A nationwide assessment of lifestyle medicine counseling: knowledge, attitudes, and confidence of Israeli senior family medicine residents.

BACKGROUND: Non-communicable diseases are the leading causes of death, largely due to the last century's often-unhealthy lifestyles. Family medicine (FM) and other physicians can improve patients' lifestyle behaviors, yet FM residency programs in Israel and other countries do not uniformly deliver lifestyle medicine (LM) training. The readiness of FM residents to counsel on lifestyle issues is not known. The purpose of this study is to assess knowledge, attitudes, and confidence levels of senior Israeli FM residents regarding LM counseling, and to evaluate the influence of LM training and personal health behaviors on residents' LM knowledge, attitudes, and confidence. METHODS: From May to June 2017, we surveyed all senior Israeli FM residents regarding their knowledge, attitudes, confidence, and personal health behaviors. We compared health behaviors, attitudes, and confidence in counselling between: 1) trained residents vs. untrained residents; 2) physically active residents vs. not physically active residents; 3) residents with a BMI < 25 vs. those with a BMI > 25; and 4) residents who eat a Mediterranean diet vs. those who do not. RESULTS: A total of 169 senior Israeli FM residents were surveyed, and 143 completed the survey, a response rate of 84.6%. Senior FM residents said they considered LM counseling to be an integral part of their role and an effective tool by which to improve a patient's health. Yet, their knowledge of LM and their confidence in delivering LM counseling are low. Compared with untrained residents (n = 84), LM-trained residents (n = 55) had higher knowledge scores (30.9% vs. 13.1%, p = 0.016) and were more confident in their ability to impact their patients' behaviors (53.7% vs. 34.5%, p = 0.004). Residents' positive personal health behaviors correlated with a higher level of confidence to provide LM counseling. CONCLUSIONS: FM physicians can play a key role in the management of patients with chronic diseases. Israeli FM residents consider counseling patients about a healthy lifestyle to be an integral part of their work, but do not feel well prepared to do so. Dedicated LM training and resident's personal health promotion may improve critically important levels of LM counseling and patient outcomes, and this training should therefore become a higher priority.

What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement.

OBJECTIVE: Physician wellness (well-being) is recognized for its intrinsic importance and impact on patient care, but it is a construct that lacks conceptual clarity. The authors conducted a systematic review to characterize the conceptualization of physician wellness in the literature by synthesizing definitions and measures used to operationalize the construct. METHODS: A total of 3057 references identified from PubMed, Web of Science, and a manual reference check were reviewed for studies that quantitatively assessed the "wellness" or "well-being" of physicians. Definitions of physician wellness were thematically synthesized. Measures of physician wellness were classified based on their dimensional, contextual, and valence attributes, and changes in the operationalization of physician wellness were assessed over time (1989-2015). RESULTS: Only 14% of included papers (11/78) explicitly defined physician wellness. At least one measure of mental, social, physical, and integrated well-being was present in 89, 50, 49, and 37% of papers, respectively. The number of papers operationalizing physician wellness using integrated, general-life well-being measures (e.g., meaning in life) increased [X 2 = 5.08, p = 0.02] over time. Changes in measurement across mental, physical, and social domains remained stable over time. CONCLUSIONS: Conceptualizations of physician wellness varied widely, with greatest emphasis on negative moods/emotions (e.g., burnout). Clarity and consensus regarding the conceptual definition of physician wellness is needed to advance the development of valid and reliable physician wellness measures, improve the consistency by which the construct is operationalized, and increase comparability of findings across studies. To guide future physician wellness assessments and interventions, the authors propose a holistic definition.

A novel integration of online and flipped classroom instructional models in public health higher education.

