Predicting Emotional Response to Unsuccessful Fertility Treatment: A Prospective Study

The predictive value of a comprehensive model with personality characteristics, stressor related cognitions, coping and social support was tested in a sample of 187 nonpregnant women. The emotional response to the unsuccessful treatment was predicted out of vulnerability factors assessed before the start of the treatment. The results indicated the importance of neuroticism as a vulnerability factor in emotional response to a severe stressor. They also underlined the importance of helplessness and marital dissatisfaction as additional risk factors, and acceptance and perceived social support as additional protective factors, in the development of anxiety and depression after a failed fertility treatment. From clinical point of view, these results suggest fertility-related cognitions and social support should receive attention when counselling women undergoing IVF or ICSI treatment.     

Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction

Adenocarcinoma of the esophagus, or GEJ, has a poor prognosis. Early lesions [i.e. high grade dysplasia (HGD) or T1-carcinoma] are potentially curable. Local endoscopic therapies are promising treatment options for superficial lesions; however, for deeper lesions, surgical resection is considered to be the treatment of choice. To contribute to therapeutic decision-making, we retrospectively analysed the outcome of transhiatal esophagectomy in 120 patients with pathologically proven HGD (n=13) or T1-adenocarcinoma (n=107) of the distal esophagus or gastro-esophageal junction (GEJ). Tumors were subdivided into six different depths of invasion (T1-mucosal m1-m3, T1-submucosal sm1-sm3), and the frequency of lymphatic dissemination and time to locoregional and/or distant recurrence were analysed. Only one of the 79 T1m1-3/sm1 tumors (1%) showed lymph node metastases as compared with 18 out of 41 T1sm2-3 tumors (44%). There was a significant difference in recurrence-free period between T1m1-m3/sm1 versus T1sm2-sm3 tumor patients (P log rank <0.0001), with 5-year recurrence-free percentages of 97% and 57%, respectively. In multivariate analysis including age, gender, tumor differentiation grade, N-stage and depth of invasion, only N-stage was an independent prognostic factor for recurrence-free period (hazard rate=5.9, 95% CI 1.7–20.7). However, if N-stage was excluded from analysis, only depth of invasion (T1sm2-3 versus T1m1-m3/sm1) was an independent prognostic factor for recurrence-free period (hazard rate=7.5, 95% CI 2.0–27.7). These data indicate that T1m1-m3/sm1 adenocarcinomas of esophagus or GEJ show a very low risk of lymphatic dissemination and are therefore eligible for local endoscopic therapy. After transhiatal surgical resection, almost half of the patients with T1sm2-sm3 lesions develop recurrent disease within 5 years, and therefore need additional therapy to improve survival.     

Career and Family Aspirations of Female Athletic Trainers Employed in the National Collegiate Athletic Association Division I Setting

Context:Female athletic trainers (ATs) tend to depart the profession of athletic training after the age of 30. Factors influencing departure are theoretical. Professional demands, particularly at the collegiate level, have also been at the forefront of anecdotal discussion on departure factors.Objective:To understand the career and family intentions of female ATs employed in the collegiate setting.Design:Qualitative study.Setting:National Collegiate Athletic Association Division I.Results:Our participants indicated a strong desire to focus on family or to start a family as part of their personal aspirations. Professionally, many female ATs were unsure of their longevity within the Division I collegiate setting or even the profession itself, with 2 main themes emerging as factors influencing decisions to depart: family planning persistence and family planning departure. Six female ATs planned to depart the profession entirely because of conflicts with motherhood and the role of the AT. Only 3 female ATs indicated a professional goal of persisting at the Division I setting regardless of their family or marital status, citing their ability to maintain work-life balance because of support networks. The remaining 17 female ATs planned to make a setting change to balance the roles of motherhood and AT because the Division I setting was not conducive to parenting.Conclusions:Our results substantiate those of previous researchers, which indicate the Division I setting can be problematic for female ATs and stimulate departure from the setting and even the profession.Key Words: retention, attrition, work-life balance

Key Points

• Female athletic trainers decided to depart the Division I setting because the required hours of the job limited the time available for parenting.
• Female athletic trainers working in the Division I setting who were able to persist after having a family credit strong support networks and the development of effective work-life balance strategies.

