Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations.

Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.

Sleep Patterns and Problems Among Army National Guard Soldiers.

Introduction: Adequate sleep plays an integral role in the physical and mental health of individuals, while simultaneously influencing their cognitive and work performance. Having recognized this, the U.S. Army has focused efforts on improving soldiers' healthy sleep behaviors. This study examines the extent to which mental health, alcohol use, and certain sleep hygiene behaviors predict sleep problems within an Army National Guard sample (N = 438). Materials and Methods: This manuscript is part of a larger study approved through the Minneapolis Veterans Affairs Medical Center Institutional Review Board. Mailed surveys were sent to Minnesota Army National Guard soldiers collecting data on sleep hygiene behaviors, mental health symptoms (post-traumatic stress disorder and depression), and alcohol use. Predictors of sleep problems were evaluated with ordinary least squares multiple linear regression analyses, regressing Insomnia Severity Index total scores on demographic variables, post-traumatic stress disorder (PTSD), depression, alcohol use, sleep hygiene factors (routine and consumption activity; both derived from exploratory factor analysis), and technology use (multiple device use and use before bed). Results: Overall, the majority of participants did not endorse high levels of sleep impairment, while 16.4% screened positive for moderate or even severe levels of clinical insomnia. Bivariate correlations demonstrated that sleep problems were correlated with PTSD symptoms (r = 0.41, p < 0.001), depression (r = 0.49, p < 0.001), Sleep Hygiene Routine (r = -0.34, p < 0.001), and more frequent use of multiple devices before bed (r = 0.15, p = 0.002). The overall regression model predicting sleep problems was significant (R2 = 0.35, adj R2 = 0.34, F[8,408] = 27.58, p < 0.001). Independent predictors of sleep problems included gender (B = 0.99, ß = 0.09, t = 2.10, p = 0.036), PTSD (B = 0.89, ß = 0.22, t = 4.86, p < 0.001), depression (B = 1.53, ß = 0.20, t = 7.56, p < 0.001), and Sleep Hygiene Routine (B = -0.88, ß = -0.23, t = -5.473, p < 0.001). Alcohol use, Sleep Hygiene Consumption, and technology use did not emerge as independent predictors. Conclusion: Although most soldiers denied sleep problems, a sizeable minority met screening criteria for clinical insomnia. Greater numbers of sleep-related complaints were related to psychological distress including depressive and PTSD symptoms, while adherence to a bedtime routine (Sleep Hygiene Routine) showed an inverse relationship. Alcohol use and sleep hygiene consumption activities were not predictive of sleep problems, suggesting that different sleep hygiene behaviors have differential relationships with sleep problems. Screening and intervention for specific sleep problems may be helpful even very early in Army National Guard service members' careers. Particular focus may be needed for those showing signs of emotional distress, such as PTSD or depression. Future research examining the impact of individual sleep hygiene components is warranted.

Neural and genetic markers of vulnerability to post-traumatic stress symptoms among survivors of the World Trade Center attacks.

Although recent research has begun to describe the neural and genetic processes underlying variability in responses to trauma, less is known about how these processes interact. We addressed this issue by using functional magnetic resonance imaging to examine the relationship between posttraumatic stress symptomatology (PTSS), a common genetic polymorphism of the serotonin transporter [5-HTT (5-hydroxy tryptamine)] gene and neural activity in response to viewing images associated with the 9/11 terrorist attack among a rare sample of high-exposure 9/11 survivors (n = 17). Participants varied in whether they carried a copy of the short allele in the promoter region of the 5-HTT gene. During scanning, participants viewed images of the 9/11 attack, non-9/11 negative and neutral images. Three key findings are reported. First, carriers of the short allele displayed higher levels of PTSS. Second, both PTSS and the presence of the short allele correlated negatively with activity in a network of cortical midline regions (e.g. the retrosplenal and more posterior cingulate cortices (PCCs)) implicated in episodic memories and self-reflection when viewing 9/11 vs non-9/11 negative control images. Finally, exploratory analyses indicated that PCC activity mediated the relationship between genotype and PTSS. These results highlight the role of PCC in distress following trauma.