BACKGROUND: In 2013, a cohort of public health students participated in a 'flipped' Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach. METHODS: Using mixed-methods, we examined learning experiences and perceptions of the flipped classroom model and assessed changes in students' self-perceived knowledge after participation in the course. We used pre- and post-course surveys to measure changes in self-perceived knowledge. The post-course survey also included items regarding learning experiences and perceptions of the flipped classroom model. We also compared standard course review and examination scores for the 2013 NextGenU/Flipped Classroom students to previous years when the course was taught with a lecture-based model. We conducted a focus group session to gain more in-depth understanding of student learning experiences and perceptions. RESULTS: Students reported an increase in knowledge and survey and focus group data revealed positive learning experiences and perceptions of the flipped classroom model. Mean examination scores for the 2013 NextGenU/Flipped classroom students were 88.8% compared to 86.4% for traditional students (2011). On a scale of 1-5 (1 = lowest rank, 5 = highest rank), the mean overall rating for the 2013 NextGenU/Flipped classroom students was 4.7/5 compared to prior years' overall ratings of 3.7 (2012), 4.3 (2011), 4.1 (2010), and 3.9 (2009). Two key themes emerged from the focus group data: 1) factors influencing positive learning experience (e.g., interactions with students and instructor); and 2) changes in attitudes towards environmental and occupation health (e.g., deepened interest in the field). CONCLUSION: Our results show that integration of the flipped classroom model with online NextGenU courses can be an effective innovation in public health higher education: students achieved similar examination scores, but NextGenU/Flipped classroom students rated their course experience more highly and reported positive learning experiences and an increase in self-perceived knowledge. These results are promising and suggest that this approach warrants further consideration and research.

Chronic conditions policies: oral health, a felt absence.

The global health scenario shows an epidemic of non-communicable diseases that lead to long-term chronic conditions, some of which are incurable. Many infectious diseases, owing to their development and length, also generate chronic conditions. Similarly, non-morbid states, such as pregnancy, and some life cycles such as adolescence and ageing, follow the same logic. Among all these chronic conditions there is a significant interrelationship with oral health, both in parallel events and common risk factors. This article presents cross-sectional qualitative research into World Health Organisation recommended health policies to address chronic conditions. Several documents published by the organisation were analysed to verify the presence of references to oral health in relation to chronic conditions, particularly cardiovascular diseases and diabetes as these most frequently have oral manifestations. The analysis showed no significant references to oral health or its indicators within the published texts. The study recognises the value of the work developed by the World Health Organisation, as well as its worldwide leadership role in the development of health policies for chronic conditions. This article proposes a coalition of dentistry organisations that could, in a more forceful and collective way, advocate for a greater presence of oral health in drafting policies addressing chronic conditions.

The association between physicians' and patients' preventive health practices.

BACKGROUND: Although much has been written about the potential power of the association between physicians' personal health practices and those of their patients, objective studies of this relationship are lacking. We investigated this association using objectively measured health care indicators. METHODS: We assessed 8 indicators of quality of health care (screening and vaccination practices) for primary care physicians (n = 1488) and their adult patients (n = 1,886,791) in Israel's largest health maintenance organization; the physicians were also patients in this health care system. RESULTS: For all 8 indicators, patients whose physicians were compliant with the preventive practices were more likely (p < 0.05) to also have undergone these preventive measures than patients with noncompliant physicians. We also found that more similar preventive practices showed somewhat stronger relations. For example, among patients whose physician had received the influenza vaccine, 49.1% of eligible patients received flu vaccines compared with 43.2% of patients whose physicians did not receive the vaccine (5.9% absolute difference, 13.7% relative difference). This is twice the relative difference (7.2%) shown for pneumococcal vaccine-eligible patients of influenza-vaccinated versus nonvaccinated physicians (60.9% v. 56.8%). When we examined the rates of unrelated practices, we found that, for example, mammography rates were identical for patients whose physicians did and did not receive the influenza vaccine. INTERPRETATION: We found a consistent, positive relation between physicians' and patients' preventive health practices. Objectively establishing this healthy doctor-healthy patient relation should encourage prevention-oriented health care systems to better support and evaluate the effects on patients of improving the physical health of medical students and physicians.

