Medical students in distress: The impact of gender, race, debt, and disability.

BACKGROUND: In 2012, over half of US medical students experienced burnout and depression. Since that time, there have been many changes to student demographics, school resources and awareness of burnout in the medical field altogether. New tools are also available to screen for student distress, a condition that correlates with low mental quality-of-life, suicidal ideation and serious thoughts of dropping out. Despite increased attention on wellbeing and improved screening methods, no large-scale studies have evaluated student distress in the modern era of medical education. The objective of this study was to determine the current prevalence of medical student distress and contributing risk factors. METHODS: Student wellbeing from a national cohort of US medical students was measured with an electronic survey in a prospective, observational survey study from 2019-2020. Medical student distress was defined as a Medical Student Wellbeing Index (MS-WBI) of ≥4. Demographic details including age, race, gender, marital status, disability, desired specialty, and debt burden were evaluated in a multivariate logistic regression model to determine possible risk factors for the development of distress. RESULTS: A total of 3,162 students responded to the survey, representing 110 unique medical schools. Of these respondents, 52.9% met criteria for distress and 22% had either taken or considered taking a leave of absence for personal wellbeing. Independent risk factors for distress included involvement in the clinical phase of medical school (OR 1.37); non-male gender (OR 1.6); debt burden >$20,000 (OR 1.37), >$100,000 (OR 1.81), and >$300,000 (OR 1.96); and disability status (OR 1.84). CONCLUSIONS: Medical student wellbeing remains poor in the modern era of medical education despite increased attention to wellbeing and increased availability of wellbeing resources. Disability status is a novel risk factor for distress identified in this study. The persistence of previously identified risk factors such as non-male gender, debt burden and clinical phase of school suggest that efforts to curb medical student distress have been inadequate to date.

Mammography decision making: Trends and predictors of provider communication in the Health Information National Trends Survey, 2011 to 2014.

BACKGROUND: In 2009, the US Preventive Services Task Force recommended that the decision to initiate screening mammography before age 50 years should be individualized. Herein, the authors examined whether health care providers are communicating regarding mammography decision making with women and whether communication is associated with screening behavior. METHODS: Data were drawn from the 2011 to 2014 Health Information National Trends Survey (HINTS). A total of 5915 female respondents aged ≥ 40 years who responded to the following question were included: "Has a doctor or other health professional ever told you that you could choose whether or not to have a mammogram?" We used logistic regression to generate odds ratios (ORs) and 95% confidence intervals (95% CIs) for predictors of provider communication and assessed whether provider communication was associated with mammography in the previous 2 years overall and stratified by age. RESULTS: Fewer than 50% of the women reported provider communication regarding mammogram choice. Women who reported provider communication were not found to be more likely to report no mammogram within the past 2 years (OR, 1.07; 95% CI, 0.87-1.31) compared with those who did not. When stratified by 10-year age group, provider communication was associated with a higher likelihood of no mammogram only among women age ≥70 years (OR, 1.64; 95% CI, 1.15-2.34), and was associated with a lower likelihood of no mammogram only among women aged 40 to 49 years (OR, 0.63; 95% CI, 0.43-0.92). CONCLUSIONS: Between 2011 and 2014, less than one-half of women received communication regarding mammogram choice despite recommendations from the US Preventive Services Task Force. Provider communication regarding mammogram choice can influence screening behavior, particularly for younger and older women. Cancer 2017;123:401-409. © 2016 American Cancer Society.

Adenosine nucleotides and the regulation of GRP94-client protein interactions.

The molecular chaperone heat shock protein 90 (Hsp90) serves essential roles in the regulation of signaling protein function, trafficking, and turnover. Hsp90 function is intimately linked to intrinsic ATP binding and hydrolysis activities, the latter of which is under the regulatory control of accessory factors. Glucose-regulated protein of 94 kDa (GRP94), the endoplasmic reticulum Hsp90, is highly homologous to cytosolic Hsp90. However, neither accessory factors nor adenosine nucleotides have been clearly implicated in the regulation of GRP94-client protein interactions. In the current study, the structural and regulatory consequences of adenosine nucleotide binding to GRP94 were investigated. We report that apo-GRP94 undergoes a time- and temperature-dependent tertiary conformational change that exposes a site(s) of protein-protein interaction; ATP, ADP, and radicicol markedly suppress this conformational change. In concert with these findings, ATP and ADP act identically to suppress GRP94 homooligomerization, as well as both local and global conformational activity. To identify a role(s) for ATP or ADP in the regulation of GRP94-client protein interactions, immunoglobulin (Ig) heavy chain folding intermediates containing bound GRP94 and immunoglobulin binding protein (BiP) were isolated from myeloma cells, and the effects of adenosine nucleotides on chaperone-Ig heavy chain interactions were examined. Whereas ATP elicited efficient release of BiP from both wild-type and mutant Ig heavy chain intermediates, GRP94 remained in stable association with Ig heavy chains in the presence of ATP or ADP. On the basis of these data, we propose that structural maturation of the client protein substrate, rather than ATP binding or hydrolysis, serves as the primary signal for dissociation of GRP94-client protein complexes.