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Purpose: The number of women in high-level leadership in academic medicine remains disproportionately low. Early career programs may help increase women's representation in leadership. We evaluated the Early Career Women's Leadership Program (ECWLP). We hypothesized that participants would rate themselves as having increased confidence in their leadership potential, improved leadership skills, and greater alignment between their goals for well-being and leading after the program. We also explored the participants' aspirations and confidence around pursuing high-level leadership before and after the program. Methods: We surveyed women physicians and scientists before and after they participated in the 2023 ECWLP, consisting of 11 seminars over six months. We analyzed pre- and post-program data using Wilcoxon signed-rank tests. We analyzed answers to open-ended questions with a content analysis approach. Results: 47/51 (92%) participants responded, and 74% answered pre- and post-program questionnaires. Several metrics increased after the program, including women's confidence in their ability to lead (p< 0.001), negotiate (p< 0.001), articulate their career vision (p< 0.001), reframe obstacles (p< 0.001), challenge their assumptions (p< 0.001), and align their personal and professional values (p= 0.002). Perceptions of conflict between aspiring to lead and having family responsibilities (p= 0.003) and achieving physical well-being (p= 0.002) decreased. Perceived barriers to advancement included not being part of influential networks, a lack of transparency in leadership, and a competitive and individualistic culture. In the qualitative analysis, women described balancing internal factors such as self-doubt with external factors like competing professional demands when considering leadership. Many believed that becoming a leader would be detrimental to their well-being. Beneficial ECWLP components included support for self-reflection, tactical planning to pursue leadership, and creating a safe environment. Conclusion: The ECWLP improved women's confidence and strategic plans to pursue leadership in a way that supported their work-life integration. Early career leadership programs may encourage and prepare women for high-level leadership. [ABSTRACT FROM AUTHOR]

While more women are in leadership positions in academic medicine now than ever before in U.S. history, evidence from recent surveys of women and graduating medical students demonstrates that sexual harassment continues in academic health centers. Academic medicine's ability to change its culture is hampered by victims' fear of reporting episodes of harassment, which is largely due to fear of retaliation. In this Perspective, the authors describe efforts in scientific societies to address the issue of sexual harassment and to begin to establish safe environments at national meetings. The authors contend that each institution must work to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish "locker room" talk that is demeaning to women.

Leadership programs for faculty are proliferating, yet we know little about their impact. In this survey of eight cohorts of a leadership program for medical school women faculty, we report participants' perceptions in three areas: (1) program impact; (2) leadership preparedness; and (3) barriers to leadership advancement. The majority of survey participants indicated that the program influenced their: foundational leadership skills; personal experiences of leadership; and sense of professional community and belonging. Half felt that despite feeling prepared for leadership, they did not have leadership opportunities. Lack of leadership turnover and transparency were ranked highest among barriers to leadership advancement.

The literature on leadership competencies does not include an understanding of how stakeholders perceive competencies for women and under-represented minority faculty members. We surveyed three groups of leaders (N = 113) to determine their perceptions of the importance of 23 leadership competencies. All three groups endorsed the same five competencies for emerging leaders: communication skills, interpersonal relationships, operating/organizational skills, personal flexibility, and planning and problem solving. For women and under-represented minorities, two were identified as being particularly important: conflict management and leadership presence and presentation. These results have important implications for faculty development leadership programs and institutions preparing future generations of leaders.

Background Higher doses of erythropoiesis-stimulating agents (ESA) have been associated with an increased risk of adverse outcomes in adults with chronic kidney disease (CKD) and end-stage kidney disease (ESRD), but to our knowledge no trials have been performed in children. We examined the association between ESA dose and all-cause mortality in a prevalent pediatric dialysis population. Methods Retrospective cohort study utilizing national data on all prevalent dialysis patients aged Results Eight-hundred and twenty-nine children were included in the analysis; 7 % died during follow-up. A higher proportion of patients receiving ESA doses in the highest category (erythropoietin [greater than or equal to] 350 units/kg/week or darbepoetin [greater than or equal to] 1.5 units/kg/week) died (50 % vs 28 %, p=0.002), and also demonstrated a trend toward lower hemoglobin (11.0 vs 11.4 g/dL, p=0.05). In multivariate analysis, patients receiving the highest dose of ESA demonstrated an increased risk of mortality (hazard ratio 3.37;p value Conclusion Higher ESA dose is independently associated with mortality in children on chronic dialysis. Keywords Hemoglobin * Anemia * Death * Epogen * Darbepoetin alfa, Introduction Treatment with recombinant human erythropoietin has transformed the management of anemia related to chronic kidney disease (CKD) in children, and erythropoiesis-stimulating agents (ESA) are now a core component of [...]