Traditionally, working women endure more challenges balancing career demands and family responsibilities than working men, often because of their mothering philosophies and traditional gender stereotypes.¹ Surprisingly, gender differences have not been found in the occurrence of conflicts between work and life in the athletic training profession.^2,3 This finding is perplexing because female athletic trainers (ATs) continue to depart from the profession.⁴ Hypothetically, the decline in the number of female ATs in the profession has been linked to the desire to strike a balance among work responsibilities, personal interests, and family obligations.^1–3,5Concerns about work-life balance (WLB) and time for parenting have been found to influence decisions to persist within the collegiate levels, as the job responsibilities often include long hours (>40 h/wk) and travel, which can limit time spent at home with family.^1–3,5 It is an unfortunate reality that female ATs make up only approximately 28% of the full-time collegiate staff.⁵ This is especially concerning when the National Athletic Trainers'' Association indicates that more than 50% of its members are female.⁶ A relationship appears to exist between balancing professional responsibilities with parenthood and retention factors, especially for those who leave the collegiate clinical setting to work in clinical settings more favorable to family life.Female ATs in the National Collegiate Athletic Association Division I setting experience great challenges in maintaining WLB because of the demands of the setting.¹ In a recent study,¹ the primary reasons female ATs continued in the Division I setting were enjoyment of the job and atmosphere, increased autonomy, positive athlete dynamics, and the social support network. It is important for female ATs to have support at work and home to persist in the collegiate or athletic training clinical setting. However, long work hours and the inability to find WLB can stress this support network. Mazerolle and colleagues^2,3 first proposed that motherhood plausibly could lead to departure from the profession as the result of a myriad of factors but mostly because of a lack of time and control over work schedules. Further investigations have supported this theory and also have found that other reasons for leaving the profession are WLB concerns, supervisory and coach conflicts, caring for children, and role overload.^1,4,5Fulfillment of WLB is an important retention factor for female coaches within the collegiate setting,⁷ thus providing some supporting evidence to the suppositions that motherhood can be a mediating factor in the retention of female ATs in the collegiate setting. Additional support can be garnered from Mazerolle et al,² who found that only 22 female ATs with children were employed at the collegiate setting, a statistic supported by Kahanov et al,⁵ who reported that only about a quarter of all full-time ATs at the collegiate setting were female.Concerns about retention, particularly of female ATs, have become an increasingly popular topic within the athletic training literature, with attention focused on the collegiate clinical setting. This setting not only is one of the largest employment settings for the AT⁶ but is recognized as a time-intensive, demanding work environment.^2,3,8,9 Moreover, data suggest women are leaving this particular clinical setting to find a more family-friendly work environment, which may or may not be in the profession of athletic training.^10,11 Additionally, 2 recent studies^10,11 suggest that female athletic training students intend to pursue careers in athletic training, but as highlighted by Kahanov and Eberman,⁴ women are rapidly departing the profession for a variety of reasons. The emigration of female ATs from the profession has been theoretically associated with the desire to attain balance among family commitments, personal time, and work responsibilities.^1,2 Difficulties maintaining WLB and sufficient time for parenting shape decisions to continue at the collegiate level.^1,2Because of the concerning trend of female AT attrition, the purpose of our study was to understand the perspectives of female ATs, regardless of marital status, and to evaluate career and family intentions. Our objective was to gain a more thorough understanding of female ATs'' professional goals as they may be influenced by family planning. Our research questions included, “What factors influence the career intentions of female ATs regarding career longevity?” and “Do female ATs have intentions to remain in the NCAA Division I setting?”     

