Family environmental antecedents of pubertal timing in girls and boys: A review and open questions.

Across nonhuman species, pubertal timing is affected by the social environment, with consequences for reproductive success and behavior. In human beings, variations in pubertal timing have not been systematically examined in relation to social environmental antecedents, although their psychological consequences are well documented. This paper focuses on links in human beings between pubertal timing and the childhood social environment, with several sections: A review of studies relating pubertal timing to the family context, a key aspect of the social environment; challenges in studying the issue; and opportunities for future work that takes advantage of and creates links with evidence in other species. The review shows that pubertal timing in girls is accelerated by adversity in aspects of the early family social context, with effects small in size; data in boys are not sufficient to enable conclusions. Inferences from existing studies are limited by variations in conceptualizations and measurement of relevant aspects of puberty and of the family social environment, and by methodological issues (e.g., reliance on existing data, use of retrospective reports, nonrandom missing data). Open questions remain about the nature, mechanisms, and specificity of the links between early family social environment and pubertal timing (e.g., form of associations, consideration of absence of positive experiences, role of timing of exposure). Animal studies provide a useful guide for addressing these questions, by delineating potential hormonal mechanisms that underlie links among social context, pubertal timing, and behavior, and encouraging attention to aspects of the social environment outside the family, especially peers.

Empathy, well-being, and mental health: do gender differences diminish by the end of medical school?

This study aims to investigate if medical students demonstrate differences related to gender in terms of empathy, burnout, tolerance, openness to spirituality, well-being, and mental health, and to examine whether these differences vary across levels of medical training. A cross-sectional study was conducted in the first semester of 2015 in a Brazilian medical school. The following were evaluated: quality of life (WHOQOL-Bref), burnout (Oldenburg), mental health (DASS-21), empathy (Empathy Inventory and ESWIM), and tolerance, well-being, and openness to spirituality (ESWIM). We investigated how these outcomes varied in terms of gender, stage of medical training, and its interaction using a two-way MANOVA. A total of 776 students were included and important differences were observed. As medical training advanced, the differences between genders that were present during students' initial years (greater empathy, worse quality of life, and worse mental health among women) tended to become nonsignificant during the clerkship years. In addition, a significant interaction between stage and gender was found for ESWIM Wellness; WHOQOL; DASS Anxiety and DASS Stress. These results may denote a shortcoming in the way medical schools approach gender differences. Educators should consider these findings when restructuring curricula to respect gender differences, thus fostering their respective potentials.

Family Experiences and Parent Personality as Antecedents of Pubertal Timing in Girls and Boys.

Pubertal timing may be influenced by typical variations in early family environmental events, but questions remain concerning the roles of specific parenting factors, developmental age of exposure to events, moderation by child temperament, and comparability of effects for girls and boys. This study focused on these questions utilizing longitudinal data from 733 same-sex twins (45% girls) in the U.S.; family context was measured at ages 1-3, 4-5, and 6-7 years and pubertal status was assessed annually via self-report at ages 9-15, enabling estimates of pubertal timing. Home environment at ages 4-5 years predicted pubertal timing better than home environment at other ages for both girls and boys, but parent personality was more predictive than home experiences (e.g., divorce, parental harshness, family conflict). Thus, effects of family environment must be considered within the context of parent characteristics, encouraging caution in implicating early environmental experiences as direct influences on early pubertal timing.

Does puberty affect the development of behavior problems as a mediator, moderator, or unique predictor?

Pubertal timing matters for psychological development. Early maturation in girls is linked to risk for depression and externalizing problems in adolescence and possibly adulthood, and early and late maturation in boys are linked to depression. It is unclear whether pubertal timing uniquely predicts problems; it might instead mediate the continuity of behavior problems from childhood to adolescence or create psychological risk specifically in youth with existing problems, thus moderating the link. We investigated these issues in 534 girls and 550 boys, measuring pubertal timing by a logistic model fit to annual self-report measures of development and, in girls, age at menarche. Prepuberty internalizing and externalizing behavior problems were reported by parents. Adolescent behavior problems were reported by parents and youth. As expected, behavior problems were moderately stable. Pubertal timing was not predicted by childhood problems, so it did not mediate the continuity of behavior problems from childhood to adolescence. Pubertal timing did not moderate links between early and later problems for girls. For boys, early maturation accentuated the link between childhood problems and adolescent substance use. Overall, the replicated links between puberty and behavior problems appear to reflect the unique effects of puberty and child behavior problems on the development of adolescent behavior problems.

