Chris Morley
SUNY: Upstate Medical University, Public Health & Preventative Medicine, Department Member
- SUNY: Upstate Medical University, Family Medicine, Faculty Memberadd
- Family Medicine, Public Health, Medical Education, Medical Anthropology, Psychiatry, Bioethics, and 18 moreMorality and Personhood, History, Public Administration, Social Science, Public Relations, Lobbying, Public Affairs, Tobacco control policy, Tobacco Control, Education, Social Sciences, Rural Health, Medical Education (in Education), Mental Health, Social History of Medicine, Rural education, Practice-Based Research, and Student Assessmentedit
Objective: To assess existing reported human trials of Withania somnifera (WS; common name, ashwagandha) for the treatment of anxiety. Design: Systematic review of the literature, with searches conducted in PubMed, SCOPUS, CINAHL, and... more
Objective: To assess existing reported human trials of Withania somnifera (WS; common name, ashwagandha) for the treatment of anxiety.
Design: Systematic review of the literature, with searches conducted in PubMed, SCOPUS, CINAHL, and Google Scholar by a medical librarian. Additionally, the reference lists of studies identified in these databases were searched by a research assistant, and queries were conducted in the AYUSH Research Portal. Search terms included “ashwagandha,” “Withania somnifera,” and terms related to anxiety and stress. Inclusion criteria were human randomized controlled trials with a treatment arm that included WS as a remedy for anxiety or stress. The study team members applied inclusion criteria while screening the records by abstract review.
Intervention: Treatment with any regimen of WS.
Outcome measures: Number and results of studies identified in the review.
Results: Sixty-two abstracts were screened; five human trials met inclusion criteria. Three studies compared several dosage levels of WS extract with placebos using versions of the Hamilton Anxiety Scale, with two demonstrating significant benefit of WS versus placebo, and the third demonstrating beneficial effects that approached but did not achieve significance (p=0.05). A fourth study compared naturopathic care with WS versus psychotherapy by using Beck Anxiety Inventory (BAI) scores as an outcome; BAI scores decreased by 56.5% in the WS group and decreased 30.5% for psychotherapy (p<0.0001). A fifth study measured changes in Perceived Stress Scale (PSS) scores in WS group versus placebo; there was a 44.0% reduction in PSS scores in the WS group and a 5.5% reduction in the placebo group (p<0.0001). All studies exhibited unclear or high risk of bias, and heterogenous design and reporting prevented the possibility of meta-analysis.
Conclusions: All five studies concluded that WS intervention resulted in greater score improvements (significantly in most cases) than placebo in outcomes on anxiety or stress scales. Current evidence should be received with caution because of an assortment of study methods and cases of potential bias.
Design: Systematic review of the literature, with searches conducted in PubMed, SCOPUS, CINAHL, and Google Scholar by a medical librarian. Additionally, the reference lists of studies identified in these databases were searched by a research assistant, and queries were conducted in the AYUSH Research Portal. Search terms included “ashwagandha,” “Withania somnifera,” and terms related to anxiety and stress. Inclusion criteria were human randomized controlled trials with a treatment arm that included WS as a remedy for anxiety or stress. The study team members applied inclusion criteria while screening the records by abstract review.
Intervention: Treatment with any regimen of WS.
Outcome measures: Number and results of studies identified in the review.
Results: Sixty-two abstracts were screened; five human trials met inclusion criteria. Three studies compared several dosage levels of WS extract with placebos using versions of the Hamilton Anxiety Scale, with two demonstrating significant benefit of WS versus placebo, and the third demonstrating beneficial effects that approached but did not achieve significance (p=0.05). A fourth study compared naturopathic care with WS versus psychotherapy by using Beck Anxiety Inventory (BAI) scores as an outcome; BAI scores decreased by 56.5% in the WS group and decreased 30.5% for psychotherapy (p<0.0001). A fifth study measured changes in Perceived Stress Scale (PSS) scores in WS group versus placebo; there was a 44.0% reduction in PSS scores in the WS group and a 5.5% reduction in the placebo group (p<0.0001). All studies exhibited unclear or high risk of bias, and heterogenous design and reporting prevented the possibility of meta-analysis.
Conclusions: All five studies concluded that WS intervention resulted in greater score improvements (significantly in most cases) than placebo in outcomes on anxiety or stress scales. Current evidence should be received with caution because of an assortment of study methods and cases of potential bias.
