Cognitive flexibility in women who recovered from anorexia nervosa - a model-based approach.

Research findings on cognitive flexibility (CF) functioning in women who recovered from anorexia nervosa (RAN) were found to be inconsistent. This was attributed to the multiple definitions of CF and the diverse measuring tools used to assess it. Applying a deductive approach to explore CF function may address these inconsistencies; thus, we used a model that divides CF into three subtypes, namely, stimulus-response mapping, switching sets and task switching. Additionally, we explored the association between CF subtypes and the disorder's clinical measures to assess the relation of CF to recovery. Forty-three RAN and 54 healthy controls performed tasks designed to assess CF subtypes based on the model's division, and the RAN group completed the Eating Disorder Examination Questionnaire. The results showed that the RAN group performed significantly worse than controls only in the stimulus-response mapping subtype. Additionally, there were no correlations between CF subtypes and clinical symptoms or the disorder measures - current and nadir body mass index, age of onset, time since recovery, and disorder duration. In conclusion, the study revealed CF impairment after recovery from AN, specifically in stimulus-response mapping. The variability in performance of the CF subtypes supports the application of a theory-driven perspective viewing CF as a modular ability in RAN. Additionally, CF is unrelated to clinical measures post-recovery and thus may not be used as a criterion for evaluating recovery.

Physician-Patient Communication Course: When the Inauguration of a New Israeli Medical School Coincided with COVID-19 Pandemic.

Purpose: The curriculum of the Adelson School of Medicine at Ariel University, the newly established sixth medical school in Israel, includes a simulation center-based extended course on physician-patient communication, aiming to help students master the core competency of interpersonal and communication skills. For more than a year following the emergence of the COVID-19 pandemic, the school suspended most face-to-face (F2F) encounters, transforming most teaching activities to remote platforms. The paper outlines the ways we adapted teaching of this course to these circumstances, the reactions of students and mentors to the changes and results of 1st year students' survey. Methods: During the lockdown in the first year 48 of 70 first-year students participated in a voluntary anonymous online evaluation of the course assessing motivation to become a physician; perceptions, feelings and attitudes towards the communication course, and advantages and disadvantages of online and F2F medical interviews. Results: 46.1% of the responding students reported that the pandemic strengthened their desire to become physicians. 56.3% claimed that they were able to a relatively large extent to empathize with COVID-19 patients who were exposed to the virus; 79.1% viewed their mentors as positive role models of communication skills. The students were able to receive and offer social support to their peers. They evaluated very highly the short instructional videos produced by the faculty. Conclusion: During the lockdown, the respondents generally indicated positive attitudes towards the communication course, the mentors and the inclusion of physician-patient communication as a topic in medical education. The students and mentors reported many disadvantages and few advantages of remote learning. Yet inevitably remote learning including online-based simulations is a step towards preparations for future practice within virtual medical care and telemedicine. The limitations of this study include the cross-sectional design, small sample size and self-reporting.

The Relationship between Socio-Demographic Factors, Preventive Health Behaviors and Acceptance of COVID-19 Vaccine among Israeli Pregnant Women during the Coronavirus Pandemic.

BACKGROUND: The outbreak of the Coronavirus disease led the World Health Organization to publish recommendations regarding preventive health behaviors (PHB). Pregnant women are at a higher risk of severe COVID-19 infection and adherence to these recommendations is critical. There are little data regarding PHB among pregnant women. The current study aims to evaluate the contribution of socio-demographic factors and COVID-19 vaccinations in predicting PHB among pregnant women. METHOD: 202 pregnant Israeli women (mean age = 30.8 years) participated in an online survey in 2021. RESULTS: 88% of the women were vaccinated and few had been infected. Of the women, 75.2% reported wearing face masks in closed spaces, while 12.4% reported wearing masks outdoors; 63.9% of the women did not travel abroad for fear of infection by the virus and 51% avoided crowded events. A simultaneous regression analysis to predict PHB indicated that pregnancy week and Coronavirus vaccination significantly and positively predicted PHB, but religious status was a negative predictor. Age, number of children, and level of education were not associated with PHB. CONCLUSIONS: These findings can be helpful as a preliminary evidence base for policy-making at present and for future epidemics regarding guidelines on PHB adjusted for pregnant women.

