Genna Hymowitz

It has long been suggested that the ability to manipulate objects in three dimensions is essential to the practice of many clinical medical specialties. Visual-spatial abilities are associated with improved skills in medicine and surgery. Although in other fields these abilities may be less important, in surgery, they are associated with better patient outcomes as well as rapid acquisition of surgical techniques.1 Data are scarce in whether having these innate abilities influences medical student choice of residency. The purpose of our study was to explore this question because we recruited 30 third-year and fourth-year medical students. Informed consent was obtained along with general demographic information and chosen medical specialty. Based on survey responses, specialty choices were equal between the groups, with 15 students pursuing a surgical specialty and the other 15 students working toward nonsurgical specialties. The students underwent a visual-spatial evaluation through the visual-spatial subsets of the Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV) intelligence test, which included the block design (BD), matrix reasoning (MR), and visual puzzles (VP).2 In all three tests, the difficulty of the task increased as they continued with the evaluation. The subject’s performance was manually scored by the evaluator using the WAIS-IV worksheet. The resulting scores from the BD, MR, and VP subsets were recorded separately. The raw scores were converted into scaled scores and percentile ranks. All scores were also used to calculate a composite scaled score known as the Perceptual Reasoning Index (PRI), a widely used measure of overall visual-spatial ability. The subjects were divided into two groups: those entering surgical specialties and those entering nonsurgical specialties. Definitions for surgical specialties were based on statements by the ACS and by the American Board of Medical Specialties. A paired Student’s t test was used to compare scaled scores for each individual subtests as well as the PRI between the two groups. P values less than 0.05 were considered significant. The scores from the visual-spatial subsets and the corresponding PRI of the subject groups are presented in Table 1. The difference between the groups was not significant on the BD subtest (P 4 0.88), the MR subtest (P 4 0.59), or the VP subtest (P 4 0.78). Similarly, there was no significant difference between groups on the PRI composite scores (P 4 0.69). Our analysis showed that medical students’ visual-spatial ability did not predict subsequent medical specialty choice because both study groups performed similarly in the three perceptual reasoning subsets of the WAISIVevaluation. The findings of this study correlate with other published studies evaluating visual-spatial skills in medical students. The best of these studies was reported by Brandt et al.3 regarding medical student career choice. However, compared with that study which used the Vandenburg and Kuse Mental Rotations Test, we used a visual-spatial evaluation method through the WAIS-IV. However, in a study by Siska et al.,4 they found a difference in medical student choice after an evaluation of multiple skill sets, including psychomotor aptitude and visual-spatial ability, where students with high aptitudes opted toward surgical careers. Ultimately, their model did not include the results of their visual-spatial evaluation, which was accomplished with a Schlauch figure test. Overall, the results of this study confirm that medical students do not base their residency choices on a single personal factor, where innate abilities are not the sole determinants of a student’s medical specialty. However, medical students may benefit from evaluations of their visual-spatial ability. This could be done not to rank the students, but more to help students in career guidance. It is to be emphasized that a low Presented as an oral presentation at the American College of Surgeons Scientific Forum, October 7, 2015, Chicago, IL. Address correspondence and reprint requests to Antonio N. Villamor, M.D., Department of Surgery, Health Sciences Center T19-020, Stony Brook Medicine, Stony Brook, NY 11794-8191. E-mail: antonio.n.villamor@gmail.com.

BACKGROUND Sleep disturbance is well established in individuals with obesity, and the relationship between poor sleep and obesity is supported by population, longitudinal, experimental, and intervention studies. However, the prevalence and characteristics of poor sleep in individuals seeking bariatric surgery have thus far been poorly examined. OBJECTIVES We sought to characterize self-reported sleep parameters in individuals seeking bariatric surgery and to compare these data with controls. SETTING Two Academic Medical Centers, United States, and an online survey of healthy controls. METHOD Individuals seeking bariatric surgery (n = 427) completed presurgical psychological evaluations at 2 comprehensive bariatric surgery programs. Data on medical co-morbidities and from self-report questionnaires on sleep quality, insomnia, anxiety, and depression were abstracted from charts. Data from controls (n = 180) were collected using an online survey tool and compared with bariatric cases. RESULTS Across study sites, 40.4% of bariatric cases took at least 30 minutes to fall asleep, 46.7% had insufficient total sleep time (<6.5 hr), 65.1% reported general poor sleep quality, and 30.8% reported clinically significant insomnia symptoms. Approximately 20% of the variance in poor sleep quality and insomnia was explained by body mass index, obstructive sleep apnea, anxiety, and depression. Cases and controls were similar, although bariatric cases reported significantly poorer sleep efficiency. CONCLUSIONS Our results suggest that similar to a control population, the majority of patients seeking bariatric surgery are experiencing sleep difficulties. Presurgical assessment and treatment of sleep problems may be beneficial to patients and may help improve weight loss treatment outcomes. Optimally, assessment would include 1 of the 2 self-report questionnaires used herein, and treatment would involve Cognitive Behavioral Therapy for Insomnia. Future research assessing sleep patterns with objective measurement tools and evaluating the impact of sleep on postsurgical outcomes is warranted.