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The establishment of practice patterns concerning the diagnosis and management of hypovitaminosis D seems to be heterogeneous among primary care physicians. We conducted a qualitative study to explore the emerging practices among primary... more
The establishment of practice patterns concerning the diagnosis and management of hypovitaminosis D seems to be heterogeneous among primary care physicians. We conducted a qualitative study to explore the emerging practices among primary care providers regarding screening and treatment for hypovitaminosis D, as well as factors that influence practice patterns. Trained researchers facilitated focus groups among primary care providers. We followed a grounded theory approach to transcript coding and analysis using ATLAS.ti analysis software. Testing or screening for hypovitaminosis D and subsequent replacement or supplementation practices varied among participants. Emerging practice concerning vitamin D appears to be constructed and reinforced by patient demand; incidental reading; brief, purposeful research; conversations with colleagues; results of consultations by specialists; and more patient demand. A multifaceted approach to promoting guideline adherence will be required to influence this practice.
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BACKGROUND AND OBJECTIVES: The Institute of Medicine recommends integrating public health (PH) and primary care to advance community health. The status of PH integration into family medicine clerkships (FMC) is unknown. We sought to... more
BACKGROUND AND OBJECTIVES: The Institute of Medicine recommends integrating public health (PH) and primary care to advance community health. The status of PH integration into family medicine clerkships (FMC) is unknown. We sought to determine the extent and methods of required PH instruction in FMC.
METHODS: We used the Council of Academic Family Medicine Educational Research Alliance (CERA) survey of FMC directors.
RESULTS: From 36%–59% of FMC directors responded to individual PH questions, reporting a mean of 36.3 hours (range 1–258) of PH instruction in the clerkship. The majority of PH instructional time relates to behavioral sciences, communication, and cultural competence. Forty-nine percent of PH instructional hours are experiential. Ninety percent of respondents agree that PH training is important for medical students; 67.5% of respondents agree that PH training is appropriate for the FMC. Respondents from public schools reported more PH training than respondents from private schools (43.85 ± 9.25 hours versus 21.29 ± 3.82 hours). There was no difference between hours of instruction reported by FMC directors with shorter (≤ 4 weeks) and longer (> 4 weeks) clerkships (40.8 ± 13.7 hours versus 33.7 ± 6.4 hours). Among respondents leaving comments, 24/36 (66.7%) cited insufficient time, 6/36 (16.7%) cited lack of funding, and others identified lack of faculty or preceptor expertise and lack of student interest as barriers to PH instruction.
CONCLUSIONS: There is variability in how FMC are addressing PH instruction. Future research should qualitatively explore pedagogical methods and seek consensus on the competencies and best practices in PH instruction most suited to FMC.
(Fam Med 2014;46(7):544-8.)
METHODS: We used the Council of Academic Family Medicine Educational Research Alliance (CERA) survey of FMC directors.
RESULTS: From 36%–59% of FMC directors responded to individual PH questions, reporting a mean of 36.3 hours (range 1–258) of PH instruction in the clerkship. The majority of PH instructional time relates to behavioral sciences, communication, and cultural competence. Forty-nine percent of PH instructional hours are experiential. Ninety percent of respondents agree that PH training is important for medical students; 67.5% of respondents agree that PH training is appropriate for the FMC. Respondents from public schools reported more PH training than respondents from private schools (43.85 ± 9.25 hours versus 21.29 ± 3.82 hours). There was no difference between hours of instruction reported by FMC directors with shorter (≤ 4 weeks) and longer (> 4 weeks) clerkships (40.8 ± 13.7 hours versus 33.7 ± 6.4 hours). Among respondents leaving comments, 24/36 (66.7%) cited insufficient time, 6/36 (16.7%) cited lack of funding, and others identified lack of faculty or preceptor expertise and lack of student interest as barriers to PH instruction.
CONCLUSIONS: There is variability in how FMC are addressing PH instruction. Future research should qualitatively explore pedagogical methods and seek consensus on the competencies and best practices in PH instruction most suited to FMC.
(Fam Med 2014;46(7):544-8.)
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Background A number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the... more
Background
A number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the traditional US curricula. This study builds on prior work testing the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school.
Methods
The original study sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning and end of academic year 2010, on three proxies for idealism. The current study extends that work by administering the same survey items to the same student cohorts at the end of their third and fourth years (MS3 and MS4), respectively. Survey topics included questions on: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions. Linear regression was then used to test the effect of the six cohort/time-points on each composite variable, controlling for demographic characteristics.
