Application of interpersonal psychotherapy for late-life depression in China: A case report

ObjectivesInterpersonal psychotherapy (IPT) is an effective treatment for late-life depression, but little is known about its acceptability and efficacy in Chinese patients. This case report describes the use of IPT in a depressed elderly Chinese man.MethodsThe patient was a 79-year-old widower who lives alone in a large city in China. This was his first contact with a mental health specialist. His wife died one ago, and his only child lives in the United States with her husband and children. Due to the COVID-19 pandemic, his daughter could not visit him, and his usual social interactions decreased, leaving him feeling isolated, lonely, and depressed. He was diagnosed with a major depressive episode and initially prescribed venlafaxine. However, he failed to show an adequate response to medication and the side effects were intolerable. He was switched to a low dose of Duloxetine (60 mg) combined with IPT.ResultsThe patient’s baseline score on the 17-item Hamilton depression rating scale (HAM-D) was 29, suggesting severe levels of depression. He received 12 sessions of IPT. Role transition was the focus of therapy. Although the patient expressed discomfort in therapy, he developed a good rapport with the therapist and was compliant with treatment. Clinical recovery was achieved at the end of acute IPT treatment (HAM-D score = 1).ConclusionResponse to IPT was excellent in this elderly patient, but several points should be noted. First, mental health-related stigma in China can affect treatment engagement. Second, older Chinese are reluctant to speak openly about their personal experiences and feelings. Hence, repeated emphasis on the principles of confidentiality in psychotherapy and forming a strong therapeutic alliance are important. Third, the “empty-nest” household is an emergent phenomenon in China. Helping elderly Chinese navigate changes in traditional Chinese living arrangements and negotiate filial piety with offspring who have moved away are important issues to address in therapy

A pilot feasibility study of a peer-led mindfulness program for medical students

Background: Mindfulness meditation has gained momentum in medical circles for bolstering wellbeing and other facets of professionalism. This study evaluated the feasibility and benefits of a peer-led mindfulness meditation program (MMP) on medical student wellness and professionalism.Method: Pre-clerkship students were recruited and randomized to the 8-week MMP or wait-list. Feasibility outcomes included ease of recruitment, program attendance and homework compliance. Other outcomes included self-reported psychological distress, empathy, self-compassion, mindfulness, altruism and program satisfaction.Results: The MMP decreased levels of stress and enhanced mindfulness, self-compassion and altruism from baseline to post-study. Changes were not significant for the wait-list condition. Although satisfaction with the MMP was high compliance was suboptimal.Conclusions: A peer-led MMP is feasible and may be a promising approach to enhance medical student wellbeing. Further research is needed to explore strategies to improve program compliance in this student population

Mindfulness in medical education: Students’ perceptions and four recommendations for implementation of a mindfulness intervention

Background: Faculties of Medicine around the globe have implemented mindfulness-based curricula to deal with medical student’s burnout, anxiety and depression. The purpose of this qualitative study is to assess students’ perception of a mandatory mindfulness intervention and their recommendations for further curricula development and implementation.Methods:  Third-year medical students participated in a mandatory three-hour mindfulness workshop embedded in their family medicine academic week. Eleven students consented to two interviews which explored their perceptions of mindfulness and the workshop in relation to their personal and professional wellbeing as well as their views for the implementation of a longitudinal mindfulness curriculum.Results:  Student and institutional benefits and barriers relating to the curriculum were identified.  Student’s benefits included positive changes in stress, self-awareness and personally   that also translated into self-reported better patient care. Students reported lack of time, forgetting to practice and lack of knowledge about mindfulness as barriers. Institutional pride for their support of student wellness and an overfilled curriculum, were the major institutional benefits and barriers respectively, to the expansion of this curriculum. Among developing an implementing a longitudinal mindfulness curriculum, we found four key features to consider: Firstly to engage the stakeholders; secondly, to incorporate the mindfulness intervention into the curriculum with both a mandatory and elective component; thirdly, to emphasize the clinical implications of the mindfulness intervention and fourthly, to have protected time for wellness interventions.Conclusions: Introducing mindfulness into the undergraduate medical school curriculum through this workshop resulted in perceived personal, institutional and professional benefits. For faculties of medicine that want to implement a mindfulness intervention, we found four key components for implementing a mindfulness intervention in their institutions. Further research is needed to better quantify the benefits and to identify ways to manage barriers at both individual and institutional levels.