Negative experiences of patients using medicinal cannabis: A systematic review of qualitative studies.

AIMS AND OBJECTIVES: In this study, we systematically reviewed qualitative studies concerning patients' experience with medicinal cannabis (MC) use, to gain insight into the negative effects of MC. BACKGROUND: Over the past decades, the use of MC for therapeutic purposes has increased. However, there is conflicting and insufficient data on possible negative physiological and psychological effects of MC treatment. DESIGN: A systematic review was conducted and the PRISMA guidelines were adopted. Literature searches were conducted using PubMed, PsycINFO and EMBASE. Critical Appraisal Skills Programme (CASP) qualitative checklist used to assess risk of bias in the included studies. METHODS: We included studies focusing on conventional medical treatment using cannabis-based products, approved by a physician for a particular health issue. RESULTS: Of the 1230 articles identified in the initial search, eight articles were included in the review. Following the compilation of themes in the eligible studies, six themes were identified: (1) MC approval; (2) administrative barriers; (3) social perception; (4) MC misuse/widespread effect; (5) adverse effects; and (6) dependence or addiction. These were grouped into two meta-themes: (1) administrative and social aspects of MC use; and (2) experiences of the effects of medicinal cannabis. CONCLUSIONS: Our findings call for specific attention to unique consequences associated with MC use. Further research is needed in order to assess the degree to which negative experiences associated with MC use may affect various aspects of patients' medical condition. RELEVANCE TO CLINICAL PRACTICE: Describing the complex experience of MC treatment and its spectrum of consequences for patients may enable physicians, therapists and researchers to provide more attentive and accurate MC treatment to their patients. PATIENT OR PUBLIC CONTRIBUTION: In this review, patients' narratives were explored, yet the research methods did not directly involve patients or the public.

Implicit and explicit attitudes toward gay men and lesbian women among heterosexual undergraduate and graduate psychology and nursing students.

Objectives: To examine implicit and explicit attitudes toward gay men and lesbian women among heterosexual undergraduate and graduate psychology and nursing students. Methods: Implicit attitudes were measured via the Implicit Association Test and explicit attitudes via the Attitudes Toward Lesbian Women and Gay questionnaire. Main results: All groups held negative implicit attitudes toward gay men and lesbian women. Among undergraduates, nursing students reported holding more negative explicit attitudes toward gay men and lesbian women than psychology students. Conclusion: The curricula in both nursing and psychology studies need to address the medical and paramedical needs and issues of sexual minorities.

[AN INSTRUMENT TO ASSESS HOSPITAL NURSES' PERCEIVED SELF-EFFICACY IN PROVIDING PALLIATIVE END-OF-LIFE CARE: A VALIDATION STUDY]

BACKGROUND: The trend of increasing numbers of terminally ill patients hospitalized in general wards requires nursing staff to be able to provide palliative care (PC). The self-efficacy (SE) to provide PC was found to be a leading factor predicting future professional behavior. There is no tool in the Hebrew language to evaluate SE for symptoms management and provision of psychosocial care within the PC. OBJECTIVES: To validate a Hebrew version of the "Palliative Care Self-Efficacy Scale )PCSES)" among nursing staff employed in various hospital wards. METHODS: A cross-sectional study was performed among nursing staff employed at four Israeli hospitals in oncology, internal medicine, surgical and emergency care wards. RESULTS: The PCSES questionnaire was translated into Hebrew and was completed by 588 nurses. Cronbach's alpha coefficients for the translated tool were high: 0.89 for the tool as a whole, 0.82 for the scale regarding ability to deal with questions regarding end-of-life care, and 0.85 for the symptoms management scale. As in the original tool, two factors that in combination explain 58.6% of the variance were found: ability to deal with questions regarding end-of-life care (46.43%) and symptoms management (12.2%). CONCLUSIONS: The psychometric characteristics of this tool demonstrate that it can be used to estimate SE in providing PC among nurses employed in various hospital wards. DISCUSSION: This tool should be used and evaluated among additional professionals involved in providing PC. It should also be tested as a method to identify changes in SE over time.