Tooth autotransplantation using an interdisciplinary approach to rehabilitation in a young patient: Case report with 7-year follow-up

This case report demonstrates the possibility of functional and aesthetic rehabilitation using an interdisciplinary approach in a child following avulsion of a tooth. Autotransplantation after the development of calcific metamorphosis of the pulp and acute apical periodontitis provided satisfactory repair after root canal treatment. A 7-year-old white boy avulsed the right maxillary central incisor (tooth 11). The extra-alveolar time exceeded 60 minutes, and this triggered external replacement resorption of the avulsed tooth. At 11 years of age, the child underwent tooth autotransplantation. After 4 years of follow-up, intraoral clinical and radiographic examination led to the diagnosis of calcific metamorphosis of the pulp and acute apical periodontitis. The patient had minimally invasive root canal treatment, orthodontic treatment and esthetic rehabilitation with a porcelain crown. Control periapical radiography and tomography of the autotransplanted tooth after 7 years revealed bone repair in the periapical region. This case report indicates that tooth autotransplantation can be used to replace anterior teeth after avulsion followed by replacement resorption. Interdisciplinary management helped to maintain the esthetics and function of the rehabilitated area.     

Motherhood and Work–Life Balance in the National Collegiate Athletic Association Division I Setting: Mentors and the Female Athletic Trainer

Context:

One of the greatest catalysts for turnover among female athletic trainers (ATs) is motherhood, especially if employed at the National Collegiate Athletic Association Division I level. The medical education literature regularly identifies the importance of role models in professional character formation. However, few researchers have examined the responsibility of mentorship and professional role models as it relates to female ATs'' perceptions of motherhood and retention.

Objective:

To evaluate perceptions of motherhood and retention in relation to mentorship and role models among female ATs currently employed in the collegiate setting.

Design:

Qualitative study.

Setting:

Female athletic trainers working in National Collegiate Athletic Association Division I.

Patients or Other Participants:

Twenty-seven female ATs employed in the National Collegiate Athletic Association Division I setting volunteered. Average age of the participants was 35 ± 9 years. All were full-time ATs with an average of 11 ± 8 years of clinical experience.

Data Collection and Analysis:

Participants responded to questions by journaling their thoughts and experiences. Multiple-analyst triangulation and peer review were included as steps to establish data credibility.

Results:

Male and female role models and mentors can positively or negatively influence the career and work–life balance perceptions of female ATs working in the Division I setting. Female ATs have a desire to see more women in the profession handle the demands of motherhood and the demands of their clinical setting. Women who have had female mentors are more positive about the prospect of balancing the rigors of motherhood and job demands.

Conclusions:

Role models and mentors are valuable resources for promoting perseverance in the profession in the highly demanding clinical settings. As more female ATs remain in the profession who are able to maintain work–life balance and are available to serve as role models, the attitudes of other women may start to change.Key Words: role models, retention, quality of life

Key Points

• Role models and mentors are being identified by female athletic trainers working in the Division I setting.
• Perceptions of work–life balance can be positively affected by how role models and mentors maintain balance within their own lives. Conversely, those individuals who cannot maintain balance can negatively affect their proteges'' perceptions of work–life balance.
• Female athletic trainers working in the Division I setting desire more female role models who are effectively balancing the multiple responsibilities of their personal and professional lives.