Une étude pilote d’un programme cursus longitudinal de méditation pleine conscience durant le doctorat en médecine

Background: To support student well-being, a mindfulness curriculum in undergraduate medical education was launched at our university in 2014. We describe the program and report 3-year results. Methods: Medical students responded to online questionnaires on mindfulness (Freiburg Mindfulness Inventory), empathy (Jefferson Scale of Physician Empathy), resilience (Connor-Davidson Resilience Scale) and perceived stress (Perceived Stress Scale) and were surveyed for demographics, home practice, and subjective experience at curriculum launch and yearly for 3 years. Results: In respondents, high stress (19.2 (SD=6)) and low resilience (71.2 (SD=12.5)) scores were seen throughout training. Scores for mindfulness correlated positively with those for empathy (r=.217 p<0.01) and resilience (r=.539, p<0.01), and negatively with stress scores (r=-.380, p<0.01). While overall scale scores did not statistically change after curriculum implementation, statistically significant increases were seen in mindfulness (12%, p=0.008), empathy (5%, p=0.045), and resilience scores (12%, p=0.002) with a trend toward lower stress scores (8%, p=0.080) in respondents who felt they applied the curriculum principles. Two hours of reported home practice per week was associated with statistically significant changes (14% increased mindfulness scores p<0.001; 6% increased empathy scores p<0.001, 10% increased resilience scores p=0.003; 11% decreased stress scores p= 0.008). Despite positive program evaluations for both mandatory and elective sessions, student attendance at elective sessions was low. Conclusion: A mindfulness curriculum integrated into formal undergraduate medical education is feasible. Benefits may be confined to those students who apply curriculum principles and practice regularly. Further study is needed.Contexte : Pour soutenir le bien-être des étudiants, un cursus de méditation pleine conscience dans le cadre du programme de doctorat en médecine a été lancé à notre université en 2014. Nous décrivons le programme et communiquons les résultats après trois ans. Méthodes :  Des étudiants en médecine ont répondu à des questionnaires en ligne sur la pleine conscience (inventaire de pleine conscience de Freiburg), l’empathie (Échelle de Jefferson sur l’empathie du médecin), la résilience (échelle de résilience de Connor-Davidson) et le stress perçu (échelle du stress perçu) et ont été interrogés pour les caractéristiques démographiques, la pratique de la méditation pleine conscience à domicile et l’expérience subjective au moment du lancement du cursus et, ensuite, annuellement pendant trois ans. Résultats : Chez les répondants, un degré de stress élevé (19,2 (ET = 6)) et une faible résilience (71,2 (ET = 12,5)) ont été observés tout au long de la formation. Il y avait une corrélation positive entre les la pleine conscience et l’empathie (r = 0,17, p < 0,01) et de la résilience (r = 0,539, p < 0,01), et négative avec le stress (r = -0,380, p < 0,01). Alors que les résultats globaux ne changent pas statistiquement après la mise en œuvre du cursus, des augmentations statistiquement significatives ont été observées pour la pleine conscience (12 %, p = 0,008), l’empathie (5 %, p = 0,045) et la résilience (12 %, p = 0,002) avec une tendance vers des résultats inférieurs pour le stress (8 %, p = 0,080) chez les répondants qui estimaient avoir appliqué les principes du programme. On retrouvait des changements significatifs chez les répondants qui rapportaient avoir pratiqué deux heures par semaine à domicile (résultats accrus de 14 % pour la pleine conscience (p < 0,001), de 6 % pour l’empathie (p < 0,001) et de 10 % pour la résilience (p = 0,003), et réduits de 11 % pour le stress (p = 0,008)). Malgré des évaluations de programme positives pour les sessions obligatoires et optionnelles, l’assiduité des étudiants aux sessions optionnelles était faible. Conclusion : Un cursus de méditation pleine conscience intégré dans des études formelles de doctorat en médecine est faisable. Les avantages peuvent être confinés aux étudiants qui appliquent les principes du programme et qui le pratiquent sur une base régulière. D’autres études sont requises