Gene-Environment Correlations Affecting Children's Early Rule-Breaking and Aggressive Play Behaviors.

Play among peers is an important developmental context for child socialization. We have earlier shown that children at genetic risk for aggression were more likely to be treated aggressively by unfamiliar peers during peer play, reflecting genotype-evoked behaviors manifested during play. In this study, 118 5-year-old twin pairs were paired randomly with an unfamiliar, same-age, same-sex child, thus controlling for parent- and child-chosen environments (passive and active rGE). Twins played separately from each other with unmatched children. Play behaviors were coded for aggressive and assertive behaviors. Children were also independently rated by parents for rule-breaking problem behaviors at age 5, and 97 children were rated again on these behaviors 2-10 years later. Analyses showed that children at genetic risk for early rule-breaking were more likely to have partners who behaved more aggressively, suggesting that this was evoked behavior during play. Some evidence of an 'early bloomer' phenomenon emerged via early difficult temperament and parent-rated delinquency significantly predicting later delinquency. Children's play, which is one of the most important influences on early development, requires further study from an rGE perspective.

Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students.

OBJECTIVE: This study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a medical institution in the USA and another one in Brazil. METHODS: This cross-cultural study included students enrolled in the first and second years of their undergraduate medical training. We evaluated depression, anxiety, and stress (DASS 21), empathy, openness to spirituality, and wellness (ESWIM), burnout (Oldenburg), and quality of life (WHOQOL-Bref) and compared them between schools. RESULTS: A total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical students and all Brazilian medical students revealed that Brazilians reported more depression and stress and US students reported greater wellness, less exhaustion, and greater environmental quality of life. In order to address a possible response bias favoring respondents with better mental health, we also compared all US medical students with the 50% of Brazilian medical students who reported better mental health. In this comparison, we found Brazilian medical students had higher physical quality of life and US students again reported greater environmental quality of life. Cultural, social, infrastructural, and curricular differences were compared between institutions. Some noted differences were that students at the US institution were older and were exposed to smaller class sizes, earlier patient encounters, problem-based learning, and psychological support. CONCLUSION: We found important differences between Brazilian and US medical students, particularly in mental health and wellness. These findings could be explained by a complex interaction between several factors, highlighting the importance of considering cultural and school-level influences on well-being.

A review of endophenotypes in schizophrenia and autism: The next phase for understanding genetic etiologies.

Many psychiatric disorders are caused by multiple genes and multiple environmental factors, making the identification of specific genetic risk factors for these disorders difficult. Endophenotypes are behaviors or characteristics that are intermediate between the genotype and a phenotype of interest. Because they are more directly related to the gene action than is the endpoint disorder, they may be useful in the identification of specific genes related to psychiatric disorders and the classification of disorders or traits that share an underlying genetic etiology. We discuss genetic and endophenotype research on schizophrenia and autism spectrum disorder (ASD) in this review. Some of the psychophysiological endophenotypes that have been studied for schizophrenia include prepulse inhibition of the startle response, the antisaccadic task assessing frontal lobe function, inhibition of the P50 event-related potential (ERP), and other auditory ERP measures. Potential ASD endophenotypes include theory of mind, language skills (specifically, age at first spoken word and first spoken phrase), social skills, and certain brain functions, such as asynchronization of neural activity and brain responses to emotional faces. Because the link between genes and specific psychiatric disorders is difficult to determine, identification of endophenotypes is useful for beginning the search to identify specific genes that affect these disorders.

Empathy in Medical Students Is Moderated by Openness to Spirituality.

