Differences in abuse reported by female and male Canadian medical students.

OBJECTIVE: To assess differences between male and female medical students concerning their experiences of abuse during training in a large Canadian medical school. DESIGN: Voluntary, anonymous cross-sectional survey of first- and fourth-year medical students during February 1991. SETTING: University of Toronto School of Medicine. PARTICIPANTS: Of 396 first- and fourth-year students surveyed after one of their regular classes, 347 (117 women, 230 men) completed the questionnaire. INTERVENTION: A 165-item, multiple-choice questionnaire concerning experiences of verbal or emotional abuse, sexual harassment and physical abuse, completed within 30 minutes. MAIN OUTCOME MEASURES: Differences between male and female respondents in abuse experiences before and during medical training, the relation between abuse before and during training, and the psychologic and behavioural effects of abuse during training. RESULTS: The experiences of the male and female respondents differed mainly in regard to sexual harassment: 42% (49/117) of the women and 11% (25/230) of the men reported sexual harassment before entering medical school (p < 0.0001); 46% (54/117) and 19% (43/230) respectively reported sexual harassment during medical training (p < 0.0001); and women who reported sexual harassment were the only respondents for whom a significant relation was found between abuse before and during training (p < 0.043). The women were more distressed than the men by all forms of abuse. A significant relation was shown between male students who reported experiencing abuse during medical training and mistreating patients (p < 0.0001). CONCLUSION: Female students'' experiences of sexual harassment differed from those of their male counterparts. As well, the female students'' reactions to and ways of coping with all types of abuse differed from those of the male students.     

Effect of Specialization in Sports on the Structural and Functional States of the Left Ventricle of the Heart in Schoolchildren of Different Biological Age

The structural and functional states of the left ventricle of the heart were studied by echocardiography in schoolchildren of three age groups. The first group included 10- to 13-year-old boys without features of sexual maturation. The second group included 13- to 15-year-old adolescents during puberty. The third group included 16- to 18-year-old adolescents with developed secondary sexual characteristics. The children were trained in sports: middle-distance running, swimming, and wrestling. It was found that the posterior wall of the ventricular myocardium in young athletes of all age groups and any specialization in sports was thicker than in untrained children of the same age. Similarly, the trained children were characterized by larger anteroposterior size of the ventricular cavity, larger cavity volume and total volume, greater myocardium mass (both absolute and calculated per kg body weight), more substantial ventricular stroke volume, lower heart rate, lesser ejection fraction, and smaller degree of shortening of the anteroposterior size of the ventricular cavity during systole as compared to untrained children of the same age. The difference between trained and untrained schoolchildren increased with increasing age, duration of the period of training in sports, and level of training in sports (athletic qualification). The training-induced changes in the structural and functional parameters of the left ventricle of the heart in middle-distance runners were larger than in schoolchildren trained in swimming and, particularly, in wrestling.     

Acid rain in the classroom: a student research project

Three fourth-year (15-year-old) school students report on their investigation of the effects of dilate sulphuric acid solutions on the growth of cress seedlings. The simple experiment required only limited apparatus and yet provided striking results in a short period of time     

A problem-based learning approach to teaching medical genetics.

A newly developed problem-based medical genetics course that was integrated into the fourth-year medical school curriculum of the University of Texas Health Science Center at San Antonio is described. To provide a basic genetic background for the clinical rotations, a supplemental computer tutorial is required during the second year. These two formats prepare the medical students to recognize genetic diseases, to provide basic genetic counseling in their daily practice, and to appropriately refer patients to genetic specialists.     

Beta-blockade and oxygen delivery to muscle during exercise.

The most commonly observed effect of beta-blockade on cardiovascular function has been a reduction in heart rate both at rest and during exercise. The body attempts to compensate by increasing stroke volume and (or) increasing the extraction of O2 from the blood to maintain O2 delivery to the muscle. This paper examines the roles of muscle mass involved in the exercise as well as the time course of change in cardiac output and peripheral blood flow in an attempt to understand whether O2 supply is limited by beta-blockade. Experiments are reported in which the kinetics of cardiac output response at the onset of submaximal cycle exercise were slowed in subjects taking oral propranolol. Taken in consideration with other data from our laboratory and with data in the literature, it was concluded that beta-blockade does impair O2 transport. The degree of impairment is dependent on the total muscle mass involved and the metabolic demand.     