Nurses' Perceptions of the Quality of Perinatal Care Provided to Lesbian Women.

Aim: Based on the Theory of Reasoned Action (TRA), we examined whether attitudes of nurses from different ethnic groups, subjective norms, behavioral intentions, assessments of relationships and communication were associated with their perceptions of the quality of perinatal care provided to lesbian women. Background: Nurses administer healthcare, provide pertinent information and consultation to lesbians from pregnancy planning through birth. Introduction: During the past few decades, worldwide, there has been a rise in lesbian-parenting. Despite the changes in Israeli society's public and legal reality, intolerance and discrimination to the homosexual population is still prevalent in Israel's healthcare system. Methods: A cross-sectional study conducted between 12/2015-4/2016. Of the 270 nurses approached, 184 completed a self-report anonymous questionnaire (a response rate of 74%). Findings: This is an important and timely study reflecting nurses' perceptions of the quality of perinatal care provided to lesbians. The study findings reflect that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses from different ethnic groups are associated with their perceptions of the quality of perinatal care provided to the lesbians. The hierarchical regression analysis demonstrated that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses contributed 56% to the variance of nurses' perception of their own quality of perinatal care. Discussion: TRA conceptualization predicted the quality of care of nurses from different ethnic groups treating lesbians in a perinatal setting. Conclusion: TRA provides a useful framework for understanding and predicting the motivational effect of health care personnel with the lesbian population, being at risk for stigmatization and receiving less quality perinatal care. Implications for nursing and heath policy: Our findings revealed the importance of formulating a recognized policy in the field of LGBT medicine at the national level. Further training of nurses as to the lesbians' unique health needs, might improve the nurses' relationships and communication as well as the quality of perinatal nursing care.

Cross-Cultural Adaptation, Reliability, and Validity of a Hebrew Version of the Physiotherapist Self-Efficacy Questionnaire Adjusted to Low Back Pain Treatment.

BACKGROUND: Clinician self-efficacy may be an important factor in the success of treatment for low back pain (LBP), which has unique clinical features and a high prevalence rate. Therefore, it is important to assess clinicians' self-efficacy in this particular condition. The Physiotherapist Self-Efficacy (PSE) questionnaire was designed to measure self-efficacy of physiotherapy students. OBJECTIVES: To translate and trans-culturally adapt the PSE into Hebrew, to adjust the questionnaire to assess clinicians' self-efficacy in the treatment of LBP, and to assess the construct validity and reliability of the PSE in the Hebrew version. METHODS: After adjustment for LBP and cross-cultural adaptation, test-retest reliability was assessed with 140 physiotherapists. The analyses used included exploratory factor analysis for structural validity, Cronbach's alpha for internal consistency, and intraclass correlation coefficients (ICC) for test-retest reliability. RESULTS: Factor analysis revealed a unidimensional structure with an acceptable model fit. The PSE translated into Hebrew exhibited a very high internal consistency (α = 0.93) and excellent test-retest reliability (ICC = 0.94). The standard error of measurement (SEM) and minimal detectable change (MDC) were 1.75 and 4.85, respectively. CONCLUSIONS: The Hebrew-translated PSE showed adequate validity and excellent reliability, indicating its suitability to measure clinician self-efficacy in treating patients with LBP.

Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel.

