Assessment of telemedicine versus in-person care in managing abdominal pain in children during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has led to a dramatic increase in telemedicine care delivery. This raises the question of whether the visit type affects the care provided to patients in the pediatric gastroenterology clinic. The aim of this study is to assess whether diagnostic, treatment, and outcome measures differ between telemedicine and in-person visits in patients seen in pediatric gastroenterology clinics for the chief complaint of abdominal pain. METHODS: We conducted a retrospective analysis of patients aged 0-22 who underwent their initial pediatric gastroenterology clinic visit, for abdominal pain, between March and September 2020 (n = 1769). The patients were divided into two groups: in-person or telemedicine. Clinical outcome measures were compared from the initial gastroenterology visit and followed for a total of 3 months. RESULTS: There was an increase number of images (M = 0.52 vs. 0.36, p < 0.001), labs (M = 4.87 vs. 4.05; p = 0.001), medications (M = 2.24 vs. 1.67; p < 0.001), and referrals (M = 0.70 vs. 0.54; p < 0.001) performed per visit in the in-person group. Electronic communications (3.97 vs. 5.12 p <0.003) was less frequent after in-person visits. There was no difference in number of procedures (M = 0.128 vs. 0.122, p = 0.718), emergency room visits (M = 0.037 vs. 0.017 p = 0.61), follow-up visits (M = 1.21 vs. 1.21 p = 0.922), or telephone encounters (M = 1.21 vs. 1.12 p = 0.35) between the two groups. CONCLUSION: Telemedicine utilizes less resources while having comparable outcome measurements in children with a chief complaint of abdominal pain.

Military acculturation and readjustment to the civilian context.

OBJECTIVE: Attitudes and beliefs related to immersion in military culture can affect postseparation transition to the civilian setting. The etiology and complexity of these reactions are often overlooked by mental health providers, which can result in negative consequences for treatment. This qualitative study examined veterans' perceptions of military culture and the impact of military service on veterans' values, beliefs, and behaviors. The goal of this research was to identify aspects of military culture that are important for health care providers to consider as they care for veterans and to inform culturally sensitive mental health care for veterans. METHOD: Fifty-two military veterans completed a self-report survey and participated in semistructured focus groups. RESULTS: Participants reported diverse military experiences, and many endorsed a high level of continuing identification with aspects of military culture. Seven broad themes related to military culture emerged from qualitative analyses: (a) military values, beliefs, and behaviors; (b) relationships; (c) occupational habits and practices; (d) acquired skills; (e) communication; (f) affiliation; and (g) psychological health and well-being. CONCLUSION: This thematic analysis elucidated strategies to improve mental health services for veterans, using a nuanced model that encourages providers to better distinguish aspects of cultural transition from psychopathology. Results underscored the importance of training mental health providers to ensure sensitivity to military culture. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Team Physiological Dynamics: A Critical Review.

OBJECTIVE: Review the use of physiological measurement in team settings and propose recommendations to improve the state of the science. BACKGROUND: New sensor and analytical capabilities enable exploration of relationships between team members' physiological dynamics. We conducted a review of physiological measures used in research on teams to understand (1) how these measures are theoretically and operationally related to team constructs and (2) what types of validity evidence exist for physiological measurement in team settings. METHOD: We identified 32 articles that investigated task-performing teams using physiological data. Articles were coded on several dimensions, including team characteristics. Study findings were categorized by relationships tested between team physiological dynamics (TPD) and team inputs, mediators/processes, outputs, or psychometric properties. RESULTS: TPD researchers overwhelmingly measure single physiological systems. Although there is research linking TPD to inputs and outputs, the research on processes is underdeveloped. CONCLUSION: We recommend several theoretical, methodological, and statistical themes to expand the growth of the TPD field. APPLICATION: Physiological measures, once established as reliable indicators of team functioning, might be used to diagnose suboptimal team states and cue interventions to ameliorate these states.

Prioritization of Diversity During the Residency Match: Trends for a New Workforce.