Do US medical students report more training on evidence-based prevention topics?

Little is known about the extent to which evidence-based prevention topics are taught in medical school. All class of 2003 medical students (n = 2316) at 16 US schools were eligible to complete three questionnaires: at the beginning of first and third years and in their senior year, with 80.3% responding. We queried these students about 21 preventive medicine topics, concerning the extent of their training and their patient counseling frequency at some of these time points. At the beginning of the third year, self-reported extensive training was low for all preventive medicine topics (range 7-26%). USPSTF-recommended topics received more curricular time (median for topics: 36% if recommended versus 24.5% if not, P = 0.025), as did topics addressed through testing rather than through discussion (median for topics: 37% for testing and 25% for discussion, P = 0.005). Extensive training was always associated with higher counseling frequency, and intention to go into primary care, female gender, a positive attitude toward prevention and positive personal health habits were associated with higher counseling frequency. Although some bemoan the overall low levels of US medical students' prevention-related training and practice, we demonstrate that at least they are preferentially evidence-based, a novel and encouraging finding for preventionists.

Physicians' perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States.

BACKGROUND: We lack national and cross-national studies of physicians' perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. METHODS: We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy. RESULTS: Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians' perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. CONCLUSIONS: U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.

Exercise behaviour and attitudes among fourth-year medical students at the University of British Columbia.

OBJECTIVE: To describe the physical activity (PA) levels and counseling attitudes of Canadian undergraduate medical students. DESIGN: Online or paper survey. SETTING: The University of British Columbia (UBC). PARTICIPANTS: Fourth-year medical students at UBC from 2007 to 2010. MAIN OUTCOME MEASURES: Physical activity levels, relationship between exercise behaviour and attitudes toward counseling, and student perception of training in the area of exercise prescription. RESULTS: A total of 546 out of 883 students participated in the survey (62% response rate). Sixty-four percent of students met the Canadian Society for Exercise Physiology 2011 recommendations for PA. Attitudes toward healthy living were related to PA levels, but the rate of counseling patients about exercise was not; however, students who engaged in more strenuous PA were more likely to perceive exercise counseling as being highly relevant to future clinical practice (P = .018). Overall, 69% of students perceived exercise counseling to be highly relevant to clinical practice, but 86% thought that their training in this area was less than extensive. CONCLUSION: Fourth-year UBC medical students engage in more strenuous PA than average age-matched Canadians, which affects their attitudes toward perceived future counseling practices. Encouraging more student participation in strenuous PA and encouraging academic training in the area of exercise counseling might be important next steps in preparing future physicians to effectively prescribe exercise to their patients.

Trends in medical students' health over 5 years: Does a wellbeing curriculum make a difference?

BACKGROUND: Trends in New Zealand (NZ) medical students' health and the influence of a wellbeing curricula are unknown. METHODS: The author's collected self-report data from NZ medical students on 'Graduation Day' from 2014 to 2018, using a serial cross-sectional survey design with validated scales assessing psychological health, stigma, coping, and lifestyle. Comparisons were made with NZ general population same-age peers. Analyses examined trends, differences between 'cohorts' of students receiving different exposures to a wellbeing curriculum, and correlations between students' own lifestyle practices and their frequency of talking with patients about those topics. RESULTS: Of 1,062 students, 886 participated. The authors found statistically significant self-reported increases from 2014 to 2018 for negative psychological indices, including scores for distress and burnout, suicidal thoughts in the preceding year, and the likelihood of being diagnosed with an anxiety disorder. There was a significant increase in numbers of students reporting having their own doctor as well as increased healthy coping strategies and a significant decrease in stigma scores. Academic cohorts of students who had completed a wellbeing curriculum were more likely to report high distress levels, having been diagnosed with a mood disorder, and being non-drinkers than students without wellbeing training. When compared to NZ peers, medical students smoked less, exercised more, and were less likely to have diagnosed mood and anxiety disorders, but reported more distress. The authors found a significant correlation between the amount of exercise students undertook and their likelihood to discuss exercise with patients. CONCLUSIONS: NZ medical students have better physical health than general population peers and are more likely to discuss exercise with patients if exercising themselves. However, cohorts of graduating students report increasing distress despite the implementation of a wellbeing curriculum. Research is needed into mechanisms between students' self-awareness, willingness to report distress, stigma, mind-set, coping, and psychological outcomes, to inform curriculum developers.