BACKGROUND: Frequent Attenders with Medically Unexplained Symptoms (FA/MUS) are common in primary care, though challenging to identify and treat. OBJECTIVES: This study sought to compare FA/MUS to FA with organic illnesses (FA/OI) and the general clinic population (Non-FA) to understand their demographic characteristics and healthcare utilisation patterns. METHODS: For this retrospective, observational study, Electronic Medical Records (EMR) were obtained from Clalit Health Services, regarding the population of a sizeable primary care clinic in Be'er-Sheva, Israel. Electronic medical records were screened to identify the top 5% of FA. FA were stratified based on whether they had OI. FA without OI were then corroborated as having MUS by their physicians. Demographics, healthcare utilisation and costs were analysed for FA/OI, FA/MUS and Non-FA. RESULTS: Out of 594 FA, 305 (53.6%) were FA/OI and 264 (46.4%) were FA/MUS. FA/OI were older (69.1 vs. 56.4 years, p<.001) and costlier (ILS27693 vs. ILS9075, p<.001) than FA/MUS. Average costs for FA/MUS were over four times higher than Non-FA (ILS9075 vs. ILS2035, p<.001). The largest disparities between FA/OI and FA/MUS were in hospitalisations (ILS6998 vs. ILS2033) and surgical procedures (ILS8143 vs. ILS3175). Regarding laboratory tests, differences were smaller between groups of FA but significantly different between FA and Non-FA. CONCLUSION: FA/MUS are more costly than Non-FA and exhibit unique healthcare utilisation and costs patterns. FA/OI had more severe illnesses necessitating hospitalisations and surgical interventions, while FA/MUS had more investigations and tests, attempting to find an explanation for their symptoms.

Nurses' Knowledge and Attitudes toward Lesbians Seeking Perinatal Care in Israel.

In recent decades, there has been an increasing tendency among lesbians to realize their desire to become parents. Nurses provide perinatal care to lesbians at women's healthcare centres from the pregnancy planning stage until childbirth, serving as a source of information, advice and support. However, little is known about nurses' personal and professional characteristics, including knowledge and attitudes concerning perinatal care of lesbians at women's health centres. The current study was a cross sectional study that assessed a convenience sample of 184 nurses who provide perinatal care to lesbians at women's health centres belonging to the two largest health organizations in Israel. The average score received by participants on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. Of all nurses surveyed, 83.2% had negative attitudes with regard to the treatment of lesbians. Nurses' personal and professional characteristics were found to be associated with these attitudes.

Electronic Distance Learning of Pre-clinical Studies During the COVID-19 Pandemic: A Preliminary Study of Medical Student Responses and Potential Future Impact.

BACKGROUND: Social distancing, implemented to decrease the spread of coronavirus disease-2019 (COVID-19), forced major changes in medical practices, including an abrupt transition from face-to-face to remote patient care. Pre-clinical medical studies were concomitantly switched to electronic distance learning. OBJECTIVES: To explore potential implications of COVID-19 on future pre-clinical medical studies. METHODS: We examined responses of pre-clinical medical students to the remote electronic learning in terms of quality of and satisfaction with teaching and technical support, attendance to classes, and the desire to continue electronic learning in the post-epidemic era. A survey of responses from first-year students at the Adelson School of Medicine was conducted. To optimize the reliability of the survey, a single research assistant conducted telephone interviews with each student, using a structured questionnaire concerning aspects of participation and satisfaction with teaching and with technical components of the remote electronic learning. RESULTS: With 100% response rate, the students reported high satisfaction with the electronic learning regarding its quality, online interactions, instructions given, technical assistance, and availability of recording for future studies. Most of the students (68.6%) noted a preference to continue < 90% of the learning online in the post-outbreak era. A high level of overall satisfaction and a low rate of technical problems during electronic learning were significantly correlated with the desire to continue online learning (P < 0.01). CONCLUSIONS: The high satisfaction and the positive experience with the electronic distance learning imposed by the COVID-19 epidemic implied a successful transition and might induce future changes in pre-clinical medical studies.

Association between parental self-reported knowledge on soy and phytoestrogen and their children's intake of soy-based infant formulae-a cross-sectional study of Israeli parents.