Results
Idealism in medicine decreased (β = -.113, p < .001) while emphasis on employment and job security increased (β = .146, p < .001) as motivators of pursuing a career in medicine at each medical school stage and time period. Students were more likely to be motivated by student debt over interest in content in specialty choice (β = .077, p = .004) across medical school stages. Negative attitudes towards primary care were most sensitive to MS group and time effects. Both negative/antagonistic views (β = .142, p < .001) and negative/sympathetic views (β = .091, p < .001) of primary care increased over each stage.
Conclusions
Our results provide further evidence that declines in medical student idealism may occur as early as the second year of medical education. Additionally, as students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.
Keywords: Career choice; Idealism; Students; Medical; Surveys
A number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the traditional US curricula. This study builds on prior work testing the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school.
Methods
The original study sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning and end of academic year 2010, on three proxies for idealism. The current study extends that work by administering the same survey items to the same student cohorts at the end of their third and fourth years (MS3 and MS4), respectively. Survey topics included questions on: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions. Linear regression was then used to test the effect of the six cohort/time-points on each composite variable, controlling for demographic characteristics.
Results
Idealism in medicine decreased (β = -.113, p < .001) while emphasis on employment and job security increased (β = .146, p < .001) as motivators of pursuing a career in medicine at each medical school stage and time period. Students were more likely to be motivated by student debt over interest in content in specialty choice (β = .077, p = .004) across medical school stages. Negative attitudes towards primary care were most sensitive to MS group and time effects. Both negative/antagonistic views (β = .142, p < .001) and negative/sympathetic views (β = .091, p < .001) of primary care increased over each stage.
Conclusions
Our results provide further evidence that declines in medical student idealism may occur as early as the second year of medical education. Additionally, as students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.
Keywords: Career choice; Idealism; Students; Medical; Surveys
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A multi-year conference grant (R13) supported an annual pre-meeting that served as a forum for psychiatry residency training directors to learn about and develop educational programs in their residencies in the area of scholarly activity.... more
A multi-year conference grant (R13) supported an annual pre-meeting that served as a forum for psychiatry residency training directors to learn about and develop educational programs in their residencies in the area of scholarly activity. The authors sought to measure the success of these programs through both a between-pre-meeting online survey and a hardcopy evaluation form collected at the close of each annual pre-meeting. All data collection methods were careful to preserve the anonymity of respondents. Reaction to the conference was overwhelmingly positive, with the majority of participants finding the instruction highly useful and beneficial, as well as having great confidence in their retention of the material and ability to integrate it into their own curricula. Attendees at the annual pre-meeting series dedicated to evidence-based medicine and research literacy techniques received well-regarded and highly useful knowledge, training, and educational tools. Incorporation of this knowledge and material into their curricula will likely have a lasting positive impact on their residents and home institutions.
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A variety of population-level tobacco control measures (TCMs) exist, such as excise taxation, smoking restrictions, cessation program funding, counter-advertising, and restrictions on tobacco marketing. Several factors may contribute to... more
A variety of population-level tobacco control measures (TCMs) exist, such as excise taxation, smoking restrictions, cessation program funding, counter-advertising, and restrictions on tobacco marketing. Several factors may contribute to often-suboptimal levels of implementation of TCMs at the state level. To use the American Lung Association (ALA) grading framework to assess impacts of TCMs and to explore relationships between environmental factors and level of implementation of TCMs as rated by the ALA. Secondary data analysis of publicly available data, using linear regression to examine relative effects of state TCMs on adult smoking rates and the extent to which environmental factors influence the strength of each TCM in states. The 50 US states, excluding territories, districts, and possessions. Cigarette excise taxes, state-level tobacco control expenditures relative to Center for Disease Control and Prevention recommendations, smoking restrictions, and support for smoking cessation by state Medicaid programs. Adult smoking rate in each state for 2010; strength of TCMs as measured by the ALA. The ALA smokefree score (β = -.045, P = .005) and tax rate per pack (β = -1.205, P = .019) were significant negative predictors of state adult smoking rates in 2010. Percentage of seats in lower houses of state legislatures held by Republicans was significant in predicting tax per pack (β = -.032, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and ALA smokefree score was negatively influenced by tobacco revenue as a percentage of state gross product (β = -15.663, P = .039), although this effect was not significant in the presence of covariates. State funding both for TCMs and for cessation coverage was also negatively influenced by tobacco-related economic factors. Consistent with previous literature, taxation and smoking restrictions have the most immediate statewide impacts on smoking rate. Probusiness/antitax politics and tobacco manufacturing affect level of implementation of these and other effective TCMs.