The positive and negative influences of role models and mentors have been well established in the medical literature, specifically in academic medicine.^1–3 In a published systematic review of the literature,¹ mentorship in academic medicine was reported to enhance personal and career development, as well as research productivity, including publications and grant awards. Mentoring was described in the late 1970s by Levinson,⁴ who exposed the relationship as one of the most significant influences an individual can have in early adulthood. Mentoring has been emphasized as a critical element for personal and career advancement and career selection.^1,2 However, mentoring is not always a positive experience. Repeated negative learning experiences may adversely affect the development of professionalism in medical students and residents.⁵ A lack of mentoring may contribute to career success deficiencies in academic medicine, especially for women.^1,3 Furthermore, female physicians are less likely than their male colleagues to identify role models for work–life balance (WLB).⁶Role models and mentors differ in that mentors are senior members of a group who intentionally encourage and support younger colleagues in their careers.⁵ Mentoring often includes role modeling. A role model teaches predominantly by example and helps to form one''s professional identity and commitment by promoting observation and comparison.⁵ Role modeling is less intentional, more informal, and more episodic than mentoring. Individuals serving as supervisors are the gatekeepers to establishing an environment that enhances a family-friendly atmosphere and ensures that their employees realize WLB. Work–life balance is attained when an individual''s right to a contented life inside and outside paid work is accepted and valued as the norm. Mazerolle et al⁷ found that head athletic trainers (ATs) informally try to encourage WLB through role modeling. Therefore, supervisors and bosses may incidentally act as role models.Of great concern in the field of athletic training is the subject of retention among female ATs, which has recently been heavily researched.^8–11 The departure of female ATs from the profession has been theoretically linked to the desire to strike a balance between family obligations and personal time with work responsibilities.^12,13 The National Collegiate Athletic Association Division I clinical setting holds unique professional challenges for ATs. Long road trips, nights away from home, pressure to win, supervision of athletic training students, infrequent days off, high athlete-to-AT ratios, athletes on scholarship, and extended competitive seasons are some of the stresses faced by an AT working in the Division I setting.¹⁴ Concerns regarding WLB and time for parenting influence decisions to persist at the collegiate level.^12,13 Several investigators^11,13 in athletic training have suggested that motherhood is a primary factor leading to the departure of females from the profession. Role models and mentoring have emerged as possible factors to aid in the retention of females in the collegiate setting once they become mothers.Limited research on mentoring exists in the context of athletic training. Two studies^15,16 have examined the effects of professional socialization among high school and collegiate ATs. Similar to mentoring, professional socialization is a process by which individuals learn the knowledge, skills, values, roles, and attitudes associated with their professional responsibilities.¹⁷ The mentoring roles of ATs evolve over their careers. Initially, ATs make network connections in order to learn, but as they become more experienced, they take on more of a mentoring role. This occurs as a result of being contacted by less experienced colleagues for advice on how to deal with problems in their clinical settings.¹⁶ Additionally, a recent study¹⁸ examined female athletic training students'' perceptions on motherhood in the athletic training profession; the students felt strongly that a female mentor who had children would greatly benefit them personally as well as professionally. Though the students named mentorship as an important retention factor, they had very limited direct mentorship from a female AT with children employed in the collegiate setting. This finding mirrors research in the medical literature⁶ highlighting a lack of role models or mentors being identified by females in various professions. Although Pitney¹⁶ highlighted the presence of mentors in the athletic training profession, a scarcity of information exists regarding the part mentors and role models play for female ATs specifically and in their influence on WLB views. The purpose of our study, therefore, was to examine the effect of role models and mentors on perceptions of career and motherhood among female ATs working in the Division I setting. This study will be the first to assess perceptions of mentors and role models among female ATs throughout the life experience spectrum (single, married, married with children). The following central research question guided this study: how do role models and mentors within athletic training influence female ATs employed in the Division I setting?     

Second primary tumors involving non-small cell lung cancer: prevalence and its influence on survival

