As compared with standard duty-hour policies, flexible, less-restrictive duty-hour policies for surgical residents were associated with noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. (FIRST ClinicalTrials.gov number, NCT02050789.).

Context Major depression and dysthymia in adolescence are associated with substantial disability, need for mental health services, and risk for recurrence. Concrete suicidal ideation and attempts during adolescence are particularly associated with significant distress, morbidity, and risk for completed suicide. Objectives To test the hypothesis that young children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for depression and suicidal ideation and attempts during adolescence and to identify early predictors of which young children with ADHD are at greatest risk. Design Prospective follow-up study. Setting Chicago, Illinois, and Pittsburgh, Pennsylvania. Patients A cohort of 125 children who met DSM-IV criteria for ADHD at 4 to 6 years of age and 123 demographically matched comparison children without ADHD were prospectively followed up in 7 structured diagnostic assessments of depression and suicidal behavior in assessment years 6 through 14, spanning 9 through 18 years of age. Main Outcome Measures DSM-IV criteria for depressive disorders and suicidal behavior. Results Children with ADHD at 4 to 6 years of age were at greatly increased risk for meeting DSM-IV criteria for major depression or dysthymia (hazard ratio, 4.32) and for attempting suicide (hazard ratio,3.60) through the age of 18 years relative to comparison children. There were marked variations in risk for these outcomes among children with ADHD, however. Within the ADHD group, children with each subtype of ADHD were at risk but for different adverse outcomes. Girls were at greater risk for depression and suicide attempts. Maternal depression and concurrent child emotional and behavior problems at 4 to 6 years of age predicted depression and suicidal behavior. Conclusions All subtypes of ADHD in young children robustly predict adolescent depression and/or suicide attempts 5 to 13 years later. Furthermore, female sex, maternal depression, and concurrent symptoms at 4 to 6 years of age predict which children with ADHD are at greatest risk for these adverse outcomes. Identifying high-risk young children with ADHD sets the stage for early prevention trials to reduce risk for later depression and suicidal behavior.

Female residents report working more, experiencing certain aspects of burnout more frequently, and having poorer psychological well-being. Qualitative themes provide insights into possible cultural and programmatic shifts to address the concerns for female residents.

Implementation of the 2011 ACGME duty hour reform was not associated with a change in general surgery patient outcomes or differences in resident examination performance. The implications of these findings should be considered when evaluating the merit of the 2011 ACGME duty hour reform and revising related policies in the future.

OBJECTIVE Food insecurity is hypothesized to make diabetes self-management more difficult. We conducted a longitudinal assessment of food insecurity with several diabetes self-care measures.RESEARCH DESIGN AND METHODSWe conducted a secondary, observational analysis of 665 low-income patients with diabetes, all of whom received self-management support as part of a larger diabetes educational intervention. We analyzed baseline food insecurity (measured by the U.S. Department of Agriculture Food Security module) in relation to changes in hemoglobin A1c (HbA1c) as well as self-reported diabetes self-efficacy and daily fruit and vegetable intake. We examined longitudinal differences using generalized estimating equation linear regression models, controlling for time, age, sex, race, income, and intervention arm.RESULTSOverall, 57% of the sample had an income <$15,000. Participants who were food insecure (33%) were younger, had less income, and were more likely to be unemployed compared with participants who were food secure. At baseline, those who were food insecure had higher mean HbA1c values (8.4% vs. 8.0%) and lower self-efficacy and fruit and vegetable intake than those who were food secure (all P < 0.05). Compared with food-secure individuals, participants who were food insecure had significantly greater improvements in HbA1c over time (0.38% decrease compared with 0.01% decrease; P value for interaction <0.05) as well as in self-efficacy (P value for interaction <0.01). There was no significant difference in HbA1c by food security status at follow-up.CONCLUSIONSParticipants experiencing food insecurity had poorer diabetes-related measures at baseline but made significant improvements in HbA1c and self-efficacy. Low-income patients who were food insecure may be particularly receptive to diabetes self-management support, even if interventions are not explicitly structured to address finances or food security challenges.

clinicaltrials.org Identifier: NCT02050789.

Background & Aims Optimal colonoscopy preparation requires patients to adhere to written instructions and be activated to complete the task. Among patients with chronic disease, health literacy and patient activation have been associated with outcome, but these factors have not been studied for colonoscopy. We examined the association between health literacy, patient activation, and quality of bowel preparation. Methods We analyzed outpatient colonoscopy results from 462 adults, 55–74 y old (mean 62±6 y), who previously completed extensive neurocognitive assessments as part of a prospective study (Health Literacy and Cognitive Function in Older Adults). We collected information on cecal intubation, polyp detection, bowel preparation quality, and histopathology. Results One third of the patients (n=134) had suboptimal quality of bowel preparation, 15% (n=62) had fair quality, and 17% (n=72) had poor quality. Limited health literacy was associated with a lower level of education (P<.001), diabetes (P<.001), and a higher number of chronic conditions (P<.001), but not quality of colonoscopy preparation. No baseline characteristics were associated with patient activation. In multivariable analysis, after adjusting for demographics and clinical characteristics, diabetes (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.35–6.36) and patient activation (OR, 2.07; 95% CI, 1.27–3.40) were independent predictors of suboptimal bowel preparation quality, but limited health literacy was not (OR, 0.76; 95% CI, 0.44–1.31). Conclusions We investigated the relationship between health literacy, patient activation, and colonoscopy preparation quality. Lower patient activation was an independent predictor of suboptimal bowel preparation quality. Interventions to improve colonoscopy preparation quality should consider the importance of patient activation within their design.

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