OBJECTIVES: Though natural phytoestrogen (PE) is a major factor in health authorities' considerations regarding soy-based infant formula (SBIF), missing their concentrations may interfere with parents' informed decision. METHODS: We performed an Internet survey investigating soy-related knowledge of parents. We built multiple logistic regression models adjusted for personal covariates for the association between parental knowledge on PE and children intake of SBIF and checked the effect of having children ≤ 2 years old on this association. RESULTS: We enrolled 304 parents, 48.3% men, mean age 33.8 (standard deviation, SD 4.9), mostly with higher education. Of them, 76% had children under two years of age. Mean parental knowledge on PE was 9.83 (SD 3.28) from 20 possible points. Parental knowledge on PE reduced children's intake of SBIF (odds ratio, OR = 0.85 [95% confidence interval 0.70; 1.02]). Stronger inverse association was found for parents with children ≤ 2 comparing with those with older children (OR = 0.85 [0.67; 1.09] and OR = 0.68 [0.39; 1.18], respectively), although these differences were not statistically significant. CONCLUSIONS: Adding PE content to information on SBIF may support informed decision.

Factors that affect Israeli paramedics' decision to quit the profession: a mixed methods study.

BACKGROUND: The rate of Israeli paramedics leaving the profession has been increasing in recent years: 50% leave the profession in three years, for the most part before retirement. While approximately 2500 paramedics have been trained, only about a third of them are still active. The number of paramedics per 100,000 in Israel is only 8, compared to around 66 in the US, and in light of the shortage of paramedics it is important to enhance retention rates. The purpose of the study was to examine the factors related to paramedics leaving the profession in Israel. METHODS: 1. An online survey was sent to 1000 paramedics via Email. 533 were recruited of whom 200 have left the profession. Questions included demographics, job satisfaction, and reasons for leaving or remaining in the profession. 2. In-depth interviews with 15 paramedics who left the profession. RESULTS: Out of 1000 emails sent, 533 Paramedics responded, of which 200 paramedics who left the profession responded (73% left five years after completing training and 93% after 10 years). Among these former paramedics, choosing the paramedic profession was based mainly on an idealistic sense of mission and eagerness to help others, yet leaving the paramedic profession was related to extrinsic factors: lack of career options, extensive and strenuous physical demands accompanied by unrewarding salaries, unusually long work hours, and shift work that negatively affected family and personal life. CONCLUSIONS: It seems that work conditions, including the lack of opportunities for promotion, lack of professional prospects, and inappropriate compensation for hard work are crucial factors in the decision to leave. RECOMMENDATIONS: A joint committee of the Ministries of Health, Justice, and Finance and MDA (Magen David Adom, the national EMS in Israel) should be established for the purpose of improving the conditions and modalities of employment of paramedics and providing appropriate emotional support for paramedics who are exposed daily to work under extreme conditions of stress and human suffering. A joint effort could greatly reduce rates of leaving, training costs, and costs incidental to turnover, as well as increase job satisfaction. Moreover, regulating the profession and expanding the scope of practice to new fields like community paramedicine as part of the EMS service and expanding the scope of physician assistants as an academic profession can create opportunities for advancement and diversity at work that will help retain paramedics in the profession.

Use of antibiotics among end-of-life hospitalized patients with advanced directives: Status examination and association with infectious disease consultation and physician burnout.

BACKGROUND: Overuse of antibiotics in end-of-life patients with advanced directives increases bacterial resistance and causes morbidity and mortality. Consultations with infectious disease (ID) physicians and burnout, which can affect antibiotic days of therapy (DOT) prescribed by physicians, have not been examined so far. OBJECTIVES: To assess antibiotic use by physicians in end-of-life (EOL) patients with advanced directives and to investigate the association between ID consultations, physician burnout, and antibiotic DOT in those patients. DESIGN: A descriptive correlational study. SETTING: Acute-care and post-acute-care hospitals. PARTICIPANTS: The study included 213 physicians and 932 their hospitalized patients in the last 2 weeks of life. METHODS: We distributed questionnaires and analyzed the data collected regarding ID consultation, EOL antibiotics prescription with and without an advanced directive, and physician burnout to 278 physicians, and 213 were completed (response rate 76%). RESULTS: Of the 932 deaths, 435 of 664 (>50%) were EOL patients with advanced directives. Of these patients, 74% received antibiotics, 29.9% had bacterial resistance cultures, and antibiotics were discontinued in only 5%. Half of the physicians lacked knowledge concerning antibiotics use issues and had significantly fewer consultations with ID physicians in EOL patients with advanced directives (mean rate, 0.27) than those without advanced directives (mean rate, 0.47). ID physicians reported significantly higher emotional exhaustion levels (mean rate, 29) than other medical specialties (mean rate, 19.2). Antibiotic DOT was significantly higher when patients had ID consultations (mean rate, 21.6) than in patients who did not (mean rate, 16.2). In post-acute-care hospitals and/or geriatric wards, antibiotic DOT was significantly higher than in other types of hospitals and/or wards. Depersonalization level was negatively related to antibiotic DOT (P < .05). CONCLUSIONS: Antibiotics are overused in EOL patients with advanced directives. ID physician burnout and impact of ID consultation should be further assessed.