Health care providers' advice to quit smoking, National Health Interview Survey, 2000, 2005, and 2010.

Although the prevalence of cigarette smoking has declined in the United States, little documentation exists to ascertain which health care providers (HCPs) promote smoking cessation. We used data from the 2000, 2005, and 2010 Cancer Control Supplement of the National Health Interview Survey to examine changes in the number of adults who received smoking cessation advice from their HCP. The percentage of smokers who received cessation advice was 53.3% in 2000, 58.9% in 2005, and 50.7% in 2010. To affect noticeably declining rates, HCPs should increase their efforts to advise smokers to quit.

Developing a framework for understanding doctors' health access: a qualitative study of Australian GPs.

Health access behaviours of doctors need to be understood if the profession is to adequately respond to concerns raised about doctors' health. There has been limited investigation of these issues and most qualitative studies have focussed on doctors who have been seriously unwell. This research project was designed to explore doctors' attitudes to health access and the barriers they experience using six independently facilitated focus groups (37 general practitioners) in Brisbane, Australia. Themes that emerged using inductive thematic analysis were grouped into three key categories. The findings challenge current representations of doctors' health within the medical literature. Doctors in this study reported positive attitudes towards their own health care. Health access, however, was difficult because of the barriers they encountered. These barriers are described in detail revealing the rationale used by doctors seeking care. A framework of patient, provider and profession barrier domains is developed to enable a comparison between the health access barriers of the doctor and those experienced by the general community. The complexity is highlighted as the socio-cultural factors woven through these barrier domains are recognised. The potential for this framework to provide a structure for future interventions to enhance doctors' health access is discussed.

Association between substance use and professional outcomes among medical students: Findings from a Canadian cross-sectional survey.

Background: While substance use is common among medical students, there is limited research on this topic involving Canadian medical students or exploring its associations with professional outcomes. The present study examines the association between Canadian medical students' substance use and related counselling attitudes and practices, career satisfaction, academic/clinical workload, and the medical school environment. Methods: We sent an electronic cross-sectional survey to students attending all 17 Canadian medical schools between November 2015 and March 2016. A total of 4,438 participants completed the survey across four years of study, with a participation rate of 40.2%. We considered four categories of substance use: cannabis, alcohol, non-medical use of prescription stimulants (NPS), and cigarettes. Covariates included professional attitudes (e.g., career satisfaction, distress, patient counselling on alcohol or smoking cessation), specialty of interest, learner mistreatment, and perceived medical school support. We used multivariate logistic regression models, generating adjusted odds ratios (AORs), to examine covariates associated with substance use and how substance use (as a covariate) was associated with different professional outcomes. Results: Individuals more interested in "lifestyle" specialties (AOR, 1.81; 95% CI, 1.08-3.05) and surgical specialties (AOR, 1.69; 95% CI, 1.16-2.47) were more likely to report excessive alcohol use. Those interested in primary care were more likely to report cannabis use in the past 12 months (AOR, 1.85; 95% CI, 1.14-3.00). We did not identify significant associations between specialty of interest and current cigarette or NPS use in the past 12 months. However, excessive alcohol use was associated with greater career satisfaction (AOR, 1.24; 95% CI: 1.04-1.49), whereas NPS in the past 12 months was associated with poorer career satisfaction (AOR, 0.63; 95% CI: 0.42-0.93). In addition, there was a negative association between NPS use and the ability to handle workloads due to physical (AOR, 0.31; 95% CI, 0.18-0.54) or mental health issues (AOR, 0.46; 95% CI, 0.30-0.71), but not for other substances. We also found significant negative associations between current cigarette use and the perceived relevance of smoking cessation counselling (AOR, 0.48; 95% CI: 0.29-0.80) and alcohol cessation counselling (AOR, 0.42; 95% CI: 0.25-0.70). Conclusions: These findings suggest that specific patterns of substance use in medical students appeared to be significantly associated with some professional outcomes, specialty of interest, and attitudes towards addiction-related clinical practice. Encouraging medical students to practise healthy habits, including minimizing harmful substance use behaviours, could be an important target for improving medical students' health and their patient care.

