Reducing the Stigma of Mental Illness Among Medical Students

Abstract: The American Osteopathic Association House of Delegates Resolution 205 recommends “increased awareness of depression amongst U.S. Medical students” due to the increasing body of research describing the rise of depression, burn-out and suicide ideation among medical students. There is consequently a need to understand mental health issues as a component of professional development. Hypothesis: A student-led symposium addressing mental and emotional health topics relevant to medical students would reduce the stigma associated with mental illness. Materials and Methods: A 2-hour student-run “Patient Perspective” was held during the second neuroscience block at an osteopathic medical school in the northeastern United States. One week before the program, a student-developed online Wellness Survey measured prevalence of mental illness, common feelings during medical school, coping mechanisms used for stress, and use of mental health resources. Immediately before and after the program, students were asked to report their familiarity with mental illness and their feelings regarding a vignette about a mentally ill woman using “Mental Illness Among Us” pre and post surveys provided by the University of California San Francisco School of Medicine and adapted for the event. During the program, data from the online survey were shared, student organizers discussed emotional wellness and positive coping mechanisms in the context of the profession, and student panelists shared their experiences with mental health issues. A faculty psychiatrist spoke about mental health resources, and attendees received pamphlets listing these resources. The event concluded with student-led breakout sessions at which stress during medical school and strategies for promoting positive coping mechanisms were discussed, followed by the post survey. Results: 113 students completed the pre survey, 89 of whom completed the post survey. For these 89, differences between post and pre responses were universally in the direction of increasing acceptance and decreasing stigma of those with mental illness; all differences were statistically significant. The largest shift regarded students’ reluctance to disclose their own theoretical mental illness to colleagues. Conclusion: Incorporating an emotional health symposium into medical students’ training may increase understanding and acceptance of those who may have mental illness and reduce stigma associated with mental illness.https://digitalcommons.pcom.edu/posters/1002/thumbnail.jp

Reducing the stigma of mental illness among medical students

Background: The American Osteopathic Association House of Delegates Resolution 205 recommends “increased awareness of depression amongst U.S. medical students” due to the increasing body of research describing the rise of depression, burn-out and suicide ideation among medical students. There is consequently a need to understand mental health issues as a component of professional development. Hypothesis: A student-led symposium addressing mental and emotional health topics relevant to medical students will reduce the stigma associated with mental illness. Materials and Methods: A 2-hour student-run “Patient Perspective” session was held during the second year neuroscience block in the PCOM DO program. One week before the program, a student-developed, online Wellness Survey measured prevalence of mental illness, common feelings during medical school, coping mechanisms used for stress, and use of mental health resources. Immediately before and after the program, students were asked to report their familiarity with mental illness and their feelings regarding a vignette about a mentally ill woman. Pre- and post-activity surveys were provided by the University of California San Francisco School of Medicine and adapted for the event. During the program, data from the online survey were shared, student organizers discussed emotional wellness and positive coping mechanisms in the context of the profession, and student panelists shared their experiences with mental health issues. A faculty psychiatrist spoke about mental health resources, and attendees received pamphlets listing these resources. The event concluded with student-led breakout sessions in which stress during medical school and strategies for promoting positive coping mechanisms were discussed, followed by administration of the post-activity survey. Results: 113 students completed the pre-activity survey; 89 completed the post-activity survey. For these 89, differences between responses were universally in the direction of increasing acceptance and decreasing stigma of those with mental illness; all differences were statistically significant. The largest shift regarded students’ reluctance to disclose their own theoretical mental illness to colleagues. Conclusion: Incorporating an emotional health symposium into medical students’ training may increase understanding and acceptance of those who may have mental illness and reduce stigma associated with mental illness

