about the role of parenting styles. This rapid scoping review aimed to identify whether research supports the role of parenting styles in the development of disordered eating symptoms among youths. Sixteen studies, retrieved from three databases (PsycArticles, PsycInfo, and BASE), met the inclusion criteria: original studies, published in English, examined the effect of parenting styles (authoritative or neglectful) on cognitive (drives for thinness and body dissatisfaction) and behavioral (weight control behaviors) disordered eating outcomes, among young people up to 18 years of age. Studies supported an association between various youth disordered eating symptoms such as unhealthy weight control behaviors, and experiences of adverse parenting styles characterized by high levels of control and low levels of responsiveness. Associations between adverse parenting styles and youth disordered eating were frequently indirect and differed depending on the sex of the parent and offspring. Synthesis of findings was limited due to variation in the operationalization and measurement of parenting styles, family context and disordered eating across studies. Longitudinal and standardized research is required to better understand the dynamic associations between parenting styles and youth disordered eating. Implications for family-based care in clinical practice are discussed

The Tobacco-Related Behavioral Risks of a Nationally Representative Sample of Adolescents

The study\u27s purpose was to determine which factors were the strongest predictors of tobacco smoking behaviors among U.S. adolescents. The population included a nationally representative sample of 6,504 adolescents residing in the U.S. Data were collected in respondents \u27homes using trained interviewers. Weighted population estimates showed that over half (55.6%) of adolescents had ever tried smoking, nearly half of whom (48.2%) reported regular smoking. Those whose closest friends smoked were twice as likely to ever smoke (OR = 2.24, p\u3c.001), twice as likely to be a regular smoker (OK = 2.28, p \u3c.OO1), and more likely (b = 5.15p \u3c.OO1) to have smoked daily than those whose friends do not smoke. Results show the very strong influence of friendships on tobacco initiation and continuance among this national sample of adolescents. Recommendations for primary and secondary prevention are noted

Do à la carte menus serve infertility patients? The ethics and regulation of in vitro fertility add-ons

Add-on treatments are the new black. They are provided (most frequently, sold) to patients undergoing in vitro fertilization on the premise that they will improve the chances of having a baby. However, the regulation of add-ons is consistently minimal, meaning that they are introduced into routine practice before they have been shown to improve the live birth rate. Debate on the adequacy of this light-touch approach rages. Defenders argue that demands for a rigorous approval process are paternalistic, as this would delay access to promising treatments. Critics respond that promising treatments may turn out to have adverse effects on patients and their offspring, contradicting the clinician's responsibility to do no harm. Some add-ons, including earlier versions of preimplantation genetic testing for aneuploidy, might even reduce the live birth rate, raising the prospect of desperate patients paying more to worsen their chances. Informed consent represents a solution in principle, but in practice there is a clear tension between impartial information and direct-to-consumer advertising. Because the effects of a treatment cannot be known until it has been robustly evaluated, we argue that strong evidence should be required before add-ons are introduced to the clinic. In the meantime, there is an imperative to identify methods for communicating the associated risks and uncertainties of add-ons to prospective patients

Does Emotional Intelligence Buffer the Effects of Acute Stress? A Systematic Review

People with higher levels of emotional intelligence (EI: adaptive emotional traits, skills and abilities) typically achieve more positive life outcomes, such as psychological wellbeing, educational attainment, and job-related success. Although the underpinning mechanisms linking EI with those outcomes are largely unknown, it has been suggested that EI may work as a ‘stress buffer’. Theoretically, when faced with a stressful situation, emotionally intelligent individuals should show a more adaptive response than those with low EI, such as reduced reactivity (less mood deterioration, less physiological arousal), and faster recovery once the threat has passed. A growing number of studies have begun to investigate that hypothesis in respect to EI measured as both an ability (AEI) and trait (TEI), but results are unclear. To test the ‘stress-buffering’ function of EI, we systematically reviewed experimental studies that explored the relationship between both types of EI and acute stress reactivity or recovery. By searching 4 databases, we identified 45 eligible studies. Results indicated that EI was only adaptive in certain contexts, and that findings differed according to stressor type, and how EI was measured. In terms of stress reactivity, TEI related to less mood deterioration during sports-based stressors (e.g. competitions), physical discomfort (e.g. dental procedure), and cognitive stressors (e.g. memory tasks), but did not appear as helpful in other contexts (e.g. speeches). Furthermore, effects of TEI on physiological stress responses, such as heart rate, were inconsistent. Effects of AEI on subjective and objective stress reactivity were often non-significant, with high levels detrimental in some cases. However, data suggest that both higher AEI and TEI relate to faster recovery from acute stress. In conclusion, results provide mixed support for the stress-buffering effect of EI. Limitations and quality of studies are also discussed. Findings could have implications for EI training programmes

Longitudinal impact of a youth tobacco education program

BACKGROUND: Information on the effectiveness of elementary school level, tobacco-use prevention programs is generally limited. This study assessed the impact of a structured, one-time intervention that was designed to modify attitudes and knowledge about tobacco. Participants were fifth-grade students from schools in western New York State. METHODS: Twenty-eight schools, which were in relatively close geographic proximity, were randomized into three groups; Group 1 was used to assess whether attitudes/knowledge were changed in the hypothesized direction by the intervention, and if those changes were retained four months later. Groups 2 and 3, were used as comparison groups to assess possible test-retest bias and historical effects. Groups 1 and 3 were pooled to assess whether attitudes/knowledge were changed by the intervention as measured by an immediate post-test. The non-parametric analytical techniques of Wilcoxon-Matched Pairs/Sign Ranks and the Mann-Whitney-Wilcoxon Rank Sums Tests were used to compare proportions of correct responses at each of the schools. RESULTS: Pooled analyses showed that short-term retention on most items was achieved. It was also found that retention on two knowledge items 'recognition that smokers have yellow teeth and fingers' and 'smoking one pack of cigarettes a day costs several hundred dollars per year' was maintained for four months. CONCLUSIONS: The findings suggest that inexpensive, one-time interventions for tobacco-use prevention can be of value. Changes in attitudes and knowledge conducive to the goal of tobacco-use prevention can be achieved for short-term retention and some relevant knowledge items can be retained for several months

Do young children get the message? The effects of repeated video viewing on explicit and implicit information

The aim of this study was to explore the effects of repeat viewing on comprehension of explicitly and implicitly presented information in an animated movie. Seventy-three pre-school children watched an animated film and were tested for comprehension after either their single or fifth viewing. Only children&rsquo;s comprehension of explicitly presented information was facilitated by repeat viewing. However, post hoc analyses revealed that children&rsquo;s explicit and implicit comprehension of a central character Thunderbolt significantly increased across viewing conditions, whereas, repeat viewing only facilitated children&rsquo;s explicit comprehension of the central character Patch. The theoretical and practical implications of these findings are discussed.<br /