Differences in Perceived Stress Scale scores among medical students between key demographic groups

Research statement This study compares perceived stress during undergraduate medical education between four key demographic groups, colloquially known as “non-traditional” students. Background The need for a diversity among medical providers has been established [1,2]. To achieve this, medical schools must seek and train increasingly diverse student bodies. However, research supports the notion that medical school is inherently stressful, that socio-economic-demographic factors influence the experience of stress, and that chronic stress during medical education has detrimental effects on the health and wellbeing of the student, ultimately detracting from academic success and sense of fulfillment in medical training [3,4,5,6,7,8,9]. Design/methods The Perceived Stress Scale (PSS) was administered to all cohorts up to four times: prior to matriculation, after the pre-clinical phase, after clerkship, and upon graduation. Using independent samples t-tests, mean PSS scores were compared among the following demographic groups: Under-Represented in Medicine (URM), Socioeconomic Status (SES), First-Generation medical student (Firstgen), and age 30+ at matriculation (Over30). Results Prior to matriculation and after the pre-clinical phase, the URM, First-gen, and Over 30 groups reported lower stress. The URM, First-gen, and Low SES groups reported higher stress at the end of third-year clerkship rotations. At the end of third-year clerkships, First-gen students had significantly higher PSS scores than their continuing-generation peers (mean 7.69 vs. 6.49, p=0.026). Conclusions and Significance Ongoing efforts to increase physician diversity necessitates diversity among medical students. Utilizing the Perceived Stress Scale (PSS) and demographic data, we have a better understanding of trends in medical student stress and the relationship to social identity. In our study, stress continued to rise after the pre-clinical phase for first-generation students, with mean PSS scores significantly higher at the end of third year compared to their continuing-generation peers. Future studies to identify sources of stress will deepen our understanding of the relationship between stress and sociodemographic factors. This insight may lead to better support for “non-traditional” medical students, and in turn, increased matriculation, graduation, and successful careers in medicine. References 1. Cohen, J. J., Gabriel, B. A., & Terrell, C. (2002). The Case For Diversity In The Health Care Workforce. Health Affairs, 21(5), 90–102. https://doi.org/10.1377/hlthaff.21.5.90 2. Cohen, J. J. & Steinecke, A. (2006). Building a Diverse Physician Workforce. JAMA: the Journal of the American Medical Association, 296(9), 1135–1137. https://doi.org/10.1001/jama.296.9.1135 3. Dyrbye, L. N., West, C. P., Satele, D., Boone, S., Tan, L., Sloan, J., & Shanafelt, T. D. (2014). Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population. Academic Medicine, 89(3), 443–451. https://doi.org/10.1097/ACM.0000000000000134 4. Manzo, G., Piña-Watson, B., & Kim, S. Y. (2022). Minority stress and academic outcomes among ethnic minority college students: Anxiety as a mediating mechanism. Journal of American College Health, ahead-of-print(ahead-of-print), 1–8. https://doi.org/10.1080/07448481.2022.2128683 5. McMichael, Lee IV, A., Fallon, B., Matusko, N., & Sandhu, G. (2022). Racial and socioeconomic inequity in the financial stress of medical school. MedEdPublish, 12, 3–3. https://doi.org/10.12688/mep.17544.2 6. Hill, M. R., Goicochea, S., & Merlo, L. J. (2018). In their own words: stressors facing medical students in the millennial generation. Medical Education Online, 23(1), 1530558–10. https://doi.org/10.1080/10872981.2018.1530558 7. Dyrbye, L. N., Sciolla, A. F., Dekhtyar, M., Rajasekaran, S., Allgood, J. A., Rea, M., Knight, A. P., Haywood, A., Smith, S., & Stephens, M. B. (2019). Medical School Strategies to Address Student Well-Being: A National Survey. Academic Medicine, 94(6), 861–868. https://doi.org/10.1097/ACM.0000000000002611 8. Kligler, Linde, B., & Katz, N. T. (2013). Becoming a doctor: A qualitative evaluation of challenges and opportunities in medical student wellness during the third year. Academic Medicine, 88(4), 535–540. https://doi.org/10.1097/ACM.0b013e3182860e6d 9. Rajapuram, Langness, S., Marshall, M. R., & Sammann, A. (2020). Medical students in distress: The impact of gender, race, debt, and disability. PloS One, 15(12), e0243250. https://doi.org/10.1371/journal.pone.024325