Use of concept mapping in an undergraduate introductory exercise physiology course

Physiology is often considered a challenging course for students. It is up to teachers to structure courses and create learning opportunities that will increase the chance of student success. In an undergraduate exercise physiology course, concept maps are assigned to help students actively process and organize information into manageable and meaningful chunks and to teach them to recognize the patterns and regularities of physiology. Students are first introduced to concept mapping with a commonly relatable nonphysiology concept and are then assigned a series of maps that become more and more complex. Students map the acute response to a drop in blood pressure, the causes of the acute increase in stroke volume during cardiorespiratory exercise, and the factors contributing to an increase in maximal O(2) consumption with cardiorespiratory endurance training. In the process, students draw the integrative nature of physiology, identify causal relationships, and learn about general models and core principles of physiology.     

Evaluating Sex and Gender Competencies in the Medical Curriculum: A Case Study

BackgroundSex and gender differences exist in the manifestation and prevalence of many conditions and diseases. Yet many clinician training programs neglect to integrate this information across their curricula.ObjectiveThis study aimed to measure the sex and gender medical knowledge of medical students enrolled in a program without an explicit directive to integrate sex and gender differences across a block system of core subjects.MethodsA forced-choice instrument consisting of 35 multiple-choice and true or false questions was adapted from an evaluation tool used in the European Curriculum in Gender Medicine held at Charité Hospital, Berlin, in September 2010.ResultsFourth-year (response rate 93%) and second-year (response rate 70%) students enrolled in Mayo Medical School completed the instrument. More than 50% of students in both classes indicated that topics related to sex and gender were covered in gynecology, cardiology, and pediatrics, and <20% of students indicated inclusion of such topics in nephrology, neurology, and orthopedics. More than twice as many second-year students indicated that topics dealing with sex and gender were included in immunology course material compared with fourth-year students. A consensus of written comments indicated that concepts of sex and gender-based medicine need to be embedded into existing curriculum, with an emphasis on clinically relevant information.ConclusionsAlthough this study represents only one medical school in the United States, information regarding sex and gender aspects of medicine is not consistently included in this curriculum without an explicit directive. These results can provide guidance for curriculum improvement to train future physicians.     

WISE 2005: stroke volume changes contribute to the pressor response during ischemic handgrip exercise in women.

The mechanism of the pressor response to small muscle mass (e.g., forearm) exercise and during metaboreflex activation may include elevations in cardiac output (Q) or total peripheral resistance (TPR). Increases in Q must be supported by reductions in visceral venous volume to sustain venous return as heart rate (HR) increases. Therefore, this study tested the hypothesis that increases in Q, supported by reductions in splanchnic volume (portal vein constriction), explain the pressor response during handgrip exercise and metaboreflex activation. Seventeen healthy women performed 2 min of static ischemic handgrip exercise and 2 min of postexercise circulatory occlusion (PECO) while HR, stroke volume and superficial femoral artery flow (Doppler), blood pressure (Finometer), portal vein diameter (ultrasound imaging), and muscle sympathetic nerve activity (MSNA; microneurography) were measured followed by the calculation of Q, TPR, and leg vascular resistance (LVR). Compared with baseline, mean arterial blood pressure (MAP) (P < 0.001) and Q (P < 0.001) both increased in each minute of exercise accompanied by a approximately 5% reduction in portal vein diameter (P < 0.05). MAP remained elevated during PECO, whereas Q decreased below exercise levels. MSNA was elevated above baseline during the second minute of exercise and through the PECO period (P < 0.05). Neither TPR nor LVR was changed from baseline during exercise and PECO. The data indicate that the majority of the blood pressure response to isometric handgrip exercise in women was due to mobilization of central blood volume and elevated stroke volume and Q rather than elevations in TVR or LVR resistance.     

Effect of exercise training and chronic glyburide treatment on glucose homeostasis in diabetic rats.

Exercise training and sulfonylurea treatment, either individually or in combination, were evaluated for their effects on plasma glucose concentrations, oral glucose tolerance, and glucose clearance in the perfused hindquarter of diabetic rats. Female rats that were injected with streptozocin (45 mg/kg iv) and had plasma glucose concentrations between 11 and 25 mM were considered diabetic and divided into sedentary, glyburide-treated, exercise-trained, and glyburide-treated plus exercise-trained groups. The sedentary streptozocin-treated rats were severely diabetic, as indicated by elevated glucose concentrations, impaired insulin response during oral glucose tolerance tests, and lower rates of glucose clearance in hindlimb skeletal muscle. Neither 8 wk of exercise training nor 4 wk of glyburide treatment alone improved these parameters. In contrast, the diabetic rats that were both trained and treated with glyburide showed some improvement in glucose homeostasis, as evidenced by lower plasma glucose concentrations, an enhanced insulin response to an oral glucose load, and a decrease in the severity of skeletal muscle insulin resistance compared with the diabetic controls. These data suggest that glyburide treatment or exercise training alone does not alter glucose homeostasis in severely insulin-deficient diabetic rats; however, the combination of exercise training and glyburide treatment may interact to improve glucose homeostasis in these animals.     

