Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices.

Until now, no information is available about the effect of the presence of a doctor-in-training on a patient's blood pressure. We tested the hypothesis that the presence of a last year medical student might increase the blood pressure of the patient, in addition to the possible pressor response to the doctor-trainer. Normotensive and hypertensive patients with a minimum age of 25 years, visiting for any reason, were recruited at 22 teaching general practices. Patients were randomised into a 'trainee' group (n=133) and a 'no trainee' (n=129) group. The blood pressure was measured at two subsequent contacts. In the 'trainee' group, a student was present at the first visit only. In the 'no trainee' group, both visits were without student. Both groups had similar anthropometric characteristics at entry. At the first visit, systolic pressure was higher in the 'trainee' group than in the control group (139.5 vs 133.1 mmHg, P=0.004), with a similar trend for diastolic pressure (80.2 vs 77.8 mmHg, P=0.07). From the first contact to the follow-up visit, blood pressure decreased in the trainee group by 4.8 mmHg systolic (P<0.001) and 1.7 mmHg diastolic (P=0.03), whereas the corresponding changes in the control group were -0.1 mmHg (P=0.90) and +1.5 mmHg (P=0.03). Thus, the between group differences in these trends averaging 4.7 mmHg (CI 1.5-7.9, P=0.005) systolic and 3.2 mmHg (CI 1.1-5.3, P=0.003) diastolic were statistically significant. We conclude that in teaching-practices, the presence of a doctor-in-training has a significant pressor effect when an experienced general practitioner measures a patient's blood pressure. If confirmed, our findings imply that doctors should be cautious to initiate or adjust antihypertensive treatment when blood pressure readings are obtained in the presence of a student.

Assessing adolescents' personality with the NEO PI-R.

The suitability of the Revised NEO Personality Inventory (NEO PI-R) to assess adolescents' personality traits was investigated in an unselected heterogeneous sample of 469 adolescents aged 12 to 17 years. They were further administered the Hierarchical Personality Inventory for Children (HiPIC) to allow an examination of convergent and discriminant validity. The adult NEO PI-R factor structure proved to be highly replicable in the sample of adolescents, with all facet scales primarily loading on the expected factors, independent of the age group. Domain and facet internal consistency coefficients were comparable to those obtained in adult samples, with less than 12% of the items showing corrected item-facet correlations below absolute value .20. Although, in general, adolescents reported few difficulties with the comprehensibility of the items, they tend to report more problems with the Openness to Ideas (05) and Openness to Values (06) items. Correlations between NEO PI-R and HiPIC scales underscored the convergent and discriminant validity of the NEO facets and HiPIC scales. It was concluded that the NEO PI-R in its present form is useful for assessing adolescents' traits at the primary level, but additional research is necessary to infer the most appropriate facet level structure.

Psychological aspects of childhood obesity: a controlled study in a clinical and nonclinical sample.

Explored the relationship between obesity and psychosocial adjustment in a combined clinical and nonclinical sample of 139 obese children and 150 non-obese children (ages from 9 to 12 years and matched for age, socioeconomic status, and gender) who filled out the Perceived Competence Scale for Children; their parents completed the Child Behavior Checklist. All obese children, independent of their help-seeking status, reported more negative physical self-perceptions than their nonobese peers and they scored lower on general self-worth. According to their parents, the obese children of the clinical sample appeared to have more behavior problems. Findings suggest that psychopathology depends on a clinical obese status, and they provide evidence for a psychosocial at-risk profile for a subgroup of obese children.