Assessing Acceptability of COVID-19 Vaccine Booster Dose Among Adult Americans: A Cross-Sectional Study

Given the emergence of breakthrough infections, new variants, and concerns of waning immunity from the primary COVID-19 vaccines, booster shots emerged as a viable option to shore-up protection against COVID-19. Following the recent authorization of vaccine boosters among vulnerable Americans, this study aims to assess COVID-19 vaccine booster hesitancy and its associated factors in a nationally representative sample. A web-based 48-item psychometric valid survey was used to measure vaccine literacy, vaccine confidence, trust, and general attitudes towards vaccines. Data were analyzed through Chi-square (with a post hoc contingency table analysis) and independent-sample t-/Welch tests. Among 2138 participants, nearly 62% intended to take booster doses and the remaining were COVID-19 vaccine booster hesitant. The vaccine-booster-hesitant group was more likely to be unvaccinated (62.6% vs. 12.9%) and did not intend to have their children vaccinated (86.1% vs. 27.5%) compared to their non-hesitant counterparts. A significantly higher proportion of booster dose hesitant individuals had very little to no trust in the COVID-19 vaccine information given by public health/government agencies (55% vs. 12%) compared to non-hesitant ones. The mean scores of vaccine confidence index and vaccine literacy were lower among the hesitant group compared to the non-hesitant group. Compared to the non-hesitant group, vaccine hesitant participants were single or never married (41.8% vs. 28.7%), less educated, and living in a southern region of the nation (40.9% vs. 33.3%). These findings underscore the need of developing effective communication strategies emphasizing vaccine science in ways that are accessible to individuals with lower levels of education and vaccine literacy to increase vaccination uptake

Divergent and convergent evolution after a common-source outbreak of hepatitis C virus.

The genomic sequences of viruses that are highly mutable and cause chronic infection tend to diverge over time. We report that these changes represent both immune-driven selection and, in the absence of immune pressure, reversion toward an ancestral consensus. Sequence changes in hepatitis C virus (HCV) structural and nonstructural genes were studied in a cohort of women accidentally infected with HCV in a rare common-source outbreak. We compared sequences present in serum obtained 18–22 yr after infection to sequences present in the shared inoculum and found that HCV evolved along a distinct path in each woman. Amino acid substitutions in known epitopes were directed away from consensus in persons having the HLA allele associated with that epitope (immune selection), and toward consensus in those lacking the allele (reversion). These data suggest that vaccines for genetically diverse viruses may be more effective if they represent consensus sequence, rather than a human isolate

Divergent and convergent evolution after a common-source outbreak of hepatitis C virus

The genomic sequences of viruses that are highly mutable and cause chronic infection tend to diverge over time. We report that these changes represent both immune-driven selection and, in the absence of immune pressure, reversion toward an ancestral consensus. Sequence changes in hepatitis C virus (HCV) structural and nonstructural genes were studied in a cohort of women accidentally infected with HCV in a rare common-source outbreak. We compared sequences present in serum obtained 18–22 yr after infection to sequences present in the shared inoculum and found that HCV evolved along a distinct path in each woman. Amino acid substitutions in known epitopes were directed away from consensus in persons having the HLA allele associated with that epitope (immune selection), and toward consensus in those lacking the allele (reversion). These data suggest that vaccines for genetically diverse viruses may be more effective if they represent consensus sequence, rather than a human isolate

