Refining duration and frequency thresholds of restless legs syndrome diagnosis criteria.

OBJECTIVE: This study assesses the prevalence of restless legs syndrome (RLS) using DSM-5 criteria and determines what is the most appropriate threshold for the frequency and duration of RLS symptoms. METHODS: The Sleep-EVAL knowledge base system queried the interviewed subjects on life, sleeping habits, and health. Questions on sleep and mental and organic disorders (DSM-5, ICD-10) were also asked. A representative sample of 19,136 noninstitutionalized individuals older than 18 years living in the United States was interviewed through a cross-sectional telephone survey. The participation rate was 83.2%. RESULTS: The prevalence of the 4 leg symptoms describing RLS occurring at least 1 d/wk varied between 5.7% and 12.3%. When the frequency was set to at least 3 d/wk, the prevalence dropped and varied between 1.8% and 4.5% for the 4 leg symptoms. Higher frequency of leg symptoms was associated with greater distress and impairment with a marked increase at 3 d/wk. Symptoms were mostly chronic, lasting for more than 3 months in about 97% of the cases. The prevalence of RLS according to DSM-5 was 1.6% (95% confidence interval 1.4%-1.8%) when frequency was set at 3 d/wk. Stricter criteria for frequency of restless legs symptoms resulted in a reduction of prevalence of the disorder. The prevalence was further reduced when clinical impact was taken into consideration. CONCLUSIONS: In order to avoid inflation of case rates and to identify patients in whom treatment is truly warranted, using a more conservative threshold of 3 times or greater per week appears the most appropriate.

"If only someone had told me ": lessons from rural providers.

PURPOSE: Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. METHODS: Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded. FINDINGS: Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. CONCLUSION: Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services, and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.

Community-Based Participatory Research for Improved Mental Health.

Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This paper describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course challenges traditional research by introducing a collaborative process meant to encourage increased participation by special populations, and narrow the parity gap in effective mental health treatment and services delivery.

Becoming a good doctor: perceived need for ethics training focused on practical and professional development topics.

OBJECTIVE: Ethics training has become a core component of medical student and resident education. Curricula have been developed without the benefit of data regarding the views of physicians-in-training on the need for ethics instruction that focuses on practical issues and professional development topics. METHODS: A written survey was sent to all medical students and PGY1-3 residents at the University of New Mexico School of Medicine. The survey consisted of eight demographic questions and 124 content questions in 10 domains. Responses to a set of 24 items related to ethically important dilemmas, which may occur in the training period and subsequent professional practice, are reported. Items were each rated on a 9-point scale addressing the level of educational attention needed compared to the amount currently provided. RESULTS: Survey respondents included 200 medical students (65% response) and 136 residents (58% response). Trainees, regardless of level of training or clinical discipline, perceived a need for more academic attention directed at practical ethical and professional dilemmas present during training and the practice of medicine. Women expressed a desire for more education directed at both training-based and practice-based ethical dilemmas when compared to men. A simple progression of interest in ethics topics related to level of medical training was not found. Residents in diverse clinical specialties differed in perceived ethics educational needs. Psychiatry residents reported a need for enhanced education directed toward training-stage ethics problems. CONCLUSIONS: This study documents the importance placed on ethics education directed at practical real-world dilemmas and ethically important professional developmental issues by physicians-in-training. Academic medicine may be better able to fulfill its responsibilities in teaching ethics and professionalism and in serving its trainees by paying greater attention to these topics in undergraduate and graduate medical curricula.

Influence of ethical safeguards on research participation: comparison of perspectives of people with schizophrenia and psychiatrists.

OBJECTIVE: Several safeguards have been developed to protect research volunteers, but little is known about how the people involved in this research-the stakeholders-view these efforts to assure participant rights and well-being. The authors' goal was to examine these perspectives. METHOD: As part of a larger study, 60 people with schizophrenia and 69 psychiatrists rated the protectiveness and influence on patients' willingness to participate in research of five safeguards: informed consent, alternative decision makers, institutional review boards, data safety monitoring boards, and confidentiality measures. RESULTS: All safeguards were perceived by both the participants with schizophrenia and by the psychiatrists as protective: on a scale of 1-5 on which 1=not protective at all and 5=very much protects, the mean scores ranged from 3.54 to 4.07. Four of the five safeguards were perceived by both the people with schizophrenia and by the psychiatrists as positively influencing patients' participation decisions. On a scale of 1-5 on which 1=much less willing and 5=much more willing to participate, the mean scores for these four safeguards ranged from 3.86 to 4.30. The mean score for the safeguard of an alternative decision maker, however, was 3.09. The ratings of protectiveness made by both the people with schizophrenia and the psychiatrists were correlated with their ratings of patients' willingness to participate in studies. CONCLUSIONS: Ethical commitment to research volunteers is expressed in safeguards. These efforts appear to be viewed positively by key stakeholders and may influence research participation decision making.