Violent masculinities: Gendered dynamics of policing in Rio de Janeiro

Historically, policing in Rio de Janeiro has been shaped by the equation of racialized violence and masculinity. Attempts to reform the police have paradoxically drawn on forms of male violence that are centered on the rational and professional use of force and on “softer” practices, such as dialogue and collaboration, symbolically coded as feminine. The failure of police reform reflects the cultural salience of understandings of masculinity centered around violence within the police, historical patterns of policing in Rio, and political actors’ strategic cultivation of male violence. Through Rio de Janeiro's failed attempt at police reform, we theorize the relation between racialized state violence, authoritarian political projects, and transgressive forms of male violence, arguing that an important appeal of authoritarianism lies in its promise to carve out a space for performing what we call wild masculinity. [masculinity, race, police, violence, gender, politics, favela, Rio de Janeiro, Brazil]publishedVersio

Proposed BioRepository platform solution for the ALS research community

ALS is a rare disorder whose cause and pathogenesis is largely unknown (1). There is a recognized need to develop biomarkers for ALS to better understand the disease, expedite diagnosis and to facilitate therapy development. Collaboration is essential to obtain a sufficient number of samples to allow statistically meaningful studies. The availability of high quality biological specimens for research purposes requires the development of standardized methods for collection, long-term storage, retrieval and distribution of specimens. The value of biological samples to scientists and clinicians correlates with the completeness and relevance of phenotypical and clinical information associated with the samples (2,3). While developing a secure Web-based system to manage an inventory of multi-site BioRepositories, algorithms were implemented to facilitate ad hoc parametric searches across heterogeneous data sources that contain data from clinical trials and research studies. A flexible schema for a barcode label was introduced to allow association of samples to these data. The ALSBank™ BioRepository platform solution for managing biological samples and associated data is currently deployed by the Northeast ALS Consortium (NEALS). The NEALS Consortium and the Massachusetts General Hospital (MGH) Neurology Clinical Trials Unit (NCTU) support a network of multiple BioBanks, thus allowing researchers to take advantage of a larger specimen collection than they might have at an individual institution. Standard operating procedures are utilized at all collection sites to promote common practices for biological sample integrity, quality control and associated clinical data. Utilizing this platform, we have created one of the largest virtual collections of ALS-related specimens available to investigators studying ALS. © 2011 Informa Healthcare

SOD1 in cerebral spinal fluid as a pharmacodynamic marker for antisense oligonucleotide therapy

Background: Therapies designed to decrease the level of SOD1 are currently in a clinical trial for patients with superoxide dismutase (SOD1)-linked familial amyotrophic lateral sclerosis (ALS). Objective: To determine whether the SOD1 protein in cerebral spinal fluid (CSF) may be a pharmacodynamic marker for antisense oligonucleotide therapy and a disease marker for ALS. Design: Antisense oligonucleotides targeting human SOD1 were administered to rats expressing SOD1G93A. The human SOD1 protein levels were measured in the rats\u27 brain and CSF samples. In human CSF samples, the following proteins were measured: SOD1, tau, phosphorylated tau, VILIP-1, and YKL-40. Participants: Ninety-three participants with ALS, 88 healthy controls, and 89 controls with a neurological disease (55 with dementia of the Alzheimer type, 19 with multiple sclerosis, and 15 with peripheral neuropathy). Results: Antisense oligonucleotide-treated SOD1G93A rats had decreased human SOD1 messenger RNA levels (mean [SD] decrease of 69% [4%]) and decreased protein levels (mean [SD] decrease of 48% [14%]) in the brain. The rats\u27 CSF samples showed a similar decrease in hSOD1 levels (mean [SD] decrease of 42% [14%]). Inhuman CSF samples, the SOD1 levels varied a mean (SD) 7.1% (5.7%) after additional measurements, separated by months, were performed. The CSF SOD1 levels were higher in the participants with ALS (mean [SE] level, 172 [8] ng/mL; P\u3c.05) and the controls with a neurological disease (mean [SE] level, 172 [6] ng/mL; P\u3c.05) than in the healthy controls (mean [SE] level, 134 [4] ng/mL). Elevated CSF SOD1 levels did not correlate with disease characteristics in participants with ALS or controls with dementia of the Alzheimer type, but they did correlate with tau, phosphorylated tau, VILIP-1 and YKL-40 levels in controls with dementia of the Alzheimer type. Conclusions: SOD1 in CSF may be an excellent pharmacodynamic marker for SOD1-lowering therapies because antisense oligonucleotide therapy lowers protein levels in the rat brain and rat CSF samples and because SOD1 levels in CSF samples from humans are stable over time. © 2013 American Medical Association. All rights reserved

