Sutter Medical Center

With more women entering the medical workforce, caregiving challenges and family-work conflicts are of growing importance to today's neurologists. The aim of this study was to assess the impact of caregiver (CG) status on academic achievements in neurology, analyze the division of labor and time devoted to domestic responsibilities, and measure family-work conflict in US academic neurology faculty. A total of 19 US neurology departments completed a survey on baseline demographics, academic achievements, CG status, division of domestic time and labor, and responses on a FWC scale. Variables were assessed using independent samples t tests (or Mann-Whitney U for non-normally distributed data) and X2 analyses as appropriate, with CGs vs noncaregivers (N-CGs) serving as the independent groups. Women were twice as likely as men to categorize themselves as caregivers (p = 0.005). There were no significant differences in academic achievements between the CG and N-CG groups. However, CG men had a statistically significantly higher number of leadership positions (p = 0.022), number of publications as first or last author (p = 0.020), and number of awards (p = 0.004) when compared with CG women. The percentage of CG women faculty who reported spending more than 22 hours per week on child care was significantly higher than that of CG men (p = 0.003). Caregiver women also reported doing more work at home; taking care of children when they are sick; taking days off work when children are sick; handling more chores related to child care (e.g., managing activities/schedules); and doing laundry, cooking, and cleaning related to child care. Finally, the CG group experienced a higher level of FWC, as evidenced by responses on the FWC scale (p < 0.001). This finding was same for CG women compared with CG men (p = 0.034). Although the caregiving burden did not directly affect academic productivity, it significantly increased FWC in US academic neurology faculty surveyed. Female CG faculty disproportionately shouldered domestic and household responsibilities. Beyond recognizing CG challenges, advocating for a change in paradigm and providing solutions to these pervasive issues could be instrumental in preventing further attrition of professionals from our field, particularly women with caregiving roles.

Treatment options for children and adolescents with type 2 diabetes mellitus (T2DM) are limited. Canagliflozin is a sodium-glucose cotransporter-2 inhibitor approved for the treatment of T2DM in adults. To assess the safety and efficacy of canagliflozin in children and adolescents with T2DM. Phase 3, randomized, double-blind, placebo-controlled, parallel-group study. (ClinicalTrials.gov: NCT03170518; EudraCT: 2016-005223-88). Multicenter (104 sites in 10 countries). Children and adolescents aged 10 years or older with T2DM (hemoglobin A1c [HbA1c] ≥6.5% to ≤11%). Participants were randomly assigned to canagliflozin (100 mg) or placebo once daily. Participants with week 12 readings of 7% or higher for HbA1c and at least 60 mL/min/1.73 m2 for estimated glomerular filtration rate were randomly assigned again at week 13 to either keep receiving 100 mg of canagliflozin (or placebo) or have their dose uptitrated to 300 mg (or placebo). The treatment period was 52 weeks. Change in HbA1c from baseline to week 26 (primary efficacy end point), secondary efficacy end points, and safety. A total of 171 participants were randomly assigned to canagliflozin (n = 84) or placebo (n = 87). At week 26, HbA1c reduction from baseline was significantly greater with canagliflozin than placebo (difference in least-squares means, -0.76% [95% CI, -1.25% to -0.27%]; P = 0.002). The proportion of participants who achieved HbA1c levels below 6.5% was significantly greater with canagliflozin than placebo (36.3% vs. 14.0%; difference, 22.3 percentage points [CI, 10.5 to 34.1 percentage points]). Treatment-emergent adverse events (AEs) occurred in 77.4% and 74.7% and serious treatment-emergent AEs in 9.5% and 5.7% of participants who received canagliflozin and placebo, respectively. Common AEs seen with canagliflozin were similar to those in the adult population. Hypoglycemia occurred in 11.9% and 10.3% of participants receiving canagliflozin and placebo, respectively. Study duration and relatively small sample size. In children and adolescents with T2DM, canagliflozin provided a clinically meaningful reduction in HbA1c, with a safety profile similar to that seen in adults. Johnson & Johnson.

The objective of this study was to examine the effect of administration of outpatient misoprostol on delivery outcomes and length of inductions. The electronic medical record was used to document deliveries in which women received outpatient misoprostol before a formal inpatient induction or received misoprostol only as an inpatient. Unadjusted and adjusted statistical analyses were used to compare Bishop Scores, induction time (admission to delivery), length of stay, birth weight, gestational age, cesarean section rate, complications, and cancellation of induction due to labor between the two cohorts. Of the 5885 women with live deliveries, 296 were given outpatient misoprostol (25 μg orally), and 5589 were given misoprostol only as an inpatient. There were no differences in induction time or length of stay between the two groups. Birth weight and gestational age were higher in the outpatient misoprostol group, and this difference was sustained after adjusting for confounding variables. Outpatient misoprostol was associated with increased adjusted odds of canceling an induction due to labor (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.26-4.83). There was no difference in the incidence of cesarean section (OR 1.16; 95% CI 0.81-1.66). The use of outpatient misoprostol is a safe and viable option for women requiring induction of labor and may be a useful adjunct for an busy unit.