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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.

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]

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 [...]

Background Like left ventricular hypertrophy (LVH), abnormal left ventricular (LV) geometry increases cardiovascular risk, but little data utilizing age and sex-specific norms are currently available on LV geometry in hypertensive children. Methods This was a cross-sectional study of 141 hypertensive children aimed at determining the prevalence of LVH and abnormal LV geometry in the patient population and whether clinical characteristics associated with these findings differ by race. LVH was defined as an LV mass index of ≥ 95th percentile or cardiologist diagnosis. Abnormal geometry was defined as the presence of LVH or a relative wall thickness of >0.41. Results The prevalence of LVH was 35 % overall. According to race, LVH prevalence was 49 % among African-Americans (AA) versus 30 % among non-AA (p Keywords Hypertension * Obesity * Heart * Hypertrophy * Left Ventricular * Ventricular Remodeling * Ethnology, Introduction Racial differences among adults with hypertension have been well described. Compared to white patients, African-American (AA) patients are not only at increased risk for hypertension [1-3], but they also [...]

Background Hypertension affects up to 5% of all children, but little is known about the role of medication adherence on blood pressure (BP) control. In this study we examined the association between adolescents' antihypertensive medication adherence and BP control, investigating for racial disparities. Methods A total of 21 adolescents with essential hypertension [mean age 14.7 [+ or -] 2.0 years, 57% male, 52% African American] were recruited from a pediatric nephrology clinic. Objective medication adherence measures were obtained with Medication Event Monitoring System (MEMS) caps and pharmacy refill records to determine medication possession ratios (MPRs). Results The African Americans adolescents had lower medication adherence than non-African Americans adolescents based on the MPR over the past 12 months (mean 0.54 [+ or -] 0.21 vs. 0.85 [+ or -] 0.16, respectively; p Conclusions Antihypertensive medication adherence measured by pharmacy refills was associated with BP control. AAs were more likely to have lower medication adherence. Targeting medication adherence through the use of electronic medical records may be a potential mechanism to reduce health disparities. Keywords Medication * Adherence * Disparities * Hypertension * Adolescents, Introduction The prevalence of hypertension in children and adolescents is increasing [1,2]. Recent estimates show that hypertension affects approximately 3.2-4.5% of all children [3,4]. Hypertension in children and adolescents is [...]

Abstract The Centers for Medicare & Medicaid Services' (CMS) end-stage renal disease (ESRD) Clinical Performance Measures (CPM) Project has collected data on all adolescent hemodialysis patients since 2000. Thus, by [...]

Objective. We examined whether height less than the 1% for age (z score Design. National cohort study of children initiating dialysis, followed for a minimum of 1 month to a maximum of 8 years. Setting. Voluntary consortium of pediatric nephrology centers across the United States and Canada in the North American Pediatric Renal Transplant Cooperative Study. Patients. Two thousand three hundred six patients [less than or equal to] 21 years old initiated on dialysis between 1992 and 2000. Outcome Measures. School attendance, transplant wait listing, hospitalization rates, and survival. Results. Although there were no differences in transplant wait listings, school-aged children with short stature were less likely to be attending school full-time than were their counterparts with more normal height, even if medically capable. Short-stature patients have significantly more hospital days per month of dialysis follow-up than those patients with better growth (mean: 1.92 vs 1.58; median: 0.73 vs 0.44 hospital days per month of follow-up). Cox proportional hazards regression analyses show that children with height Conclusions. Poor growth during chronic renal insufficiency leading to short stature at dialysis initiation is a marker for a more complicated clinical course for children with kidney failure. Aggressive nutritional support and early referral to a nephrologist to optimize growth may improve long-term outcomes for children with chronic kidney disease. Pediatrics 2002;109:909-913; growth, kidney disease, morbidity., Growth failure is a significant problem for children with chronic kidney disease. Reports from the US Renal Data System (1) and the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) [...]