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

BACKGROUND: Subarachnoid hemorrhage (SAH) is characterized by the worst headache of life and associated with long-term opioid use. Discrete pain trajectories predict chronic opioid use following other etiologies of acute pain, but it is unknown whether they exist following SAH. If discrete pain trajectories following SAH exist, it is uncertain whether they predict long-term opioid use. We sought to characterize pain trajectories after SAH and determine whether they are associated with persistent opioid use. METHODS: We reviewed pain scores from patients admitted to a single tertiary care center for SAH from November 2015 to September 2019. Group-based trajectory modeling identified discrete pain trajectories during hospitalization. We compared outcomes across trajectory groups using χ and Kruskal-Wallis tests. Multivariable regression determined whether trajectory group membership was an independent predictor of long-term opioid use, defined as continued use at outpatient follow-up. RESULTS: We identified five discrete pain trajectories among 305 patients. Group 1 remained pain free. Group 2 reported low scores with intermittent spikes and slight increase over time. Group 3 noted increasing pain severity through day 7 with mild improvement until day 14. Group 4 experienced maximum pain with steady decrement over time. Group 5 reported moderate pain with subtle improvement. In multivariable analysis, trajectory groups 3 (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.5-8.3) and 5 (OR 8.0; 95% CI 3.1-21.1), history of depression (OR 3.6; 95% CI 1.3-10.0) and racial/ethnic minority (OR 2.3; 95% CI 1.3-4.1) were associated with continued opioid use at follow-up (median 62 days following admission, interquartile range 48-96). CONCLUSIONS: Discrete pain trajectories following SAH exist. Recognition of pain trajectories may help identify those at risk for long-term opioid use

The impact of 68Gallium DOTA PET/CT in managing patients with sporadic and familial pancreatic neuroendocrine tumours

OBJECTIVE: Pancreatic neuroendocrine tumours (panNETs) arise sporadically or as part of a genetic predisposition syndrome. CT/MRI, endoscopic ultrasonography and functional imaging using Octreoscan localise and stage disease. This study aimed to evaluate the complementary role of (68)Gallium ((68)Ga)-DOTA PET/CT in managing patients with panNETs. DESIGN: A retrospective study conducted across three tertiary UK NET referral centres. METHODS: Demographic, clinical, biochemical, cross-sectional and functional imaging data were collected from patients who had undergone a (68)Ga-DOTA PET/CT scan for a suspected panNET. RESULTS: We collected data for 183 patients (97 male): median (SD) age 63 (14.9) years, 89.1 vs. 9.3% (n=163 vs. 17) alive vs. dead (3 data missing), 141 sporadic vs. 42 familial (MEN1, n=36; 85.7%) panNETs. Non-functional vs. functional tumours comprised 73.2 vs. 21.3% (n=134 vs. 39) (10 missing). Histological confirmation was available in 89% of individuals (n=163) but tumour grading (Ki67 classiifcation) was technically possible only in a smaller cohort (n=143): grade 1, 50.3% (n=72); grade 2, 46.2% (n=66) and grade 3, 3.5% (n=5) (40 histopathological classification either not technically feasible or biopsy not perfomed). 60.1% (n=110) were localised, 14.2% (n=26) locally advanced and 23.5% (n=43) metastatic (4 missing). 224 (68)Ga-DOTA PET/CT scans were performed in total for: diagnosis/staging 40% (n=88), post-operative assessment/clinical surveillance 53% (n=117) and consideration of peptide receptor radionuclide therapy (PRRT) 8% (n=17) (2 missing). PET/CT results confirmed other imaging findings (53%), identified new disease sites (28.5%) and excluded suspected disease (5%). Overall, (68)Ga-DOTA PET/CT imaging findings provided additional information in 119 (54%) patients and influenced management in 85 (39%) cases. CONCLUSION: (68)Ga-DOTA PET/CT imaging more accurately stages and guides treatment in patients with sporadic/familial panNETs with newly diagnosed/recurrent disease