Losses and Gains of Psychosocial Resources: Effects on Stress Among Women Undergoing Infertility Treatments and Participating in Social Network Systems.

This theory-driven study assessed the association between infertility-related stress and perceived losses of psycho-social resources; and the buffering effect of resource gains and type of infertility (primary/secondary) on this relationship, among women who participate in online infertility-related social network systems (SNS). Ninety women participating in infertility-related SNS completed online questionnaires assessing resource losses and gains and stress levels. Results: Resource loss significantly predicted stress (ß = .66, p < .001). Resource loss and the number of children were correlated negatively (r = -.22, p < .05). Residency was significantly related to resource loss (r = -.23, p < .05) and perceived stress (r = -.23, p < .05). Israeli participants reported lesser resource loss and lesser perceived stress, compared to participants from other countries. Surprisingly, neither resource gains related to SNS participation nor infertility-type served as moderators in the relationship between resource loss and stress. The association between resource loss and stress supports COR theory formulation of stress etiology. However, while participants noted significant resource gains from use of SNS, these did not buffer the effects of resource loss on stress. Thus, although it may be enticing to turn to SNS for social support, individuals with infertility need to be encouraged to use face-to-face social support too.

Nurses' perceptions of their relationships and communication with lesbian women seeking perinatal care.

AIMS AND OBJECTIVE: To examine whether nurses' assessment of their relationships and communication with lesbian women seeking perinatal care is associated with their personal and professional characteristics and knowledge of homosexuality. BACKGROUND: Recently, there has been a growing incidence of same-sex parenthood. Nurses administer health care to lesbian women from pregnancy planning through birth, providing consultation. Although there has been a shift in attitudes towards homosexuality, discrimination is still quite common. DESIGN: This research is part of a larger cross-sectional study carried out at women's healthcare centres, concerning nurses' perceived quality of perinatal care provided to lesbian women. METHODS: The study was conducted from December 2015-April 2016 at women's health centres in Israel encompassing 184 registered nurses who completed self-report questionnaires. They were assessed as to their knowledge of homosexuality and nurse-patient relationships and communication. The Squire checklist was used. RESULTS: Most (73.4%) had prior acquaintance with lesbian women; only 17.9% had been educated as to lesbian women's unique health needs; of these, 66.7% thought that they had been given professional tools for working with lesbian women; 60.4% were unaware of the importance of knowing the patient's sexual orientation. The average score on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. A significant positive correlation was found between nurses' knowledge of homosexuality and assessment of their relationships and communication with lesbian women seeking perinatal care. In addition, nurses' personal and professional characteristics, such as place of birth, religiosity and familiarity with lesbian women, were related to their assessment of their relationships and communication. CONCLUSION: Nurses' knowledge of homosexuality and personal and professional characteristics were associated with their perceptions regarding relationships and communication with lesbian women seeking perinatal care. RELEVANCE TO CLINICAL PRACTICE: Further training might broaden, refine rigid perceptions and contribute to advancing equal perinatal nursing care of lesbian women.

Burnout and intentions to quit the practice among community pediatricians: associations with specific professional activities.