THEORY: Empathy is one component of medical student education that may be important to nurture, but there are many potential psychological barriers to empathy, such as student depression, burnout, and low quality of life or wellness behaviors. However, few studies have addressed how positive behaviors such as wellness and spirituality, in combination with these barriers, might affect empathy. HYPOTHESES: We hypothesized a negative relationship between psychological distress and empathy, and a positive relationship between empathy and wellness behaviors. We also hypothesized that openness to others' spirituality would moderate the effects of psychological distress on empathy in medical students. METHOD: This cross-sectional study included 106 medical students in a public medical school in the U.S. Midwest. Mailed questionnaires collected student information on specialty choice and sociodemographics, empathy, spirituality openness, religiosity, wellness, burnout, depression, anxiety, and stress. Hierarchical multiple regression analysis was conducted, with empathy as the dependent variable, psychological distress and all wellness behaviors as predictors, and spirituality openness as a moderator. RESULTS: Specialty choice, burnout, wellness behaviors, spirituality openness, and religiosity were significant independent predictors of empathy. In addition, when added singly, one interaction was significant: Spirituality Openness × Depression. Spirituality openness was related to empathy only in nondepressed students. Empathy of students with higher levels of depression was generally lower and not affected by spirituality openness. CONCLUSIONS: Nondepressed students who reported lower openness to spirituality might benefit most from empathy training, because these students reported the lowest empathy. Highly depressed or disengaged students may require interventions before empathy can be addressed. In addition, burnout was related to lower levels of empathy and wellness was related to higher levels. These provide potential points of intervention for medical schools developing tools to increase medical trainees' empathy levels.

Inaccuracy of perceived competence ratings is associated with problem behaviors in 5-year-old children.

The authors examined problem behaviors in preschool children as a function of perceived competence. Prior research has demonstrated a link between inaccuracy of self-perceptions and teacher-reported externalizing behaviors in preschool aged boys. This study extended past research by adding data collected from observed behaviors in a laboratory setting, as well as parent reports of internalizing and externalizing behaviors. Five-year-old children completed the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA) in the lab, participated in a 10-min puzzle interaction task with their cotwin and mother, and completed a short task assessing cognitive abilities. Children were grouped into 3 self-esteem categories (unrealistically low, realistic, and unrealistically high) based on comparisons of self-reported (PSPCSA) versus actual competencies for maternal acceptance, peer acceptance, and cognitive competence. Results showed that children who overreported their maternal acceptance and peer acceptance had significantly more parent-reported externalizing problems as well as internalizing problems. There were no significant differences in accuracy for cognitive competence. The findings from this study underscore the negative impact of unrealistically high self-appraisal on problem behaviors in young children.

The Association between Positive Parenting and Externalizing Behavior.

The present study examined the role of positive parenting on externalizing behaviors in a longitudinal, genetically informative sample. It often is assumed that positive parenting prevents behavior problems in children via an environmentally mediated process. Alternatively, the association may be due to either an evocative gene-environment correlation, in which parents react to children's genetically-influenced behavior in a positive way, or a passive gene-environment correlation, where parents passively transmit a risk environment and the genetic risk factor for the behavioral outcome to their children. The present study estimated the contribution of these processes in the association between positive parenting and children's externalizing behavior. Positive parenting was assessed via observations at ages 7, 9, 14, 24, and 36 months and externalizing behaviors were assessed through parent report at ages 4, 5, 7, 9, 10, 11, and 12 years. The significant association between positive parenting and externalizing behavior was negative, with children of mothers who showed significantly more positive parenting during toddlerhood having lower levels of externalizing behavior in childhood; however, there was not adequate power to distinguish whether this covariation was due to genetic, shared environmental, or nonshared environmental influences.

Simulation-Based Medical Education in Family Medicine Residencies: A CERA Study.

BACKGROUND AND OBJECTIVES: To better understand the current use of simulation and barriers to its use in family medicine resident education, we surveyed US family medicine residency (FMR) program directors (PDs) about opinions and use of simulation-based medical education (SBME) in their programs. A number of specialties have incorporated or required simulation-based educational techniques in residency education over the past 10 years, but little is known about the current use of SBME in family medicine graduate medical education. We also evaluated associations between program characteristics and the use of SBME in FMR education. METHODS: Questions were included on the 2019 Council of Academic Family Medicine Education Research Alliance (CERA) survey of US FMR PDs. The survey included questions regarding current use of SBME along with questions to identify barriers to its use in family medicine programs. RESULTS: Thirty-nine percent (n=250) of PDs completed the survey; 84.5% reported using simulation. PDs reporting they did not use simulation were less likely to view simulation as valuable for education or assessment. Unexpectedly, residency program size was not associated with simulation use or access to a dedicated location for SBME. DISCUSSION: Use of SBME in family medicine resident education has increased since 2011. PDs value simulation for education and remediation, and most programs have introduced some degree of simulation despite barriers. The results of this study can inform resources to support the continued integration of SBME into family medicine resident education.

