Assessment and impact of paediatric internalized weight bias: A systematic review.

BACKGROUND: Internalized weight bias (IWB) refers to an individual's belief in negative weight-related stigma. Children and adolescents are particularly vulnerable to IWB, but little is known about IWB in this population. OBJECTIVE: To conduct a systematic review to (1) identify the instruments that measure IWB among children and adolescents and (2) explore comorbid variables associated with paediatric IWB. METHODS: This systematic review was conducted in accordance with the PRISMA guidelines. Articles were pulled from Ovid and PubMED Medline, Ovid HealthStar and ProQuest PsychInfo. Studies were included if they were observational studies, addressed the topic of IWB, and included children under the age of 18. Major outcomes were collected and analysed using inductive qualitative methods. RESULTS: 24 studies met inclusion/exclusion criteria. Researchers used two main instruments to measure IWB: Weight Bias Internalization Scale and Weight Self Stigma Questionnaire. There was some variation in the response scales and wording of these instruments between studies. Outcomes with significant associations were divided into four categories: physical health (n = 4), mental health (n = 9), social functioning (n = 5), and eating behaviours (n = 8). CONCLUSIONS: IWB is significantly associated with and may contribute to maladaptive eating behaviours and adverse psychopathology in children.

The use of emotional intelligence skills in combating burnout among residency and fellowship program directors.

BACKGROUND: Current rates of burnout among physicians are alarming when compared to nonphysician U.S. workers, and numerous interventions have been introduced to mitigate the issue. However, no interventions have specifically targeted the 30% burnout rate among physician program directors. The complex and demanding role of program directors necessitates building relationships, solving crises, securing jobs for residents and maintaining well-being of trainees. The aim of this study is to investigate the impact of emotional intelligence (EQ) on burnout levels among program directors. METHODS: A cross-sectional survey was administered from May 17 to June 30, 2021 to program directors and assistant/ associate program directors at an academic medical center in south-central Pennsylvania. A self-report questionnaire was used to collect data. The survey included an open-ended question along with the Trait Emotional Intelligence Questionnaire- Short Form (TEIQue-SF), Copenhagen Burnout Inventory (CBI), and demographic questions. All data were analyzed using SAS Version 9.4. RESULTS: Of the 109 program directors and assistant/associate program directors invited in the survey, 34 (31.20%) responded. The findings indicate that there is a moderate inverse association between EQ and burnout, suggesting EQ as a protective factor against burnout. We also found that program directors who were considering leaving their position demonstrated higher levels of burnout compared to those who did not. Results from the open-ended question suggest that perceived lack of support, micromanagement, criticism, and extra duties with less payment were among the reasons program directors and associates were considering steeping down from their position. The results showed no association between EQ skills and years of practicing. CONCLUSIONS: Burnout among program directors and assistant/associate program directors is not as alarming as rates of burnout among physicians-in-training. However, despite high level of EQ skills and low burnout level, nearly 43% of program directors were considering leaving their position. Nurturing EQ skills may be useful in improving retention and reducing turnover among medical leaders.

Adjuvant radiotherapy may not significantly change outcomes in high-risk cutaneous squamous cell carcinomas with clear surgical margins: A systematic review and meta-analysis.

BACKGROUND: The role of adjuvant radiotherapy for high-risk cutaneous squamous cell carcinomas after surgery with negative margins is unclear. OBJECTIVE: To conduct a systematic review and meta-analysis examining the risk of poor outcomes for patients treated with surgery alone versus surgery and adjuvant radiotherapy. METHODS: A comprehensive search of articles was executed in PubMed, Embase, and the Cochrane Database. Random-effected meta-analyses were conducted. RESULTS: Thirty-three studies comprising 3867 high-risk cutaneous squamous cell carcinomas were included. There were no statistically significant differences in poor outcomes between the surgery only group and surgery with adjuvant radiotherapy group. Estimates for local recurrence for the surgery alone group versus the surgery with adjuvant radiotherapy group were 15.2% (95% confidence interval [CI], 6.3%-27%) versus 8.8% (95% CI, 1.6%-20.9%); for regional metastases, 11.5% (95% CI, 7.2%-16.7%) versus 4.4% (95% CI, 0%-18%); for distant metastases, 2.6% (95% CI, 0.6%-6%) versus 1.7% (95% CI, 0.2%-4.5%); and for disease-specific deaths, 8.2% (95% CI, 1.2%-20.6%) versus 19.7% (95% CI, 3.8%-43.7%), respectively. LIMITATIONS: Retrospective nature of most studies with the lack of sufficient patient-specific data. CONCLUSIONS: For patients with high-risk cutaneous squamous cell carcinomas treated with margin-negative resection, there were no significant differences in poor outcomes between the surgery only group and the surgery with adjuvant radiotherapy group. Randomized controlled trials are necessary to define the benefit of adjuvant radiotherapy in this setting.

Evaluating the need for dermatological care in a postsurgical bariatric sample.

BACKGROUND: Bariatric surgery rates are increasing in tandem with obesity in the United States. patients after surgery bariatric can lose up to or more than one-third of their excess weight within the first year. This sudden loss of weight can lead to skin redundancy and increased susceptibility to dermatological issues. There is a paucity of literature addressing the issue of skin redundancy and associated factors following bariatric surgery. OBJECTIVES: To evaluate the prevalence and severity of dermatological concerns among postbariatric surgery patients and assess the impact of these issues on patients' quality of life. SETTING: Surgical Weight Loss Clinic at an academic medical center in south-central Pennsylvania. METHODS: A cross-sectional survey was administered from September 9 to November 30, 2020 to adult postoperative patients. Data were collected via self-report questionnaires with a retest issued approximately 72 hours later. The survey included questions regarding occurrences of skin disturbances and the Dermatology Life Quality Index. All analyses were conducted using SAS version 9.4. RESULTS: A total of 575 patients were invited to participate, with 103 participating and 69 completing the retest. The health questionnaire indicated that 69.6% of patients had challenges with skin rashes or irritation due to loose skin; 80.6% were interested in having skin removal surgery; and only 5.8% were referred to a dermatologist for their concerns. CONCLUSION: The presence of skin concerns was associated with impaired HRQOL among postbariatric patients. This suggests a need to further educate the bariatric interdisciplinary team to evaluate the impacts of skin pathology on postbariatric patients.