BACKGROUND: Burnout is an occupational disease expressed by loss of mental and physical energy due to prolonged and unsuccessful coping with stressors at work. A prior survey among Israeli pediatricians published in 2006 found a correlation between burnout and job structure match, defined as the match between engagement with, and satisfaction from, specific professional activities. The aims of the present study were to characterize the current levels of burnout and its correlates among community pediatricians, to identify changes over time since the prior survey, and to identify professional activities that may reduce burnout. METHODS: A questionnaire was distributed among pediatricians both at a medical conference and by a web-based survey. RESULTS: Of the 518 pediatricians approached, 238 (46%) responded to the questionnaire. High burnout levels were identified in 33% (95% CI:27-39%) of the respondents. Higher burnout prevalence was found among pediatricians who were not board-certified, salaried, younger, and working long hours. The greater the discrepancy between the engagement of the pediatrician and the satisfaction felt in the measured professional activities, the greater was the burnout level (p < 0.01). The following activities were especially associated with burnout: administrative work (frequent engagement, disliked duty) and research and teaching (infrequent engagement, satisfying activities). A comparison of the engagement-satisfaction match between 2006 and 2017 showed that the discrepancy had increased significantly in research (p < 0.001), student tutoring (P < 0.001), continuing medical education and participation in professional conferences (P = 0.0074), management (p = 0.043) and community health promotion (P = 0.006). A significant correlation was found between burnout and thoughts of quitting pediatrics or medicine (p < 0.001). CONCLUSIONS: Healthcare managers should encourage diversification of the pediatrician's job by enabling greater engagement in the identified "anti-burnout" professional activities, such as: participation in professional consultations, management, tutoring students and conducting research.

Mastery avoidance: An overlooked aspect of medical students' motivation.

Background: Previous research on medical students' motivation mostly overlooked an important concept, namely, mastery-avoidance goals. The mastery-avoidance goal is defined as engaging in a task to avoid losing knowledge or skills that have already been acquired. We aimed to explore the role of mastery-avoidance goals in changes occurring in low frustration tolerance (LFT) levels over a span of one academic year. This approach enables us to understand which type of motivational orientation is expected to explain most adaptive educational outcomes. Methods: First year medical students (n = 241) participating in a physician-patient communication course completed the surveys of motivational orientations and LFT at the beginning and at the end of the academic year. A confirmatory factor analysis supported the construct validity of the motivational orientations structure. Results: Cross-lagged analysis using structural equation modelling revealed that the mastery-approach goal was negatively related to the progression of LFT while mastery-avoidance goal was positively related. Conclusions: The findings suggest that what matters is not merely the level of motivation, but rather the type of motivational orientations that students pursue. Encouraging students to improve their current skills, while discouraging competitiveness and reducing fear of losing competence, may enhance the effectiveness of medical training programmes.

Cognitive Dysfunction: Part and Parcel of the Diabetic Foot.

OBJECTIVE: The presence of a foot ulcer increases the self-treatment burden imposed on the individual with diabetes. Additionally, this condition increases the cognitive demands needed for adherence to medical recommendations. A potential gap could exist between medical recommendations and the individual's ability to implement them. Hence, the goal of this study was to examine whether the cognitive profile of people with diabetic foot ulcers differs from that of people with diabetes without this complication. RESEARCH DESIGN AND METHODS: This was a case-control study. Ninety-nine individuals with diabetic foot ulcers (case patients) and 95 individuals with type 2 diabetes (control subjects) (age range 45-75 years), who were matched for diabetes duration and sex, underwent extensive neuropsychological evaluation using a NeuroTrax computerized battery, digit symbol, and verbal fluency tests. A global cognitive score after standardization for age and education was computed as well as scores in the following six cognitive domains: memory, executive function, reaction time, attention, psychomotor abilities, and estimated premorbid cognition. RESULTS: Individuals with diabetic foot ulcers had significantly (P < 0.001) lower cognitive scores than individuals with diabetes without this complication, in all tested cognitive domains, excluding estimated premorbid cognition. Individuals with diabetic foot ulcers demonstrated a significant difference between precognitive and current cognitive abilities, as opposed to the nonsignificant difference among control subjects. The differences persisted in multivariable analysis after adjusting for depression and smoking. CONCLUSIONS: Individuals with diabetic foot ulcers were found to possess fewer cognitive resources than individuals with diabetes without this complication. Thus, they appear to face more self-treatment challenges, while possessing significantly fewer cognitive resources.