BACKGROUND: The medical community has been paying increasing attention to diversity. Nascent research suggests that the physician workforce may be experiencing value shifts in this area. OBJECTIVE: This study aims to understand how residency applicant perspectives toward diversity may be evolving. METHODS: The National Resident Matching Program surveys all applicants regarding factors they consider important when ranking residency programs. Survey data from 2008-2017 were analyzed for changes in respondent perceptions of cultural, racial, and ethnic diversity of geographic location (geographic diversity) and cultural, racial, ethnic, and gender diversity at the destination institution (institutional diversity). We calculated weighted averages and visualized: percentage of respondents citing diversity as a factor when applying for interviews; and mean applicant ratings of diversity when ranking programs, using a 5-point scale (1, not important, to 5, extremely important). RESULTS: Respondents at 5 time points ranged from 13 156 to 16 575, with response rates from 42.4% to 58.5%. Between 2008 and 2017, the percentage of applicants citing diversity as a consideration when applying to interview increased from 27.8% to 33.2% for geographic diversity and from 22.3% to 33.8% for institutional diversity. Applicants' mean ratings of importance of diversity when ranking programs increased from 2.7 to 4.2 for geographic diversity and from 2.4 to 4.2 for institutional diversity. CONCLUSIONS: Over the past 9 years and across specialties, a growing percentage of applicants are considering geographic and institutional diversity when applying to interview at residency programs. Applicants report that both forms of diversity are increasingly important when ranking programs.

A preliminary investigation of attachment style and inflammation in African-American young adults.

Individuals' social experiences are associated with their mental health, physical health, and even mortality. Over the last 30 years, researchers have examined the ways in which these social experiences might be associated with chronic inflammation - a component underlying many of the chronic diseases of aging. Little research, however, has examined the role of adults' attachment style as a specific social component that might be associated with inflammation. In the present study, we utilized data from a sample of 59 African-American adults from the Maryland Adolescent Development in Context Study (MADICS) to examine the links between attachment avoidance and attachment anxiety and C-reactive protein (CRP) and interleukin (IL)-6. After controlling for demographic characteristics, body mass index, and depressive symptoms, attachment avoidance and anxiety were associated with IL-6 but not CRP. This study adds to the growing body of research identifying the wide range of social experiences associated with inflammation and further suggests that attachment relationship experiences may have implications for biological processes relevant to many chronic diseases of aging.

Trauma exposure and disordered eating: A qualitative study.

Quantitative studies have demonstrated a positive association between trauma exposure and disordered eating. However, reasons for this relationship are unclear. We used qualitative methods to understand why some individuals exposed to trauma report disordered eating. We conducted five focus groups and two dyadic interviews between spring 2013 and fall 2014 with women at a Veterans Health Administration medical center (N = 20). Most participants were recruited from outpatient mental health clinics. Participants completed demographic and psychological questionnaires. Using thematic analysis of transcripts, we identified trauma and disordered eating-related themes. Most participants were women of color (55%), and many reported psychological symptoms (65%). The mean age was 48 years (SD = 15). Thematic analysis resulted in three themes. First, trauma can be associated with disordered eating, often in relation to negative affect and maladaptive thoughts. Second, disordered eating can provide short-term, but not long-term, relief from trauma-related negative affect. Third, disordered eating can provide a mechanism to avoid unwanted attention from potential and past perpetrators of trauma. Trauma-related disordered eating, particularly in relation to sexual trauma, may have a distinct profile. Querying patients about causes of disordered eating when women report trauma histories may help clinicians ensure patients receive appropriate treatment.

Screen for Disordered Eating: Improving the accuracy of eating disorder screening in primary care.