Polygenic Risk Scores for Subtyping of Schizophrenia

Schizophrenia is a complex disorder with many comorbid conditions. In this study, we used polygenic risk scores (PRSs) from schizophrenia and comorbid traits to explore consistent cluster structure in schizophrenia patients. With 10 comorbid traits, we found a stable 4-cluster structure in two datasets (MGS and SSCCS). When the same traits and parameters were applied for the patients in a clinical trial of antipsychotics, the CATIE study, a 5-cluster structure was observed. One of the 4 clusters found in the MGS and SSCCS was further split into two clusters in CATIE, while the other 3 clusters remained unchanged. For the 5 CATIE clusters, we evaluated their association with the changes of clinical symptoms, neurocognitive functions, and laboratory tests between the enrollment baseline and the end of Phase I trial. Class I was found responsive to treatment, with significant reduction for the total, positive, and negative symptoms (p=0.0001, 0.0099, and 0.0028, respectively), and improvement for cognitive functions (VIGILANCE, p=0.0099; PROCESSING SPEED, p=0.0006; WORKING MEMORY, p=0.0023; and REASONING, p=0.0015). Class II had modest reduction of positive symptoms (p=0.0492) and better PROCESSING SPEED (p=0.0071). Class IV had a specific reduction of negative symptoms (p=0.0111) and modest cognitive improvement for all tested domains. Interestingly, Class IV was also associated with decreased lymphocyte counts and increased neutrophil counts, an indication of ongoing inflammation or immune dysfunction. In contrast, Classes III and V showed no symptom reduction but a higher level of phosphorus. Overall, our results suggest that PRSs from schizophrenia and comorbid traits can be utilized to classify patients into subtypes with distinctive clinical features. This genetic susceptibility based subtyping may be useful to facilitate more effective treatment and outcome prediction

Seoul Virus and Hantavirus Disease, Shenyang, People’s Republic of China

This outbreak was caused by the virus circulating in local wild rats through infection of laboratory rats

HCV–HIV Coinfection: Simple Messages from a Complex Disease

The authors discuss our current understanding of the immunopathogenesis of HCV-HIV coinfection

Major decline of hepatitis C virus incidence rate over two decades in a cohort of drug users

Injecting drug users (DU) are at high risk for hepatitis C virus (HCV) and HIV infections. To examine the prevalence and incidence of these infections over a 20-year period (1985–005), the authors evaluated 1276 DU from the Amsterdam Cohort Studies who had been tested prospectively for HIV infection and retrospectively for HCV infection. To compare HCV and HIV incidences, a smooth trend was assumed for both curves over calendar time. Risk factors for HCV seroconversion were determined using Poisson regression. Among ever-injecting DU, the prevalence of HCV antibodies was 84.5% at study entry, and 30.9% were co-infected with HIV. Their yearly HCV incidence dropped from 27.5/100 person years (PY) in the 1980s to 2/100 PY in recent years. In multivariate analyses, ever-injecting DU who currently injected and borrowed needles were at increased risk of HCV seroconversion (incidence rate ratio 29.9, 95% CI 12.6, 70.9) compared to ever-injecting DU who did not currently inject. The risk of HCV seroconversion decreased over calendar time. The HCV incidence in ever-injecting DU was on average 4.4 times the HIV incidence, a pattern seen over the entire study period. The simultaneous decline of both HCV and HIV incidence probably results from reduced risk behavior at the population level

Antibody Vh Repertoire Differences between Resolving and Chronically Evolving Hepatitis C Virus Infections

Despite the production of neutralizing antibodies to hepatitis C virus (HCV), many patients fail to clear the virus and instead develop chronic infection and long-term complications. To understand how HCV infection perturbs the antibody repertoire and to identify molecular features of antibody genes associated with either viral clearance or chronic infection, we sequenced the V(D)J region of naïve and memory B cells of 6 persons who spontaneously resolved an HCV infection (SR), 9 patients with a newly diagnosed chronically evolving infection (CE), and 7 healthy donors. In both naïve and memory B cells, the frequency of use of particular antibody gene subfamilies and segments varied among the three clinical groups, especially between SR and CE. Compared to CE, SR antibody genes used fewer VH, D and JH gene segments in naïve B cells and fewer VH segments in memory B cells. SR and CE groups significantly differed in the frequency of use of 7 gene segments in naïve B cell clones and 3 gene segments in memory clones. The nucleotide mutation rates were similar among groups, but the pattern of replacement and silent mutations in memory B cell clones indicated greater antigen selection in SR than CE. Greater clonal evolution of SR than CE memory B cells was revealed by analysis of phylogenetic trees and CDR3 lengths. Pauciclonality of the peripheral memory B cell population is a distinguishing feature of persons who spontaneously resolved an HCV infection. This finding, previously considered characteristic only of patients with HCV-associated lymphoproliferative disorders, suggests that the B cell clones potentially involved in clearance of the virus may also be those susceptible to abnormal expansion