Adaptations in beta-adrenergic cardiovascular responses to training in older women.

To determine whether endurance exercise training can alter the beta-adrenergic-stimulated inotropic response in older women, we studied 10 postmenopausal healthy women (65.4 +/- 0.9 yr old) who exercised for 11 mo. Left ventricular (LV) function was evaluated with two-dimensional echocardiography during infusion of isoproterenol after atropine. Maximal O(2) consumption increased 23% in response to training (from 1.35 +/- 0.06 to 1.66 +/- 0.07 l/min; P = 0.004). Training had no effect on baseline LV function, end-diastolic diameter, LV wall thickness, or LV mass. The increase in LV systolic function in response to isoproterenol was unaffected by training. Furthermore, neither the systolic shortening-to-end-systolic wall stress relationship nor the end-systolic wall stress-to-end-systolic diameter relationship during isoproterenol infusion changed with training. We conclude that older postmenopausal women can increase their maximal O(2) consumption with exercise training without eccentric LV hypertrophy or enhancement of beta-adrenergic-mediated LV contractile function. These observations provide an explanation for the finding that maximal cardiac output and stroke volume are not increased in older women in response to training.     

Effect of sympathectomy on the heart pump function in rats during postnatal ontogenesis

The influence of guanetidine sympathectomy (30 mg/kg) on the heart pump function in rats during 3 weeks in postnatal ontogenesis has been investigated. Sympathectomy restrains age-dependent establishment of stroke volume, cardiac output and heart rate. The adaptation effects of regular physical training do not develop in the animals with sympathectomy, i.e. heart rate does not decrease and stroke volume does not increase. The initial stage of adaptation of the sympathectomized animals to physical training is accompanied by decrease in stroke volume and remarkable increase in heart rate which indicates the reduction of contractile activity in the myocardium.     

Effects of sprint training on maximal stroke volume of rats with a chronic myocardial infarction.

The hemodynamic response to maximal exercise was determined in rats with a chronic myocardial infarction (MI) that were subjected to 6-8 wk of high-intensity sprint training (HIST) or limited exercise activity (sedentary control). Training was performed 6 days/wk and consisted of five 1-min bouts of treadmill running at work loads (15% grade, 97 m/min) in excess of the animal's maximal O2 uptake (VO2max). The left ventricular infarct size for the HIST and sedentary control rats was 35 +/- 4 and 34 +/- 3% of the total endocardial circumference, respectively. VO2max was significantly greater for MI rats subjected to the HIST paradigm than for sedentary control rats. This increase in VO2max was due to an increase in the maximal stroke volume that could be generated by the HIST rat during exercise, inasmuch as the maximal heart rate response and the ability to extract O2 from the blood were similar between the two groups of rats. Citrate synthase activities measured in the plantaris muscle of the HIST and sedentary control rats were similar. These results suggest that the increase in VO2max produced with HIST in MI rats may be linked to changes in central cardiac function, as indicated by the increase in maximal stroke volume that could be generated by the MI rat during maximal exercise conditions.     

Attenuation of cardiovascular adaptations to exercise in frail octogenarians.

To determine the mechanisms underlying increased aerobic power in response to exercise training in octogenarians, we studied mildly frail elderly men and women randomly assigned to an exercise group (n = 22) who participated in a training program of 6 mo of physical therapy, strength training, and walking followed by 3 mo of more intense endurance exercise at 78% of peak heart rate or a control sedentary group (n = 24). Peak O2 consumption (V(O2 peak)) increased 14% in the exercise group (P < 0.0001) but decreased slightly in controls. Training induced 14% increase (P = 0.027) in peak exercise cardiac output (Q), determined via acetylene re-breathing, and no change in arteriovenous O2 content difference. The increase in Q was mediated by increases in heart rate (P = 0.009) and probably stroke volume (P = 0.096). Left ventricular stroke work also increased significantly. In the men, the increase in V(O2 peak) was exclusively due to a large increase in peak Q (22%). In the women, the gain in V(O2 peak) was due to small increases in Q and O2 extraction from skeletal muscles. Pulse pressure normalized for stroke volume and arterial elastance during peak effort did not change with training. Controls showed no changes. The results suggest that, although frail octogenarians have a diminished capacity for improvement in aerobic power in response to exercise training, this adaptation is mediated mostly by an increase in Q during peak effort. Furthermore, Q likely plays a greater role in the adaptive increase in V(O2 peak) in old men than old women.     

