Differences in motives between Millennial and Generation X medical students

Medical Education 2010: 44: 570–576 Objectives Three domains comprise the field of human assessment: ability, motive and personality. Differences in personality and cognitive abilities between generations have been documented, but differences in motive between generations have not been explored. This study explored generational differences in medical students regarding motives using the Thematic Apperception Test (TAT). Methods Four hundred and twenty six students (97% response rate) at one medical school (Generation X = 229, Millennials = 197) who matriculated in 1995 & 1996 (Generation X) or in 2003 & 2004 (Millennials) wrote a story after being shown two TAT picture cards. Student stories for each TAT card were scored for different aspects of motives: Achievement, Affiliation, and Power. Results A multiple analysis of variance (p < 0.05) showed significant differences between Millennials’ and Generation X‐ers’ needs for Power on both TAT cards and needs for Achievement and Affiliation on one TAT card. The main effect for gender was significant for both TAT cards regarding Achievement. No main effect for ethnicity was noted. Conclusions Differences in needs for Achievement, Affiliation and Power exist between Millennial and Generation X medical students. Generation X‐ers scored higher on the motive of Power, whereas Millennials scored higher on the motives of Achievement and Affiliation.     

Pattern of Thyroid Autoimmunity in Chinese Patients With Pernicious Anemia

BackgroundAutoimmune thyroid disease (AITD) often coexists with pernicious anemia (PA) among whites. The study aimed to determine thyroid autoimmunity in Chinese patients with PAMethodsFrom the data of a hospital-based longitudinal study of Chinese PA patients (1994–2007), those with complete information of antibodies to thyroid peroxidase (TPO), thyroglobulin (Tg), and gastric parietal cell; serum thyroid-stimulating hormone and free thyroxine; gastric mucosal histology; and family history of AITD were analyzed.ResultsAmong 126 Chinese PA patients, 44% had TPO/Tg antibodies and 13.5% AITD. TPO/Tg antibodies occurred in 33% (16 of 49) of male and 52% (40 of 77) of female patients (P = 0.034). Graves disease (8 patients) tended to antedate PA and was associated with no or low titers of TPO/Tg antibodies. Primary hypothyroidism (9 patients) developed during follow-up and was associated with high TPO/Tg antibody titers. The TPO/Tg antibodies did not affect the clinical course of PA but was associated with an enhanced risk of developing AITD and vitiligo. Overall, AITD (before and after PA) occurred in 23% (13 of 56) and 5.7% (4 of 70) of PA patients with and without antibodies (P = 004). During follow-up (mean duration of 75.24 ± 46.39 months), 10 patients developed AITD—7 new onset of hypothyroidism and 3 progression/relapse of prior AITD. Logistic regression analysis of presenting features of PA revealed 2 independent factors for AITD development during follow-up—presence of thyroid antibodies (odds ratio 20.2, 95% confidence interval 1.8–223) and history of prior AITD (odds ratio 39.8, 95% confidence interval 2.3–679).ConclusionIt is recommended to screen thyroid antibodies and monitor thyroid function during follow-up.     

Cytokine responses in a severe case of glandular fever treated successfully with foscarnet combined with prednisolone and intravenous immunoglobulin

Viral loads and cytokine responses Epstein–Barr virus (EBV) were measured in an 18‐year‐old boy with severe glandular fever complicated by a mild anaemia, severe thrombocytopaenia and neutropaenia. Hepatosplenomegaly was detected by abdominal ultrasound in the presence of significant hepatitis. Cytokine testing demonstrated elevated cell‐mediated Th1 (IFN‐γ, IL‐12, sTNFR1, CXCL10, CXCL9 and CCL3) and humoral Th2 (IL‐4) immune responses. Serum antibodies to EBV virus capsid antigen (VCA) IgM and IgG antibodies were detected, together with a raised EBV DNA level (up to about 70,000 DNA copies/mL) in the acute phase of the illness. This EBV DNA load decreased rapidly in response to treatment with a combination of foscarnet, intravenous immunoglobulin and prednisolone, and the boy's symptoms settled eventually after approximately 50 days of illness, following this combined antiviral and immune‐modulating therapy. Detailed immunological, virological, haematological and biochemical laboratory parameters are presented to document this patient's severe EBV disease and eventual recovery. J. Med. Virol. 81:99–105, 2009. © 2008 Wiley‐Liss, Inc.     

A clinical advancement program for registered nurses with an outpatient focus.

Clinical advancement programs have been in use for almost 30 years. Although clinical advancement programs have been designed for many areas, it appears that one has never been developed specific to the outpatient-focused registered nurse. This article describes the development of a clinical advancement program for non-hospital-based registered nurses employed at the Guthrie Clinic in Sayre, Pennsylvania and highlights recommendations for instituting this program in any outpatient setting.     

Impulsivity and cigarette craving: differences across subtypes

Rationale  

Cigarette smoking has been linked to a number of personality characteristics, including impulsivity. Smokers tend to endorse high levels of impulsivity, and more impulsive smokers have greater difficulty quitting, but little is known about potential explanatory mechanisms. Although indirect evidence suggests craving as a candidate mechanism, direct evidence has been mixed.     