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The regional study by Baumgardner and colleagues converges with existing literature to clearly show that the distribution of ADHD diagnosis falls along socioeconomic lines, according to the relative wealth of neighborhoods. This adds... more
The regional study by Baumgardner and colleagues converges with existing literature to clearly show that the distribution of ADHD diagnosis falls along socioeconomic lines, according to the relative wealth of neighborhoods. This adds additional evidence that trends in the diagnosis and treatment for ADHD in children move in the exact opposite direction from those who are at highest risk for meeting criteria, for experiencing impairment, for and downstream socioeconomic sequelae. Contributing factors, such as marginal diagnoses (such as when parent and teacher symptom reports diverge), inadequate insurance coverage, limited time, and lack of familiarity and comfort with diagnostic and prescribing guidelines, may leave the door open to misdiagnosis and treatment. In some cases, this may take the form of over-diagnosis and over-treatment, in the form of false-positive diagnoses with ADHD, and treatments for it, or may alternatively take the form of false-negative diagnoses. If the social and epidemiological data are any indication, it is furthermore likely that such false-positive or false-negative outcomes may break along socioeconomic lines. Increased use of formal screening tools, increased curricular time for mental health in primary care residencies, support for physicians in the field in the form of referral options and remote consultation and support, may all serve to improve quality of care for individual patients, and may also serve to regularize treatment across socioeconomic and sociodemographic lines, hence reducing disparities. Further research is needed to study the root causes and dynamics that create such disparities, but the steps outlined above may help in the near term.
Research Interests: Psychology, Primary Health Care, Adolescent, Humans, Child, and 16 moreWisconsin, Female, Male, Differential Diagnosis, Social Environment, Risk factors, Ethnic Groups, Clinical Sciences, Sex Factors, Age Factors, Urban Population, Risk Factors, Cross Sectional Studies, Socioeconomic Factors, Child preschool, and Attention deficit disorder with hyperactivity
Research Interests: Genomics, Schizophrenia, Family, Transcription Regulation, Gene expression, and 17 moreMolecular Psychiatry, Portugal, Biological Sciences, Molecular, Humans, Haplotypes, Female, Male, Pedigree, Risk factors, Meta Analysis, Genetic linkage analysis, Single Nucleotide Polymorphism, Linkage Disequilibrium, European Continental Ancestry Group, Risk Factors, and Reference Values
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Reports of an increase in the incidence and severity of methicillin-resistant Staphylococcus aureus (MRSA) infections provoked widespread media attention in October 2007. This study attempted to determine whether this widespread media... more
Reports of an increase in the incidence and severity of methicillin-resistant Staphylococcus aureus (MRSA) infections provoked widespread media attention in October 2007. This study attempted to determine whether this widespread media attention led to changes in physician practices related to skin infections. Data collection via LexisNexis, Central New York (CNY) microbiologic laboratory records, publicly available data on Internet search activity, and a survey of CNY healthcare providers allowed for examination of concurrent trends in media attention, public information-seeking behavior, and physician response. During the period of October 15-29, 2007, a roughly 10-fold increase in the number of newspaper and television news broadcasts mentioning &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;MRSA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;staph&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; coincided with a six-to eightfold increase in Internet search activity for the terms &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;MRSA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;staph&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and a 79 percent increase in provider-reported patient concern with MRSA. In addition, providers reported more frequent orders for cultures and prescription of antibiotics since then. Practices serving urban or low socioeconomic status patients tended to see less MRSA-related concern and activity, indicating a potential disparity in penetration of MRSA information into different populations. Increased media coverage of MRSA coincided with increased public information-seeking behavior. Self-reported survey data demonstrate that this period was associated with a change in healthcare provider practice, and a concomitant twofold increase in the number of outpatient skin and soft tissue cultures reinforces this link. However, increased public attention appears not to have penetrated urban, less-affluent areas, raising questions about how quickly healthcare information penetrates different patient populations.