Longitudinal associations among peer victimization and physical and mental health problems.

OBJECTIVE: This study examined how chronic experiences of peer victimization throughout childhood relate to mental and physical health outcomes in adolescence. METHODS: Children were tested in a laboratory playroom at the age of 5 years. They completed questionnaires at time 2, between the ages of 10 and 18 years, and a telephone interview at time 3, between the ages of 12 and 20 years. A total of 70 youth participated at all three time periods. Chronic victims were defined as having high levels of peer victimization at all three time points. RESULTS: Youth who were chronically victimized reported experiencing significantly more mental and physical health problems than youth categorized as desisters or nonvictims. Also, for girls only, chronic victims reported more specific health problems (headaches, sleep problems) than did nonchronic victims. CONCLUSIONS: The present findings may assist health professionals in assessing and treating physical and mental health problems that appear to be related to peer victimization.

Self-esteem accuracy and externalizing problems in preschool-aged boys.

Although the existing literature addressing the relation between self-esteem and externalizing problems is inconsistent, it appears that accuracy of self-esteem ratings may be an important factor to consider. However, no studies to date have explored this with preschool-aged children. In this study, the authors investigated differences in externalizing problems between underraters, realistic raters, and overraters of self-esteem of 5-year-old boys in three domains: cognitive competence, physical competence, and peer acceptance. Compared to teacher ratings of competence, boys who overrated their cognitive competence and peer acceptance were more likely to be rated by teachers as exhibiting more externalizing problems the following year. Findings suggest that overconfidence may have important implications for the development of externalizing problems in young children.

Measuring Students' Perceptions of the Medical School Learning Environment: Translation, Transcultural Adaptation, and Validation of 2 Instruments to the Brazilian Portuguese Language.

BACKGROUND: Although learning environment (LE) is an important component of medical training, there are few instruments to investigate LE in Latin American and Brazilian medical schools. Therefore, this study aims to translate, adapt transculturally, and validate the Medical School Learning Environment Scale (MSLES) and the Johns Hopkins Learning Environment Scale (JHLES) to the Brazilian Portuguese language. METHOD: This study was carried out between June 2016 and October 2017. Both scales have been translated and cross-culturally adapted to Brazilian Portuguese Language and then back translated and approved by the original authors. A principal components analysis (PCA) was performed for both the MSLES and the JHLES. Test-retest reliability was assessed by comparing the first administration of the MSLES and the JHLES with a second administration 45 days later. Validity was assessed by comparing the MSLES and the JHLES with 2 overall LE perception questions; a sociodemographic questionnaire; and the Depression, Anxiety, and Stress Scale (DASS-21). RESULTS: A total of 248 out of 334 (74.2%) first- to third-year medical students from a Brazilian public university were included. Principal component analysis generated 4 factors for MSLES and 7 factors for JHLES. Both showed good reliability for the total scale (MSLES α = .809; JHLES α = .901), as well as for each subdomain. Concurrent and convergent validity were observed by the strong correlations found between both scale totals (r = 0.749), as well as with both general LE questions: recommend the school to a friend (MSLES: r = 0.321; JHLES: r = 0.457) and overall LE rating (MSLES: r = 0.505; JHLES: r = 0.579). The 45-day test-retest comparison resulted in a Pearson correlation coefficient of 0.697 for the JHLES and 0.757 for the MSLES. CONCLUSIONS: Reliability and validity have been demonstrated for both the MSLES and the JHLES. Thus, both represent feasible options for measuring LE in Brazilian medical students.

Health Outcomes Associated With Internalizing Problems in Early Childhood and Adolescence.

