Serum Dioxin, Testosterone, and Subsequent Risk of Benign Prostatic Hyperplasia: A Prospective Cohort Study of Air Force Veterans

BACKGROUND: Operation Ranch Hand veterans were involved in spraying herbicides, including Agent Orange, during the Vietnam War in 1962–1971; Agent Orange was contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). It has been hypothesized that dioxins may be partially responsible for an increase of male reproductive tract disorders such as testicular cancer, cryptorchidism, and hypospadias. OBJECTIVES: In this study, our objective was to assess the effect of serum TCDD concentration on the risk of development of benign prostatic hyperplasia (BPH) and on serum testosterone levels. METHODS: This study was a longitudinal, prospective cohort study made up of U.S. Air Force veterans involved in Operation Ranch Hand. Other Air Force veterans who did not spray herbicides were included as comparisons. BPH was determined by medical record review and by medical examinations conducted during the study. Data were available for 971 Ranch Hand and 1,266 comparison veterans. We investigated the relationship between BPH and serum TCDD level using the Cox proportional hazards models adjusted for testosterone levels, body mass index (BMI), and the percentage change in BMI per year. RESULTS: In univariate and multivariate analyses, the risk of BPH decreased with increasing serum TCDD in the comparison group. The multivariate risk ratio for BPH in the comparison group was 0.84 (95% confidence interval, 0.73–0.98). Excluding men with prostate cancer, inflammatory or other prostatic diseases did not substantially alter the association. Serum testosterone levels were inversely associated with serum TCDD levels in both Ranch Hand and comparison groups. CONCLUSIONS: TCDD exposure at general population levels is associated with a decreasing risk of BPH with higher exposure levels. TCDD exposure is also negatively associated with serum testosterone levels

Community service learning: an effective vehicle for interprofessional education

Background Health professions students have limited exposure to each other during education and training, yet there are many expectations for interaction in the workplace as part of functioning health care teams. We reasoned that providing students an opportunity to work together in a service learning project under faculty supervision would enhance student knowledge and appreciation of each other’s disciplines and give them a better understanding of working together. Methods and Findings Teams of students from four disciplines (medicine, nursing, dentistry, dental hygiene) worked as volunteers with a unique population of transitional homeless families to develop individualized health and wellness plans. Pre- and post-participation surveys were used to measure changes in student perceptions of working in multi-disciplinary teams, and focus groups were used to identify strengths and weaknesses of the project and future directions. Conclusions Results showed positive predispositions to working with each other which were further enhanced by collaborative, interprofessional experience. Students’ confidence in working together in multidisciplinary teams and understanding of the training and expertise of other professions increased after participation and changes were statistically significant. Interprofessional education and community service-based learning may be a powerful combination for demonstrating the value of clinical teamwork to health professions students

Burnout among psychiatrists in the Veterans Health Administration

Research suggests that mental health workers are at high risk for burnout, and that burnout can increase staff turnover and reduce quality of care. The Veterans Administration (VA) employs over 3000 psychiatrists across the United States, but little is known about burnout in this population. This study was conducted to examine predictors of burnout and intent to leave the VA among a national sample of VA psychiatrists. Participants (N = 125) responded to an anonymous online survey. Regression analyses were used to examine relationships between workplace variables, patient characteristics, and burnout as measured by the Maslach Burnout Inventory-General Survey – which includes sub-scales for cynicism, exhaustion, and professional efficacy – as well as intent to leave the VA. Based on established cut-off scores, 90% of the sample reported high cynicism, 86% reported high exhaustion, and 74% reported high professional efficacy. High cynicism predicted the intent to leave the VA (p = .004). Not feeling part of a coherent team predicted greater cynicism (p = .01), and patient characteristics such as suspected malingering showed a positive trend with cynicism (p = .05). Workplace characteristics such as unfair treatment by supervisors (p = .03) and insufficient resources (p = .001) predicted greater exhaustion. The current findings suggest that burnout is prevalent in the VA psychiatry workforce. Specific administrative measures to reduce burnout may have potential to improve the emotional health of that workforce and ensure high quality of care for the veteran population it serves. The size of both the VA psychiatry workforce and patient population underscores the importance of greater understanding of burnout as it occurs in the VA