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Research Interests: Mental Health, Primary Health Care, Health insurance, Health Services Research, Adolescent, and 17 moreRace, Humans, Child, United States, Female, Male, Young Adult, Infant, Newborn Infant, Adult, Public health systems and services research, Clinical Competence, Binary Logistic Regression, Internet, Insurance Coverage, Child preschool, and Attention deficit disorder with hyperactivity
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The diagnosis of attention-deficit hyperactivity disorder is a subject of controversy, for a host of reasons. This paper seeks to explore the manner in which children's interests may be subsumed to those of parents, teachers, and society... more
The diagnosis of attention-deficit hyperactivity disorder is a subject of controversy, for a host of reasons. This paper seeks to explore the manner in which children's interests may be subsumed to those of parents, teachers, and society as a whole in the course of diagnosis, treatment, and labeling, utilizing a framework for children's citizenship proposed by Elizabeth Cohen. Additionally, the paper explores aspects of discipline associated with the diagnosis, as well as distributional pathologies resulting from the application of the diagnosis in potentially biased ways.
Research Interests: Philosophy, Applied Ethics, Public Opinion, Political Theory, Attention-Deficit/Hyperactivity Disorder, and 13 moreMental Health, Philosophy of Medicine, Child Welfare, Child Behavior, Humans, Child, United States, Stereotyping, Social Environment, Parents, School health services, Parent‐child Relations, and Attention deficit disorder with hyperactivity
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Research Interests: Genetics, Genomics, Schizophrenia, Bipolar Disorder, Functional Genomics, and 16 moreHumans, Haplotypes, Female, Male, Siblings, American, Clinical Sciences, Middle Aged, Family Health, Adult, Analysis of Variance, Reproducibility of Results, Genetic variation, Gene Expression Analysis, Neurosciences, and Gene expression profiling
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In January 1954, US tobacco manufacturers jointly sponsored an advocacy advertisement entitled &quot;A Frank Statement to Cigarette Smokers&quot; which appeared in 448 newspapers in 258 cities reaching an estimated 43 245 000... more
In January 1954, US tobacco manufacturers jointly sponsored an advocacy advertisement entitled &quot;A Frank Statement to Cigarette Smokers&quot; which appeared in 448 newspapers in 258 cities reaching an estimated 43 245 000 Americans. The advertisement questioned research findings implicating smoking as a cause of cancer, promised consumers that their cigarettes were safe, and pledged to support impartial research to investigate allegations that smoking was harmful to human health. To examine (1) the extent to which cigarette companies fulfilled the promises made to consumers in the 1954 &quot;Frank Statement&quot;, and (2) the effect of these promises on consumer knowledge, beliefs, and smoking practices. This study reviews statements made since 1954 by the tobacco companies individually and collectively through the Tobacco Institute and Tobacco Industry Research Committee/Council for Tobacco Research on the subject of smoking as a cause disease, and the industry&#39;s pledge to support and disclose the results of impartial research on smoking and health. Many of the industry documents evaluated in this study were obtained from a collection consisting of 116 documents entitled the &quot;Statement of Defendants&#39; Misrepresentations&quot; prepared by attorneys representing the state of Connecticut in the Medicaid litigation against the tobacco industry in 1998. In addition, we searched for corroborating material from tobacco industry documents collected from the tobacco industry&#39;s document websites. In order to contrast industry statements on smoking and health with what smokers&#39; actually believed about smoking we reviewed reports of public polling data on smokers&#39; knowledge and beliefs about smoking and disease gathered from tobacco industry sources and from surveys conducted by public health researchers. Analysis of public statements issued by the tobacco industry sources over the past five decades shows that the companies maintained the stance that smoking had not been proven to be injurious to health through 1999. The public statements of the tobacco industry are in sharp contrast to the private views expressed by many of their own scientists. The tobacco documents reveal that many scientists within the tobacco industry acknowledged as early as the 1950s that cigarette smoking was unsafe. The sincerity of the industry&#39;s promise to support research to find out if smoking was harmful to health and to disclose information about the health effects of smoking can also be questioned based upon the industry&#39;s own documents which reveal: (1) scepticism about the scientific value of the smoking and health research program established by the industry; and (2) evidence that research findings implicating smoking as a health problem were often not published or disclosed outside the industry. Industry documents also show that the companies knew that their own customers were misinformed about smoking and health issues. It is clear that the cigarette companies failed to fulfill the promises made to consumers in the 1954 &quot;Frank Statement&quot; advertisement. The failure of cigarette manufacturers to honour these promises has resulted in a public that even today remains misinformed about the health risks of smoking.