IntroductionMany physicians do not feel competent providing nutritional counseling to patients. A minimum of 25 hours dedicated to nutrition is recommended in preclinical years, but only 40% of U.S. medical schools achieve this goal. Nutrition counseling is best done when physicians work collaboratively with registered dietitians (RDs). We sought to introduce this interprofessional approach in our preclinical curriculum.MethodsIn our first-year doctoring course, students viewed a nutrition lecture from a physician and RD. Teams of two to three medical students and one dietetics student were formed. The medical students took a history and performed nutrition counseling on the dietetics student role-playing a patient. The RD student provided feedback and reviewed clinical questions pertaining to the nutrition case. Medical students presented answers to their assigned case to the whole group. Medical students completed pre-/postsurveys assessing satisfaction and perceived confidence with nutrition counseling and were formally assessed using a standardized patient. The scores were compared to students from the year before who received the lecture but not the RD student activity.ResultsEighty-one medical students participated. After the activity, there was an increase in confidence with nutrition counseling (p < .001), and 74% found working with dietetics students to be helpful or extremely helpful. The nutrition counseling mean score increased from 68% (historical control, n = 76) to 84% (n = 75; p < .001) on the standardized patient assessment.DiscussionThis format is an effective method of teaching nutrition counseling and promoting interprofessional behavior among rising physicians and RDs.
Poor comparability of social groups is one of the major methodological problems that threatens the validity of health disparities (HD) research findings. We illustrate a methodological solution that can additionally unpack the mechanisms behind differential effects on depression and anxiety. We describe racial/ethnic differences in the prevalence of depression and anxiety scores between Black and White women using classic methods, and then we illustrate a 1:1 matching procedure that allows for building of individual-level difference scores, i.e., actual HD difference score variables, for each pair of comparable participants. We compare the prevalence of depression disorder between Black and White young women after matching them 1:1 on common socio-economic characteristics (age, employment, education, and marital status). In essence, we follow matching or stratification methods, but make a step further and match cases 1:1 on propensity scores, i.e., we create Black–White ‘dyads’. Instead of concluding from plain comparisons that 11% more White young women (18–30 years old) report a depressive disorder than Black young women, the matched data confirms the trend, but provides more nuances. In 27% of the pairs of comparable pairs the White woman was depressed (and the comparable Black woman was not), while in 15% of the pairs the Black woman was depressed (and the comparable White woman was not). We find that Black-to-White disparities in neighborhood disorder do not predict depression differences (HDs), while such an effect is evident for anxiety HDs. The 1:1 matching approach allows us to examine more complex HD effects, like differential mediational or resilience mechanisms that appear to be protective of Black women’s mental health.
Objectives To examine the underlying mechanisms through which steady state emotions, specifically affect and emotion regulation, influence sleep quality among young adult low-income women. Design Cross-sectional Setting Stress and Health Study (2006–2012) in southeast Texas Participants A subgroup (n=392) of racially and ethnically diverse young adult women ages 18–31. Measurements Participants provided measures of positive and negative affect, difficulties in emotion regulation, and sleep quality. Structural equation models were designed to identify differential mediating roles of emotion dysregulation in the association between both positive and negative affect and sleep quality. Results The relationship between positive affect and improved sleep quality operated completely through domains of emotion regulation (β= −0.054, 95% CI: −0.08 to −0.03), whereas the adverse effects of negative affect exhibited both direct (β= 0.142, 95% CI: 0.06 to 0.23) and indirect (β= 0.124, 95% CI: 0.08 to 0.16) effects on poor sleep. Negative affect was associated with poor sleep quality via two pathways—it directly influenced sleep quality and it indirectly influenced sleep quality among women experiencing difficulties in emotion regulation. Conclusions Therapies targeting improvement and maintenance of healthy emotion regulation domains, while delineating the positive affect state from the negative affect state, may lessen the burden of poor sleep quality among low-income women.
Exposure to adverse environmental and social conditions affects physical and mental health through complex mechanisms. Different racial/ethnic (R/E) groups may be more or less vulnerable to the same conditions, and the resilience mechanisms that can protect them likely operate differently in each population. We investigate how adverse neighborhood conditions (neighborhood disorder, NDis) differentially impact mental health (anxiety, Anx) in a sample of white and Black (African American) young women from Southeast Texas, USA. We illustrate a simple yet underutilized segmented regression model where linearity is relaxed to allow for a shift in the strength of the effect with the levels of the predictor. We compare how these effects change within R/E groups with the level of the predictor, but also how the “tipping points,” where the effects change in strength, may differ by R/E. We find with classic linear regression that neighborhood disorder adversely affects Black women’s anxiety, while in white women the effect seems negligible. Segmented regressions show that the Ndis → Anx effects in both groups of women appear to shift at similar levels, about one-fifth of a standard deviation below the mean of NDis, but the effect for Black women appears to start out as negative, then shifts in sign, i.e., to increase anxiety, while for white women, the opposite pattern emerges. Our findings can aid in devising better strategies for reducing health disparities that take into account different coping or resilience mechanisms operating differentially at distinct levels of adversity. We recommend that researchers investigate when adversity becomes exceedingly harmful and whether this happens differentially in distinct populations, so that intervention policies can be planned to reverse conditions that are more amenable to change, in effect pushing back the overall social risk factors below such tipping points.
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