What should chris say? The ability of children with specific language impairment to recognize the need to dissemble emotions in social situations.

PURPOSE: In this study, the authors examined the ability of children with specific language impairment (SLI) and their typical peers to judge when an experienced emotion should be dissembled (hidden) in accord with social display rules. METHOD: Participants included 19 children with SLI and19 children with typical language skills, both groups ranging in age from 7;9 (years;months) to 10;10, with a mean age of 9;1. Children were presented with 10 hypothetical social situations in which a character, Chris, experienced an emotion that should be dissembled for social purposes. The participants' responses were categorized as to whether or not they dissembled or displayed the emotion. RESULTS: Although the task was difficult for many participants, children with SLI indicated that the experienced emotion should be dissembled significantly less often than did their typical peers. Children in the 2 groups did not significantly differ in their judgments of the social display rules governing these situations. CONCLUSION: These results suggested that the children with SLI did not understand the impact of displaying emotion on relationships in the same way as did their typical peers. In this respect, they seemed to lag behind the typical children in their developing emotion knowledge.     

High Food Insecurity and Its Correlates Among Families Living on a Rural American Indian Reservation

Objectives. We sought to better understand the prevalence and consequences of food insecurity among American Indian families with young children.Methods. Parents or caregivers of kindergarten-age children enrolled in the Bright Start study (dyad n = 432) living on the Pine Ridge Reservation in South Dakota completed a questionnaire on their child’s dietary intake, the home food environment, and food security. We assessed food security with a standard 6-item scale and examined associations of food insecurity with family sociodemographic characteristics, parents’ and children’s weight, children’s dietary patterns, and the home food environment.Results. Almost 40% of families reported experiencing food insecurity. Children from food-insecure households were more likely to eat some less healthful types of foods, including items purchased at convenience stores (P = .002), and food-insecure parents reported experiencing many barriers to accessing healthful food. Food security status was not associated with differences in home food availability or children’s or parents’ weight status.Conclusions. Food insecurity is prevalent among families living on the Pine Ridge Reservation. Increasing reservation access to food that is high quality, reasonably priced, and healthful should be a public health goal.Food insecurity is defined as the state of either having limited or uncertain access to food that is nutritionally adequate, culturally acceptable, and safe or having an uncertain ability to acquire acceptable foods in socially acceptable ways.1 Food insecurity harms children’s physical, social, and emotional health. Compared with food-secure children, children who experience food insecurity are less likely to have a diet that meets recommended guidelines for nutrition2–4; are more likely to experience chronic illnesses, acute illness,5,6 psychosocial problems, and psychiatric distress5,7–9; and are more likely to have lower academic performance.10 There is some evidence to suggest that food insecurity contributes to overeating and obesity,11–13 although several studies of preschool– and grade school–aged children have not observed associations between food insecurity and weight status.2,12,14,15 The roots of food insecurity for a family often lie in economic factors, such as having insufficient income, limited wealth, excessive debt, and high living expenses. However, psychosocial factors, including maternal mental and physical health status, domestic violence, parental cooking and financial skills, parental education level, and familial social networks, also play roles in food insecurity.7,16 Additionally, lack of access to food in their community increases families’ likelihood of being food insecure.16 Nationwide in 2009, 21.3% of US households with children experienced food insecurity during the previous year.17Since the middle of the twentieth century, substantial changes have occurred in the availability of and access to healthful food on American Indian reservations.18,19 Although, traditionally, American Indian populations used the land they lived on for hunting and growing food, and therefore consumed a plant-based diet supplemented with fish or low-fat meat, today this is no longer the case.20 American Indians living on reservations often rely on food–commodity and nutrition assistance programs21,22 and frequently purchase food from fast-food outlets and small grocery or convenience stores, which typically have a limited availability of high-quality produce and low-fat foods.19Given the high rates of poverty23 on American Indian reservations and poor food access on rural reservations, food insecurity and its health impacts among American Indian families living on or near reservations are of great concern.24,25 Using data from the 2001–2004 Current Population Survey, Gundersen examined food insecurity among American Indians living on and those living off reservations and found that during this period 28% of American Indian households with children experienced food insecurity, compared with 16% of non–American Indian households with children.24 This disparity remained even after adjusting for education, income, marital status, and age, suggesting that American Indians had additional specific risk factors for food insecurity. Furthermore, American Indians living in nonmetropolitan areas were more likely to be food insecure than were those living in metropolitan areas—although identifying those individuals specifically residing on or near reservations was not possible with this data set. Small, reservation-specific studies have examined food insecurity among selected groups of American Indians living on reservations, such as young adults, and have similarly observed that food insecurity is a prevalent and significant problem for these subpopulations.26–28Although it is clear that a sizable proportion of American Indians experience food insecurity, the correlates and consequences of food insecurity among American Indian families of young children living on or near reservations are not well understood. To address this need, we examined the prevalence and correlates of food insecurity among Lakota children and their families living on the Pine Ridge Reservation in South Dakota.