Feasibility and effectiveness of an online mindfulness meditation program for medical students

Background: The need to incorporate tools to promote medical student wellness in medical education is underscored by the concerning rates of psychological distress among them. The objective of this prospective cohort study was to obtain preliminary data on the feasibility and effectiveness of an online mindfulness intervention for medical student wellness.Methods: A convenience sample of 52 medical students consented to participate in this study. Feasibility was assessed by ease of recruitment, number of modules completed, satisfaction with the program, and adherence to a regular meditation practice. Participants completed the Maslach Burnout Inventory, the Jefferson Scale of Empathy-medical student version, the Five Face of Mindfulness Questionnaire-short form, and the Self Compassion Scale-short form pre and post intervention.Results: The convenience sample was recruited within a two-month period. Forty-five participants completed at least one of seven modules. Descriptive statistics (mean±standard deviation) revealed that the mean number of modules completed was 4.85±2.7. Mean satisfaction with the modules was 7.07±1.1 out of 10. Adherence to a regular formal meditation practice was poor; the average amount of formal meditation practice per module was 34.14±27.44 minutes. Self-compassion and the “observe and describe” facets of mindfulness practice significantly statistically increased from baseline, but no such change was observed for levels of burnout and empathy.Conclusion: The present study indicates that an online mindfulness meditation program may be of interest to medical students. The results did not provide any evidence that the program was effective but we believe further research and development is warranted

Actin-interacting and flagellar proteins in Leishmania spp.: Bioinformatics predictions to functional assignments in phagosome formation

Several motile processes are responsible for the movement of proteins into and within the flagellar membrane, but little is known about the process by which specific proteins (either actin-associated or not) are targeted to protozoan flagellar membranes. Actin is a major cytoskeleton protein, while polymerization and depolymerization of parasite actin and actin-interacting proteins (AIPs) during both processes of motility and host cell entry might be key events for successful infection. For a better understanding the eukaryotic flagellar dynamics, we have surveyed genomes, transcriptomes and proteomes of pathogenic Leishmania spp. to identify pertinent genes/proteins and to build in silico models to properly address their putative roles in trypanosomatid virulence. In a search for AIPs involved in flagellar activities, we applied computational biology and proteomic tools to infer from the biological meaning of coronins and Arp2/3, two important elements in phagosome formation after parasite phagocytosis by macrophages. Results presented here provide the first report of Leishmania coronin and Arp2/3 as flagellar proteins that also might be involved in phagosome formation through actin polymerization within the flagellar environment. This is an issue worthy of further in vitro examination that remains now as a direct, positive bioinformatics-derived inference to be presented

Knowing When Not to Use the Internet: Shyness and Adolescents’ On-Line and Off-Line Interactions with Friends

The goal of the study was to explore the content of on-line and off-line peer interactions among shy and non-shy adolescents. Participants were 148 ten-to-eighteen year old adolescents in Rome, Italy (n = 98) and Ottawa, Canada (n = 50). Participants completed self reports of shyness and loneliness and web logs of their interactions with friends both in person and on-line. Among the results, there was little general difference in the general content and emotion expressed during the two modalities of interaction with friends, both of which were used in a wide variety of ways. Importantly, shy participants used the on-line modality more extensively than their non-shy counterparts to express negative emotions and to convey content regarding negative exchanges with peers. Such use of electronic communication may be an important contributor to their loneliness