OBJECTIVE: To develop a primary care eating disorder screen with greater accuracy and greater potential for generalizability, compared to existing screens. DESIGN: Cross-sectional survey to assess discriminative accuracy of a new screen, Screen for Disordered Eating (SDE), compared to Eating Disorders Screen for Primary Care (EDS-PC) and SCOFF screener, using prevalence rates of Binge Eating Disorder (BED), Bulimia Nervosa (BN), Anorexia Nervosa (AN), and Any Eating Disorder (AED), as measured by the Eating Disorder Examination Questionnaire (EDE-Q). RESULTS: The SDE correctly classified 87.2% (CI: 74.3%-95.2%) of BED cases, all cases of BN and AN, and 90.5% (CI: 80.4%-96.4%) of AED cases. Sensitivity estimates were higher than the SCOFF, which correctly identified 69.6% (CI: 54.2%-82.3%) of BED, 77.8% (CI: 40.0%-97.2%) of BN, 37.5% (CI: 8.52%-75.5%) of AN, and 66.1% (CI: 53%-77.7%) of AED. While the EDS-PC had slightly higher sensitivity than the SDE, the SDE had better specificity. The SDE outperformed the SCOFF in classifying true cases, the EDS-PC in classifying true non-cases, and the EDS-PC in distinguishing cases from non-cases. CONCLUSIONS: The SDE is the first screen, inclusive of BED, valid for detecting eating disorders in primary care. Findings have broad implications to address eating disorder screening in primary care settings.

Military experience can influence Women's eating habits.

BACKGROUND: Disordered eating, ranging from occasional binge eating or restriction to behaviors associated with eating disorder diagnoses, is common among military personnel and veterans. However, there is little information on how military service affects eating habits. OBJECTIVE: To describe possible pathways between military service and disordered eating among women veterans, a high risk group. MATERIALS AND METHODS: Twenty women veterans who reported changing eating habits in response to stress participated in audio-recorded focus groups or dyadic interviews between April 2013 and October 2014. We used thematic analysis of transcripts to identify and understand women's self-reported eating habits before, during, and after military service. RESULTS: Participants reported entering the military with varied eating habits, but little disordered eating. Participants described several ways military environments affected eating habits, for example, by promoting fast, irregular, binge-like eating and disrupting the reward value of food. Participants believed military-related stressors, which were often related to gender, also affected eating habits. Such stressors included military sexual trauma and the need to meet military weight requirements in general and after giving birth. Participants also reported that poor eating habits continued after military service, often because they remained under stress. CONCLUSIONS: For some women, military service can result in socialization to poor eating habits, which when combined with exposure to stressors can lead to disordered eating. Additional research is needed, including work to understand possible benefits associated with providing support in relation to military weight requirements and the transition out of military service. Given the unique experiences of women in the military, future work could also focus on health services surrounding pregnancy-related weight change and the stress associated with being a woman in predominantly male military environments.

Perceptions of parental secure base support in African American adolescents and young adults: A preliminary study of predictive links to adult C-reactive protein.

Within the field of relationship science there is increasing interest in the connections between close relationships and physical health. In the present study, we examined whether adolescents' (~12 years old) and young adults' (~20 years old) perceptions of their parents as a secure base prospectively predict C-reactive protein (CRP), a commonly used marker of inflammatory activity, at age 32 in a well-characterized sample of African Americans. We utilized existing data collected as part of the Maryland Adolescent Development in Context Study (MADICS) to construct measures of perceptions of parental secure base support (SBS), general parental support, and peer support in early adolescence and early adulthood. In the present study, SBS was operationalized as the perceived ability to depend on parents in times of need. Fifty-nine African American MADICS participants who reported on perceived support in early adolescence and early adulthood participated in a follow-up home visit at age 32 during which serum CRP was measured via a blood draw. After controlling for inflammation-related confounds (e.g., tobacco use, body mass index), adolescents' perceptions of parental SBS, but not peer support or general parental support, predicted lower CRP values at age 32 (b = -.92, SE = .34, p < .05). None of the support variables in early adulthood predicted CRP at 32 years. This study adds to a growing literature on relationships and health-related outcomes and provides the first evidence for a link between parental SBS in adolescence and a marker of inflammatory activity in adulthood.