OBJECTIVES: Patients with lung cancer have a relative high risk for second primary cancers. We studied the prevalence of second primary tumors in patients with a diagnosis of non-small cell lung cancer (NSCLC) in their history or at follow-up. Furthermore, we studied survival in subgroups of those patients. METHODS AND PATIENTS: Retrospectively, 860 patients with NSCLC that had been diagnosed in the period from January 1, 1990, to December 31, 1999, were evaluated for second primary cancers either in their history or in the follow-up period. The patients were divided into the following four groups: group I, patients with another primary tumor detected in the follow-up period (n = 44); group II, patients with another primary tumor in their history (n = 148); group III, patients with no other primary tumor found in their history or at follow-up (n = 634); and group IV, patients with more than one other primary tumor in found in their history or at follow-up (n = 34). RESULTS: The most frequently diagnosed double tumors were located in the lungs, the head and neck region, and the urinary tract. The interval between another malignancy as the first tumor (group II, 83 months) and NSCLC as the second malignancy was significantly longer than vice versa (group I, 14.5 months; p < 0.05). In > 80% of patients, the second primary tumors were diagnosed within 1 year after NSCLC was diagnosed. The 5-year survival rate is significantly better for patients with more than two primary malignancies compared to patients without two primary malignancies and patients with one other tumor in their history (p = 0.004 and 0.012, respectively). The 5-year survival rate in patients with a second tumor in the follow-up period was better than in patients without any other second tumor (p = 0.029). As the TNM stage and therapy were comparable in all subgroups, it could not be used as explanation for the difference in survival rates. CONCLUSION: In 25% of patients, additional tumors that were NSCLC were diagnosed either in their history or in the follow-up period. The majority of second tumors following NSCLC are diagnosed within 1 year. Nevertheless, patients with a second tumor tend to have an overall better survival rate than patients without second primaries, suggesting different growth habits.     

Patient Versus Professional Based Psychosocial Risk Factor Screening for Adverse Pregnancy Outcomes

To identify Psychopathology, Psychosocial problems and substance use (PPS) as predictors of adverse pregnancy outcomes, two screen-and-advice instruments were developed: Mind2Care (M2C, self-report) and Rotterdam Reproductive Risk Reduction (R4U, professional’s checklist). To decide on the best clinical approach of these risks, the performance of both instruments was compared. Observational study of 164 pregnant women who booked at two midwifery practices in Rotterdam. Women were consecutively screened with M2C and R4U. For referral to tailored care based on specific PPS risks, inter-test agreement of single risks was performed in terms of overall accuracy and positive accuracy (risk present according to both instruments). With univariate regression analysis we explored determinants of poor agreement (<90 %). For triage based on risk accumulation and for detecting women-at-risk for adverse birth outcomes, M2C and R4U sum scores were compared. Overall accuracy of single risks was high (mean 93 %). Positive accuracy was lower (mean 46 %) with poorest accuracy for current psychiatric symptoms. Educational level and ethnicity partly explained poor accuracy (p < 0.05). Overall low PPS prevalence decreased the statistical power. For triage, M2C and R4U sum scores were interchangeable from sum scores of five or more (difference <1 %). The probability of adverse birth outcomes similarly increased with risk accumulation for both instruments, identifying 55–75 % of women-at-risk. The self-report M2C and the professional’s R4U checklist seem interchangeable for triage of women-at-risk for PPS or adverse birth outcomes. However, the instruments seem to provide complementary information if used as a guidance to tailored risk-specific care.     

Mental health conditions and the risk of chronic opioid therapy among patients with rheumatoid arthritis: a retrospective veterans affairs cohort study

Clinical Rheumatology - Patients with rheumatoid arthritis (RA) often receive opioid analgesics for pain management. We examined the association between mental health conditions and the risk of...     

The onset of ventricular isovolumic contraction as reflected in the carotid artery distension waveform

The blood pressure waveform carries information about the cardiac contraction and the impedance characteristics of the vascular bed. Here, we demonstrate that the start of isovolumic ventricular contraction is persistently reflected as an inflection point in the pressure wave as recorded in the aortic root (TP(IC)) as well as in the carotid artery distension waveform (TD(IC)) as it travels down the arterial tree. In a group of six patients with normal pressure gradients across the aortic valve after valve replacement, the TP(IC) had a small delay with respect to the onset of isovolumic ventricular contraction (<10 ms). In a group (n = 21) of young presumably healthy volunteers, the inflection point occurred persistently in the carotid distension waveform, as recorded by means of ultrasound, before the systolic foot (intersubject delay between inflection point and systolic foot: mean +/- SD = 40.0 +/- 9.4 ms, intrasubject SD 4.6 ms). Retrograde coronary blood flow during isovolumic ventricular contraction may be the origin of the persistent end-diastolic pressure and distension perturbation. This study shows that the duration of the isovolumic contraction can be reliably extracted from the carotid artery distension waveform.