ABSTRACT Disordered eating and weight problems are associated with experiencing childhood abuse. While weight-related abuse (WRA; teasing and verbal abuse specific to one’s weight) uniquely predicts disordered eating and mood problems in adulthood, the link between WRA and adult outcomes is largely unexplored. Relationships between perpetrators and victims (e.g., family member vs. stranger) have demonstrated an impact on outcomes in research on sexual abuse, and may elucidate important aspects of the relationship between psychopathology and abuse. Thus, we investigated the effect of the perpetrator’s relationship to the victim on disordered eating symptoms in a population of young adults (N = 371) oversampled for current overweight and obesity. Parent perpetration of WRA was the strongest predictor of both depression and abuse-related emotional impact ratings. In contrast, friend and classmate perpetration of WRA were the sole predictors of binge eating and anxiety symptoms, respectively. Results highlight the importance of investigating the impact of multiple types of perpetrators of WRA, as well as the need to examine family and other close relationships in the treatment of disordered eating and internalizing symptoms.

Weight-related teasing (WRT)/stigmatization may be distinct from teasing and general abuse and may differentially impact adult outcomes. As WRT increases in severity so do depression and disordered eating. Currently, there are no validated measures designed to assess abuse specific to weight. Thus, we developed the Weight-Related Abuse Questionnaire (WRAQ) and validated it in young adult and clinically obese populations. The WRAQ was administered to 3 samples of participants: 292 undergraduate students, 382 undergraduate students, and 59 individuals seeking bariatric surgery. Concurrent validity was assessed via measures of WRT and general childhood abuse. Convergent validity was assessed with measures of depression and disordered eating. Study 1 data were used to further develop the structure of the WRAQ. Study 2 indicated that the WRAQ had excellent psychometric properties (based on factor analyses and reliability/scale consistency analysis) and strong concurrent and convergent validity, supporting the validity of the questionnaire. 6-month test-retest reliability was also good. In Study 3 responses on the WRAQ converged well with interview responses, showed good psychometric properties, and showed moderate correlations with measures of childhood abuse and psychopathology. The WRAQ has strong psychometric properties and is strongly associated with measures of current psychopathology. Additionally, it fills a gap in the assessment literature and may be a beneficial tool for determining which individuals are at increased risk for psychopathology.

Risk for suicidality (current or past suicidal ideation or attempt) increases after bariatric surgery; however, there is a paucity of research investigating suicidality predictors in this population. This study involved a retrospective chart review of individuals seeking psychological clearance for bariatric surgery. In total, 32 participants (15.8%) were classified as reporting suicidality. These participants endorsed greater depressive symptomatology and hopelessness, and hopelessness and mood disorder diagnosis each uniquely predicted whether or not a patient was classified as reporting suicidality. The findings within suggest that increased attention to the relationship among these variables may improve methods for identification of high-risk patients. Implications for clinical practiced are discussed.

Bleomycin yields pulmonary injury characterized by inflammation that proceeds to fibrosis. The production of IL-10 by pulmonary macrophages is increased in the inflammation that accompanies bleomycin lung injury. In the present study, IL-10 deficient and wildtype mice received 0.075 units of bleomycin intratracheally at day 0 and were sacrificed at day 7 or day 14. At day 7, pulmonary inflammation was increased in IL-10-deficient mice as reflected by increased representation of CD3+ and CD4+ lymphocytes and GR-1+ pulmonary granulocytes in the bronchoalveolar lavage (BAL) fluid. Pulmonary interstitial CD80+ and CD86+ mononuclear cells were increased in situ. At day 14, mononuclear cell inflammation was comparable between groups but pulmonary eosinophils were increased in the wildtype. There was no difference in the degree of pulmonary fibrosis, as judged by histology or lung hydroxyproline content. Lung chemokine expression of MIP-1alpha/beta, MIP-2, and eotaxin was increased at days 7 and 14 with a trend towards increased MCP-1 expression at day 14. The findings suggest an immunomodulatory role for IL-10 in the inflammatory response but not in the pulmonary fibrosis yielded by bleomycin.