Contexte: Bien que la consommation d'alcool et de drogues soit courante chez les étudiants en médecine, peu d'études sur ce sujet ont été menées auprès d'étudiants canadiens en médecine ou ont exploré ses liens avec les résultats professionnels. La présente étude examine l'association entre la consommation de substances psychoactives des étudiants canadiens en médecine et les comportements et habitudes en matière de suivi psychologique, la satisfaction à l'égard de la carrière, la charge de travail universitaire/en clinique et l'environnement de la faculté de médecine. Méthodes: Nous avons fait parvenir une enquête transversale électronique aux étudiants fréquentant les 17 facultés de médecine canadiennes entre novembre 2015 et mars 2016. Au total, 4 438 participants ont répondu à l'enquête sur quatre années d'études, avec un taux de participation de 40,2 %. Nous avons considéré quatre catégories de consommation de substances : le cannabis, l'alcool, l'utilisation non médicale de stimulants sur ordonnance (NSO) et les cigarettes. Les covariables comprenaient les attitudes professionnelles (par exemple, la satisfaction professionnelle, la détresse, les conseils aux patients sur l'arrêt de l'alcool ou du tabac), la spécialité choisie, les maltraitances infligées aux étudiants et le soutien perçu de la faculté de médecine. Nous avons utilisé des modèles de régression logistique multivariés, générant des rapports de cotes ajustés (RCA), pour examiner les covariables associées à la consommation de substances et la façon dont la consommation de substances (en tant que covariable) était associée à différents résultats professionnels. Résultats: Les personnes plus intéressées par les spécialités "mode de vie" (RCA, 1,81 ; IC 95 %, 1,08-3,05) et les spécialités chirurgicales (RCA, 1,69 ; IC 95 %, 1,16-2,47) étaient plus susceptibles de déclarer une consommation excessive d'alcool. Les personnes intéressées par les soins primaires étaient plus susceptibles de déclarer avoir consommé du cannabis au cours des 12 derniers mois (RCA, 1,85 ; IC à 95 %, 1,14-3,00). Nous n'avons pas identifié d'associations significatives entre la spécialité choisie et la consommation de cigarettes ou de NSO au cours des 12 derniers mois. Toutefois, la consommation excessive d'alcool était associée à une plus grande satisfaction professionnelle (RCA, 1,24 ; IC à 95 % : 1,04-1,49), tandis que la consommation de NSO au cours des 12 derniers mois était associé à une plus faible satisfaction professionnelle (RCA, 0,63 ; IC à 95 % : 0,42-0,93). En outre, il existe une association négative entre la consommation de NSO et la capacité à gérer la charge de travail en raison de problèmes de santé physique (RCA, 0,31 ; IC à 95%, 0,18-0,54) ou mentale (RCA, 0,46 ; IC à 95%, 0,30-0,71), mais pas pour les autres substances. Nous avons également constaté des associations négatives significatives entre l'usage de la cigarette et la pertinence perçue des conseils en matière d'arrêt du tabac (RCA, 0,48 ; IC 95 % : 0,29-0,80) et des conseils en matière d'arrêt de l'alcool (RCA, 0,42 ; IC 95 % : 0,25-0,70). Conclusions: Ces résultats suggèrent que des modèles spécifiques de consommation de substances psychoactives chez les étudiants en médecine semblent être significativement associés à certains résultats professionnels, à la spécialité choisie et aux attitudes envers la pratique clinique liée à la dépendance. Encourager les étudiants en médecine à adopter des habitudes saines, notamment en minimisant les comportements nocifs liés à la consommation de substances, pourrait être un objectif important pour améliorer la santé des étudiants en médecine et les soins aux patients. Motsclés: Consommation de substances psychoactives ; Étudiants en médecine ; Enquête ; Canada.

Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications.

Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-022-00841-x.

Implementing and Sustaining Brief Addiction Medicine Interventions with the Support of a Quality Improvement Blended-eLearning Course: Learner Experiences and Meaningful Outcomes in Kenya.

Quality improvement methods could assist in achieving needed health systems improvements to address mental health and substance use, especially in low-middle-income countries (LMICs). Online learning is a promising avenue to deliver quality improvement training. This Computer-based Drug and Alcohol Training Assessment in Kenya (eDATA-K) study assessed users' experience and outcome of a blended-eLearning quality improvement course and collaborative learning sessions. A theory of change, developed with decision-makers, identified relevant indicators of success. Data, analyzed using descriptive statistics and thematic analysis, were collected through extensive field observations, the eLearning platform, focus group discussions, and key informant interviews. The results showed that 22 community health workers and clinicians in five facilities developed competencies enabling them to form quality improvement teams and sustain the new substance-use services for the 8 months of the study, resulting in 4591 people screened, of which 575 received a brief intervention. Factors promoting course completion included personal motivation, prior positive experience with NextGenU.org's courses, and a certificate. Significant challenges included workload and network issues. The findings support the effectiveness of the blended-eLearning model to assist health workers in sustaining new services, in a supportive environment, even in a LMIC peri-urban and rural settings.

Perception of Medical Student Mistreatment: Does Specialty Matter?

PURPOSE: Medical student mistreatment is pervasive, yet whether all physicians have a shared understanding of the problem is unclear. The authors presented professionally designed trigger videos to physicians from 6 different specialties to determine if they perceive mistreatment and its severity similarly. METHOD: From October 2016 to August 2018, resident and attending physicians from 10 U.S. medical schools viewed 5 trigger videos showing behaviors that could be perceived as mistreatment. They completed a survey exploring their perceptions. The authors compared perceptions of mistreatment across specialties and, for each scenario, evaluated the relationship between specialty and perception of mistreatment. RESULTS: Six-hundred fifty resident and attending physicians participated. There were statistically significant differences in perception of mistreatment across specialties for 3 of the 5 scenarios: aggressive questioning (range, 74.1%-91.2%), negative feedback (range, 25.4%-63.7%), and assignment of inappropriate tasks (range, 5.5%-25.5%) (P ≤ .001, for all). After adjusting for gender, race, professional role, and prior mistreatment, physicians in surgery viewed 3 scenarios (aggressive questioning, negative feedback, and inappropriate tasks) as less likely to represent mistreatment compared with internal medicine physicians. Physicians from obstetrics-gynecology and "other" specialties perceived less mistreatment in 2 scenarios (aggressive questioning and negative feedback), while family physicians perceived more mistreatment in 1 scenario (negative feedback) compared with internal medicine physicians. The mean severity of perceived mistreatment on a 1 to 7 scale (7 most serious) also varied statistically significantly across the specialties for 3 scenarios: aggressive questioning (range, 4.4-5.4; P < .001), ethnic insensitivity (range, 5.1-6.1; P = .001), and sexual harassment (range, 5.5-6.3; P = .004). CONCLUSIONS: Specialty was associated with differences in the perception of mistreatment and rating of its severity. Further investigation is needed to understand why these perceptions of mistreatment vary among specialties and how to address these differences.