Effect of physical training on hemodynamic performance following myocardial infarction: a controlled study.

The effect of physical training on hemodynamic performance was evaluated in a group of patients who had had a myocardial infarction and a group of healthy, age-matched controls. Before training, the patients'' mean ventilatory equivalent was significantly less than that of the controls at the lowest workload (300 kpm/min), the mean stroke volume was significantly increased at the highest workload then achieved (600 kpm/min), and the mean arteriovenous oxygen content difference was significantly smaller at the highest workload. The patients had a relative bradycardia before training and there was no significant reduction in mean resting or submaximal heart rate after training. Their mean oxygen uptake was significantly reduced at the lowest exercise workload after training and this response was significantly different from that of the controls after 8 weeks of training. Mean cardiac output during exercise was significantly reduced in the patients after training, but only at the 600-kpm/min workload, the response being blunted at 900 kpm/min; mean stroke volume was also significantly reduced at this workload after training; both these responses were significantly different from those of the controls Mean arteriovenous oxygen content difference at 6oo kpm/min was significantly increased in the patients after training, though the response was not significantly different from that of the controls. Mean ventilatory equivalent was also significantly increased in patients after training, becoming similar to that of the controls.     

Peer instruction enhanced student performance on qualitative problem-solving questions

We tested the hypothesis that peer instruction enhances student performance on qualitative problem-solving questions. To test this hypothesis, qualitative problems were included in a peer instruction format during our Physiology course. Each class of 90 min was divided into four to six short segments of 15 to 20 min each. Each short segment was followed by a qualitative problem-solving scenario that could be answered with a multiple-choice quiz. All students were allowed 1 min to think and to record their answers. Subsequently, students were allowed 1 min to discuss their answers with classmates. Students were then allowed to change their first answer if desired, and both answers were recorded. Finally, the instructor and students discussed the answer. Peer instruction significantly improved student performance on qualitative problem-solving questions (59.3 +/- 0.5% vs. 80.3 +/- 0.4%). Furthermore, after peer instruction, only 6.5% of the students changed their correct response to an incorrect response; however, 56.8% of students changed their incorrect response to a correct response. Therefore, students with incorrect responses changed their answers more often than students with correct responses. In conclusion, pausing four to six times during a 90-min class to allow peer instruction enhanced student performance on qualitative problem-solving questions.     

Keys to success for a school-based malaria control program in primary schools in Thailand

School-based malaria control has been recognized as a new approach for the control of this disease in the Greater Mekong Subregion since 2000. We evaluated a school-based malaria control program near the western border of Thailand using a before-after intervention study. The major intervention activities included teacher training with specialized malaria teaching materials and participatory learning methods. The target population was 17 school principals, 111 teachers and 852 schoolchildren of grade 3, 4, and 5 in 17 schools. After the intervention, the teachers taught about malaria more actively than before. The teachers who could design a lesson plan on malaria increased from 30.7% to 47.7% (p=0.015) and the teachers who had taught about malaria increased from 71.9% to 84.3% (p=0.035). As a result of the program, the schoolchildren changed their behavior positively towards malaria prevention with significant difference in 6 of 7 questions. For example, the schoolchildren 'who always took care of mosquito bites' increased from 42.7% to 62.1% (p<0.001) and the schoolchildren 'who always reported their parents or teachers when they had fever' increased from 36.0% to 56.0% (p<0.001). In conclusion, the keys to a successful intervention lie in good teaching materials and a participatory approach utilizing the well-established Thailand's school health system. Beyond Thailand, school-based malaria control could be applied to other Greater Mekong Subregion countries with careful analysis of school health context in each country.     

Heart Rate and Stroke Volume Responses in Children of Early School Age to Change in Their Physical Activity Regimen

A study was made of the adaptation of the cardiac pump function in children of early school age to change in their physical activity associated with the transition from preschool to elementary school. Children of the experimental group, who engaged in physical exercise daily over the first school year, developed so-called bradycardia of training, which enhanced the tendency of the heart rate to decrease with age. The level of bradycardia attained in the first school year was retained over the two subsequent years, despite a considerable decrease in the amount of physical activity in this period. Daily exercising significantly increased the stroke volume, which remained at a high level even after the daily exercising program was stopped. Children of the control group participated only in physical activities of the regular physical education program. Their heart rate remained unchanged over the first two school years. At the beginning of the third year, a decrease in the heart rate and a rise in the stroke volume were observed, as expected of their age.     