Author(s): Laurence Greenbaum [sup.1] , Victoria Norwood [sup.2] , Eileen Brewer [sup.3] , William Smoyer [sup.4] , Marva Moxey-Mims [sup.5] , Joseph Flynn [sup.6] , Barbara Fivush [sup.7] , Patrick [...]

Objective: To investigate longitudinal associations of health beliefs, which included self-efficacy, outcome expectancies, and perceived barriers, and demographic risk factors (i.e., age, gender, race, and family income) with antihypertensive medication adherence in adolescents with chronic kidney disease (CKD) over 24 months.Method: The sample included 114 adolescents (M age = 15.03 years, SD = 2.44) diagnosed with CKD. Adolescents reported their self-efficacy for taking medications, medication outcome expectancies, and barriers to adherence at baseline and 12 and 24 months after baseline. Antihypertensive medication adherence was assessed via electronic monitoring for 2 weeks at baseline and 6, 12, 18, and 24 months after baseline.Results: Adherence increased and then decreased over the 2-year study period (inverted U-shape). Self-efficacy, outcome expectancies, and barriers did not change over time. Older adolescent age, female gender, African American race, <$50,000 annual family income, and public health insurance were associated with lower adherence. However, family income was the primary demographic risk factor that predicted adherence over time (≥$50,000 annual family income was longitudinally associated with higher adherence). Higher self-efficacy and more positive and less negative outcome expectancies across time were also associated with higher antihypertensive medication adherence across time.Conclusions: Clinical interventions should be developed to target medication self-efficacy and outcome expectancies to improve long-term antihypertensive medication adherence in adolescents with CKD. Family income may be considered when conceptualizing contextual factors that likely contribute to adolescents' consistent challenges with medication adherence over time. [ABSTRACT FROM AUTHOR]

The literature on leadership competencies does not include an understanding of how stakeholders perceive competencies for women and under-represented minority faculty members. We surveyed three groups of leaders (N=113) to determine their perceptions of the importance of 23 leadership competencies. All three groups endorsed the same five competencies for emerging leaders: communication skills, interpersonal relationships, operating/organizational skills, personal flexibility, and planning and problem solving. For women and under-represented minorities, two were identified as being particularly important: conflict management and leadership presence and presentation. These results have important implications for faculty development leadership programs and institutions preparing future generations of leaders. [ABSTRACT FROM AUTHOR]

Left ventricular hypertrophy (LVH) is prevalent among hypertensive children; however, blood pressure (BP) does not predict its presence. The authors conducted a 1-year prospective cohort study to examine the hypothesis that obesity-related risk factors are associated with left ventricular mass index (LVMI) in hypertensive children, and the association between adiposity and LVMI is mediated by BP-dependent and -independent pathways. A total of 49 hypertensive children were enrolled: 51% were overweight/obese and 41% had LVH at baseline. Children overweight/obese at baseline and follow-up had a greater LVMI increase than those of healthy weight at each visit: mean change of 6.4 g/m(2.7) vs 0.95 g/m(2.7) . Baseline body mass index z score was independently associated with LVMI change (β=4.08, 1.54-6.61; P=.002). Only pulse pressure and serum aldosterone partially mediated this relationship. Hypertensive youth manifest multiple cardiovascular disease risk factors that worsen over time despite treatment. Of these, adiposity is most associated with LVH and increasing LVMI. [ABSTRACT FROM AUTHOR]