Mortality of young physicians in the United States, 1980-1988.

BACKGROUND: The obituary section of most issues of JAMA announces the death of at least one physician under the age of 40 years. The premature death of a physician is a significant loss to society. METHOD: The authors ascertained the mortality of physicians ages 25 to 39 years occurring from January 1, 1980, through December 31, 1988, from obituary listings in JAMA, and calculated mortality rates by gender and age. Death certificates were sought for all decedents listed as residing in California, Illinois, and Pennsylvania. Cause of death was investigated for this subset. RESULTS: There were 835 young-physician fatalities reported in JAMA during the study period, (an average of 93 deaths per year). The mortality rate among female doctors was 26/100,000; among male doctors it was 40/100,000. The mortality rate of young doctors was less than half that of the general population of white persons of the same age. Of the 122 deaths for which a death certificate was located, 45 (37%) were due to disease, 32 were suicides (26%), 31 were unintentional injuries (25%), and five (4%) were homicides. CONCLUSION: Young physicians enjoy a considerable mortality advantage over non-physicians of similar age. If the study findings in the death certificate sample are generalizable, at least half of the deaths of young physicians are theoretically preventable (suicides, homicides, and unintentional injuries). Residency program directors should consider how their training programs may affect the likelihood of a young physician's dying from a preventable cause.

Psychological reactance and violence within dating relationships.

86 male and 127 female undergraduates were classified into either nonviolent or violent groups based on their self-reported conflict-resolution behaviors within their dating relationships. Using the four subscales of Hong's Psychological Reactance Scale to define the dependent variables, multivariate analyses indicated that individuals in mutually violent relationships had significantly higher scores on all four of the reactance subscales than did those in nonviolent relationships. Men had higher scores than women only on the reactance to conformity subscale. These findings may suggest that both partners in violent dating relationships may be more protective of their personal sense of freedom and more sensitive to perceived threats to these freedoms and that psychological reactance as related to interpersonal control may be an important variable in violent behavior.

Sexual orientation and boyhood gender conformity: development of the Boyhood Gender Conformity Scale (BGCS)

Two hundred twenty-five [corrected] respondents (109 [corrected] heterosexuals and 116 [corrected] homosexuals) completed a survey containing a 20-item Boyhood Gender Conformity Scale (BGCS). This scale was largely composed of edited and abridged gender items from Part A of Freund et al.'s Feminine Gender Identity Scale (FGIS-A) and Whitam's "childhood indicators." The combined scale was developed in an attempt to obtain a reliable, valid, and potent discriminating instrument for accurately classifying adult male respondents for sexual orientation on the basis of their reported boyhood gender conformity or nonconforming behavior and identity. In addition, 33% of these respondents were administered the original FGIS-A and Whitam inventory during a 2-week test-retest analysis conducted to determine the validity and reliability of the new instrument. All the original items significantly discriminated between heterosexual and homosexual respondents. From these a 13-item function and a 5-item function proved to be the most powerful discriminators between the two groups. Significant correlations between each of the three scales and a very high test-retest correlation coefficient supported the reliability and validity assumption for the BGCS. The conclusion was made that the five-item function (playing with boys, preferring [corrected] boys' games, imagining self as sports figure, reading adventure and sports stories, considered a "sissy") was the most potent and parsimonious discriminator among adult males for sexual orientation. It was similarly noted that the absence of masculine behaviors and traits appeared to be a more powerful predictor of later homosexual orientation than the traditionally feminine or cross-sexed traits and behaviors.

Pneumomediastinum following transanal excision of a rectal tumour.

A 45 year old male underwent full thickness transanal excision of a recurrent rectal villous adenoma. On the evening of surgery he developed an unexplained fever of 38.9 degrees C. Plain X-rays revealed a significant pneumomediastinum and pneumoretroperitoneum. This was thought to be due to passage of intrarectal air into the mesorectum and extravasation along tissue planes. The patient was managed with restricted fluids by mouth, an antidiarrhoeal agent, intravenous antibiotics, and frequent clinical and radiological observations. During the following 48 hours the fever settled and the pneumomediastinum resolved by the tenth postoperative day. Sigmoidoscopic examination at this time showed a healing rectal wound. This case illustrates a potential consequence of pelvic surgery and emphasizes the extent of the visceral space that exists as a continuum between the pelvis, abdomen, thorax and neck. This is an unusual complication with a dramatic radiological appearance, but one that can be managed successfully with expectation of a completely benign course.

Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience, and learning curve.

OBJECTIVE: Although sonographic screening for blunt abdominal trauma is gaining acceptance, standards for implementation, training, credentialing, and quality control remain to be established. DESIGN: This prospective study examines a Level I trauma service experience with the de novo establishment of a trauma ultrasound (US) program credentialed through the Department of Surgery under the auspices of Continuous Quality Improvement. MATERIALS AND METHODS: All trauma surgeons attended a combined didactic and "hands on" 8-hour trauma US course. Abdominal sonography was subsequently performed on patients with potential blunt abdominal trauma followed by a standard diagnostic evaluation, which included computed tomographic scan, diagnostic peritoneal lavage, or observation. MEASUREMENTS AND MAIN RESULTS: Three hundred patients were studied over a 4-month period. They averaged 35 years of age with an average injury severity score of 12. The time required to perform the US examination averaged less than 3 minutes. Standard diagnostic evaluation included computed tomographic scan (21%), diagnostic peritoneal lavage (45%), and observation (34%). US examinations resulted in 277 true negatives, 17 true positives, two false positives, and four false negatives for a sensitivity of 81.0%, a specificity of 99.3%, and an accuracy of 98.0%. Annualized cost savings with the use of US evaluation versus standard diagnostic evaluation would amount to over $100,000.00. CONCLUSIONS: This experience with the de novo implementation of a trauma US program suggests that the training and credentialing requirements in this study are sufficient to provide surgeon ultrasonographers with acceptable competence in US diagnosis of blunt abdominal trauma.