Oral care and stroke units

Objective: To investigate oral care provision reported by senior nurses in stroke care settings in Scotland. Background: Stroke can have adverse effects on oral care and health. Little is known about current oral care practices in stroke care settings. Materials and methods: We designed a postal survey to be completed by ward managers or senior nurses. After piloting, the survey was distributed to all 71 units in Scotland, identified as providing specialist care for patients in the acute or rehabilitation stages following stroke. Pre‐notification and reminder letters were circulated. Responses were anonymous. Results: All but one survey was completed and returned. Help from dental professionals was available to most units (64/70) mostly on request. Only a third of units received oral care training in the last year (23/70). The majority of this training was ward based (20/23). The use of oral care assessment tools and protocols was limited (16/70 and 15/70 units respectively). Not all units had access to toothbrushes, toothpaste or chlorhexidine. For patients unable to perform oral care independently, senior nurses expected the patients’ teeth or dentures to be cleaned at least twice a day in 59 of 70 and 49 of 70 units respectively. Conclusion: The response rate was excellent and has provided a national overview of oral care provision for patients in stroke care settings. Access to staff training, assessments, protocols and oral hygiene material varied considerably. This information provides a valuable baseline from which to develop and evaluate the effectiveness of ward‐based oral care interventions for stroke patients.     

Medical student perceptions of a behavioural and social science curriculum

Background In 2006, Oregon Health & Science University began implementing changes to better integrate mental health and social science into the curriculum by addressing the Institute of Medicine''s (IOM''s) 2004 recommendation for the inclusion of six behavioural and social science (BSS) domains: health policy and economics, patient behaviour, physician–patient interaction, mind–body interactions, physician role and behaviour, and social and cultural issues.Methods We conducted three focus groups with a purposive sample of 23 fourth-year medical students who were exposed to 4 years of the new curriculum. Students were asked to reflect upon the adequacy of their BSS training specifically as it related to the six IOM domains. The 90-minute focus groups were recorded, transcribed and analysed.Results Students felt the MS1 and MS2 years of the curriculum presented a strong didactic orientation to behavioural and social science precepts. However, they reported that these principles were not well integrated into clinical care during the second two years. Students identified three opportunities to further the inclusion of BSS in their clinical training: presentation of BSS concepts prior to relevant clinical exposure, consistent BSS skills mentoring in the clinical setting, and improving cultural congruence between aspects of BSS and biomedicine.Conclusions Students exposed to the revised BSS curriculum tend to value its principles; however, modelling and practical training in the application of these principles during the second two years of medical school are needed to reinforce this learning and demonstrate methods of integrating BSS principles into practice.     

Mechanisms of microgravity induced orthostatic intolerance: implications for effective countermeasures

The development of orthostatic hypotension and instability immediately after return from spaceflight has been a significant operational problem to astronauts for more than four decades. Significant reductions in stroke volume and peripheral vascular resistance contribute to ineffective maintenance of systemic arterial blood pressure during standing after spaceflight despite compensatory elevations in heart rate. The primary mechanism underlying reduced stroke volume appears to be a reduction in preload associated with reduced circulating blood volume, although cardiac atrophy might also contribute. Space flight and ground based experiments have demonstrated that an inability to provide adequate peripheral vasoconstriction in astronauts that become presyncopal may be associated with several mechanisms including reduced sympathetic nerve activity, arterial smooth muscle atrophy and/or hyporeactivity, hypersensitivity of beta-adrenergic receptors, etc. In addition, an inability to provide adequate tachycardia in presyncopal subjects may be associated with reduced carotid-cardiac baroreflex sensitivity. Based on the current knowledge and understanding of cardiovascular mechanisms that are altered during exposure to microgravity, a major focus of future research should be directed to the systematic evaluation of potential countermeasures that specifically target and restore the function of these mechanisms. Based on a preliminary systematic evaluation presented in this review, acute physical exercise designed to elicit maximal effort, G-suit inflation, artificial gravity, and specific pharmacological interventions, alone or in combination, have shown promise as successful countermeasures that provide protection against post-flight orthostatic intolerance.