Mental health concerns among Canadian physicians: results from the 2007-2008 Canadian Physician Health Study.

OBJECTIVE: In light of prior reports on the prevalence of stress, depression, and other mental health problems among physicians in training and practice, we examined the mental health concerns of Canadian physicians using data from the 2007-2008 Canadian Physician Health Study. METHODS: Among 3213 respondents, 5 variables (depressive symptoms during the past year, anhedonia in the past year, mental health concerns making it difficult to handle one's workload in the past month, problems with work-life balance, and poor awareness of resources for mental health problems) were examined in relation to sex, specialty, practice type (solo practice vs group or other practice settings), and practice setting (inner city, urban/suburban, or rural/small town/remote). RESULTS: Nearly one quarter of physicians reported a 2-week period of depressed mood, and depression was more common among female physicians and general practitioners/family physicians. Anhedonia was reported by one fifth; anesthesiologists were most likely to report anhedonia, followed by general practitioners/family physicians. More than one quarter reported mental health concerns making it difficult to handle their workload, which was more common among female physicians and general practitioners/family physicians and psychiatrists. Nearly one quarter reported poor work-life balance. Lack of familiarity with mental health resources was problematic, which was more prominent among female physicians and specialists outside of general practice/family medicine or psychiatry. CONCLUSIONS: Mental health concerns are relatively common among Canadian physicians. Training programs and programmatic/policy enhancements should redouble efforts to address depression and other mental health concerns among physicians for the benefit of the workforce and patients served by Canadian physicians.

Changes in cannabis use, exposure, and health perceptions following legalization of adult recreational cannabis use in California: a prospective observational study.

BACKGROUND: Most U.S. states have legalized cannabis for medical and/or recreational use. In a 6-month prospective observational study, we examined changes in adult cannabis use patterns and health perceptions following broadened legalization of cannabis use from medical to recreational purposes in California. METHODS: Respondents were part of Stanford University's WELL for Life registry, an online adult cohort concentrated in Northern California. Surveys were administered online in the 10 days prior to state legalization of recreational use (1/1/18) and 1-month (2/1/18-2/15/18) and 6-months (7/1/2018-7/15/18) following the change in state policy. Online surveys assessed self-reported past 30-day cannabis use, exposure to others' cannabis use, and health perceptions of cannabis use. Logistic regression models and generalized estimating equations (GEE) examined associations between participant characteristics and cannabis use pre- to 1-month and 6-months post-legalization. RESULTS: The sample (N = 429, 51% female, 55% non-Hispanic White, age mean = 56 ± 14.6) voted 58% in favor of state legalization of recreational cannabis use, with 26% opposed, and 16% abstained. Cannabis use in the past 30-days significantly increased from pre-legalization (17%) to 1-month post-legalization (21%; odds ratio (OR) = 1.28, p-value (p) = .01) and stayed elevated over pre-legalization levels at 6-months post-legalization (20%; OR = 1.28, p = .01). Exposure to others' cannabis use in the past 30 days did not change significantly over time: 41% pre-legalization, 44% 1-month post-legalization (OR = 1.18, p = .11), and 42% 6-months post-legalization (OR = 1.08, p = .61). Perceptions of health benefits of cannabis use increased from pre-legalization to 6-months post-legalization (OR = 1.19, p = .02). Younger adults, those with fewer years of education, and those reporting histories of depression were more likely to report recent cannabis use pre- and post-legalization. Other mental illness was associated with cannabis use at post-legalization only. In a multivariate GEE adjusted for sociodemographic characteristics and diagnoses, favoring legalization and the interaction of time and positive health perceptions were associated with a greater likelihood of using cannabis. CONCLUSIONS: Legalized recreational cannabis use was associated with greater self-reported past 30-day use post-legalization, and with more-positive health perceptions of cannabis use. Future research is needed to examine longer-term perceptions and behavioral patterns following legalization of recreational cannabis use, especially among those with mental illness.