Physical and mental health problems are becoming more common among the general population. Studies examining mental and physical health often indicate that mental illness early in life is associated with more detrimental health outcomes later. However, additional work is needed to better identity which psychological problems may contribute to poorer health outcomes. Given recent increases in childhood anxiety and depression specifically, it is beneficial to further investigate the relationship between internalizing problems, both early and later in life, and related health problems. Furthermore, little work has focused on studying internalizing problems in children as young as preschool-aged. Therefore, the current project used a longitudinal design to assess the effects of preschool and adolescent internalizing problems on health-related problems in adolescence. We analyzed data from 70 youth (47% male) who had been tested in our lab when they were 5 years old and then were administered questionnaires over a telephone interview when they were adolescents, between the ages of 12 and 20 years old. We used multi-informant measures, including parent-report at age 5 and youth-report at follow-up, 7 to 15 years later. Parents reported on children's internalizing behavior problems and negative emotionality (NE). Youth reported on their own internalizing behavior problems as well as health problems, physical activity, and overeating behaviors. Path modeling was used to examine predictions of internalizing and health behaviors. At age 5, parent-reported NE and internalizing problems were related, in addition to 5-year-old internalizing predicting health problems and overeating at follow-up. At follow-up, youth-reported internalizing was positively related to health problems and negatively related to physical activity, suggesting some similarities and differences between parent and youth responses. Additionally, girls reported significantly higher rates of internalizing and health problems at follow-up. These results indicate a significant relationship between preschool-aged and adolescent internalizing problems and related health outcomes experienced in adolescence.

Mapping scientific research on the negative aspects of the medical school learning environment.

OBJECTIVE: We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially harmful aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviors, burnout, violence and mistreatment among students and physicians. METHODS: A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest, and PsycINFO) up to December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (harmful), unethical behaviors, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities discrimination, professional misconduct, and other negative aspects. RESULTS: Of the 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviors (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. CONCLUSION: There is a definite increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention to experimental, longitudinal, and cross-cultural study designs.

A Multimethodological Study of Preschoolers' Preferences for Aggressive Television and Video Games.

The association between aggressive media and related behavior is complicated, and the role of underlying genetics has not been adequately explored. A better understanding of the role of genetics on the relationship between aggressive media and behavior, especially in young children, is critical. Using a twin/triplets sample (N = 184 children), the authors investigated the association between preschoolers' preferred media choices and their aggressive behaviors. A multimeasure methodology was utilized, examining children's reports of their preferred media games and shows, observed child negativity and aggression in the lab, and parent reports of their own and their children's aggressive behaviors. The results demonstrated a significant relationship between maternal aggression and parent-reported child aggression, especially for boys. Genetic analyses demonstrated significant heritability for children's parent-reported aggressive behaviors, supporting the biological basis of aggression, but not for media aggression preferences. Controlling for genetics, the authors found that the association between media preferences and aggressive behavior may be genetic in origin. These results emphasize the importance of considering shared genetics underlying the relationship between children's aggressive behaviors and their media preferences, as well as environmental influences. By examining preschoolers, the present study provides insight into the importance of media influences in children younger than those previously studied.

On the relative importance of individual-level characteristics and dyadic interaction effects in negotiations: Variance partitioning evidence from a twins study.

Negotiations are inherently dyadic. Negotiators' individual-level characteristics may not only make them perform better or worse in general, but also may make them particularly well- or poorly-suited to negotiate with a particular counterpart. The present research estimates the extent to which performance in a distributive negotiation is affected by (a) the negotiators' individual-level characteristics and (b) dyadic interaction effects that are defined by the unique pairings between the negotiators and their counterparts. Because negotiators cannot interact multiple times without carryover effects, we estimated the relative importance of these factors with a new methodology that used twin siblings as stand-ins for each other. Participants engaged in a series of 1-on-1 negotiations with counterparts while, elsewhere, their cotwins engaged in the same series of 1-on-1 negotiations with the cotwins of those counterparts. In these data, dyadic interaction effects explained more variation in negotiation economic outcomes than did individual differences, whereas individual differences explain more than twice as much of the variation in subjective negotiation outcomes than did dyadic interaction effects. These results suggest dyadic interaction effects represent an understudied area for future research, particularly with regard to the economic outcomes of negotiations. (PsycINFO Database Record

Mapping the scientific research on the negative aspects of the medical school learning environment.

OBJECTIVE: We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially negative aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviours, burnout, violence and mistreatment among students and physicians. METHODS: A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest and PsycINFO) through December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (negative), unethical behaviours, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities' discrimination, professional misconduct, and "other" negative aspects. RESULTS: Of 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviours (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. CONCLUSION: There is a clear increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention paid to experimental, longitudinal, and cross-cultural study designs.