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Okon II, Osama M, Akpan A, Fabrini Paleare LF, Ferreira MY, Shafqat MD, Razouqi Y, James E, Omer M, Ja'afar IK, Chaurasia B, Iqbal M, Balogun S, Maidan A, Hussain Jakhar MO, Precious FK, Gbayisomore TJ, Lucero-Prisno DE. The Evolving Role of Palliative Care in Older People with Glioblastoma. World Neurosurg 2024; 192:140-149. [PMID: 39362596 DOI: 10.1016/j.wneu.2024.09.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/05/2024]
Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in older adults and has a poor prognosis and limited response to treatment. The growing impact of palliative care on older people undergoing neurosurgery is becoming increasingly important. Palliative care aims to improve the quality of life for people and their families by addressing their physical, psychosocial, and spiritual needs. The prevalence of GBM peaks between 65 and 84 years of age, and treatment options may be hindered by chronic multiple conditions in older people. Older people are at risk of receiving suboptimal end-of-life care due to factors such as a focus on curative medicine, acceptance of terminal illness, which may discourage the person, and lack of awareness of palliative care for people with a noncancer diagnosis. People with GBM experience a significant illness burden, including neurological symptoms, mood disturbances, and cognitive impairment. A multidisciplinary approach, including palliative care, is recommended to improve treatment outcomes and quality of life. However, palliative care is often not consistently included in multidisciplinary teams despite the lack of curative treatment options and significant symptom burden. The palliative care needs of people with GBM can be complex, and published evidence in this area is limited. Nonetheless, there are similarities between the needs of people with GBM and those with other, more common cancer diagnoses and nonmalignant chronic neurologic illnesses. The integration of palliative care into the management of older people with GBM during neurosurgery is crucial for addressing their unique needs and improving their quality of life. In this review, we aimed to comprehensively evaluate the impact of palliative care on people with GBM and its importance.
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Affiliation(s)
- Inibehe Ime Okon
- Department of Neurosurgery, Dell Medical School, University of Texas, Austin, Texas, United States.
| | - Mahmoud Osama
- Department of Neurosurgery, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Asangaedem Akpan
- Consultant Geriatrician, Bunbury Regional Hospital, Banbury, Western Australia, Australia
| | | | - Márcio Yuri Ferreira
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| | - Muhammad Danish Shafqat
- Clinical Health Science, Shifa College of Medicine, Islamabad, Islamabad Capital Territory, Pakistan
| | - Youssef Razouqi
- Interdisciplinary Laboratory of Biotechnology and Health, Neurosciences and Cellular Physiology research team, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Emmanuel James
- Department of Medicine and surgery, University of Benin, Edo State, Nigeria
| | - Mohammad Omer
- Department of Surgery, International School of Medicine-International University of Kyrgyzstan, Bishkek, Bishkek City, Kyrgyzstan
| | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Mohammed Iqbal
- Department of Neurosurgery, Dell Medical School, University of Texas, Austin, Texas, United States
| | - Simon Balogun
- Department of Neurosurgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Aiman Maidan
- Department of Neurosurgery, National Center for Neurosurgery, Astana, Kazakhstan
| | | | | | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Office for Research, Innovation and Extension Services, Southern Leyte State University, Sogod, Southern Leyte, Philippines; Center for University Research, University of Makati, Makati City, Philippines
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Ahmed S, Méndez RY, Naveed S, Akhter S, Mushtaque I, Malik MA, Ahmad W, Figueroa RN, Younas A. Assessment of hepatitis-related knowledge, attitudes, and practices on quality of life with the moderating role of internalized stigma among hepatitis B-positive patients in Pakistan. Health Psychol Behav Med 2023; 11:2192782. [PMID: 37008419 PMCID: PMC10064821 DOI: 10.1080/21642850.2023.2192782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Aim This study aimed to assess the Pakistani hepatitis B patients' knowledge, attitudes, and practices towards hepatitis management and the impact of self-management on the quality of life of hepatitis B patients as well as the moderating role of stigmatization. Methods A cross-sectional study design was used, and the data was collected from a total of 432 hepatitis B positive patients through a self-designed questionnaire. The studied subjects consisted of men (n = 205, 47%), women (n = 165, 38%), and transgender (n = 62, 14%). The obtained data were statistically analyzed using SPSS software version 26.0 for Windows. Results The mean age of the study participants was 48. Knowledge has a significant positive relationship with hepatitis self-management and quality of life, whereas knowledge has a negative relationship with stigmatization. Furthermore, multivariate analysis revealed that men were more knowledgeable about the disease than women and transgender people (6.14 ± 2.08 vs. 3.23 ± 1.61 vs. 1.03 ± 0.73, F = 8.2**, p = .000). On the scale of attitude and practice, significant gender differences were found. Women had more experience with hepatitis self-management than men or transgender (4.21 ± 13.0 vs. 2.17 ± 6.02 vs. 0.37 ± 0.31, F = 6.21**, p = .000). The regression analysis showed that self-management has a positive association with quality of life (B = 0.36, p = .001). The moderation analysis revealed that stigmatization negatively moderates the relationship between self-management and quality of life (B = -0.53, p = .001). Conclusion Generally, patients had good knowledge about the disease and its self-management. However, a societal and community-level awareness campaign should be organized on the quality of life and stigmatization of people with chronic illness regarding their human rights, dignity, and physical, mental, and social well-being.
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Khairallah GM, Makarem NN, Rahme DV, El Jaouni MA, Brome D. The effect of workplace bullying on fatigue in school teachers: the moderating roles of gender and spirituality. Libyan J Med 2023; 18:2266239. [PMID: 37851853 PMCID: PMC10586066 DOI: 10.1080/19932820.2023.2266239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
Workplace bullying is quite prevalent and has been linked to many health complaints. The relationship between workplace bullying and fatigue was documented in previous studies. However, knowledge on how this relationship develops with the interplaying factors of spirituality and gender was not investigated before especially among schoolteachers. The aim of this study is to explore the relationship between workplace bullying and fatigue as moderated by spirituality and gender among schoolteachers in Lebanon. This is a cross-sectional study, where 215 schoolteachers aged 18 till 64 and employed for a minimum of 6 months were recruited through systematic sampling. Six private and six public schools in Beirut participated in the study. Online questionnaires using validated scales were used. Both simple and multiple ordinal logistic regression were performed for the statistical analysis. Results showed that workplace bullying is a predictor of fatigue with an odds ratio of 2.74 and p-value 0.008. Gender was found to be an effect modifier for this relationship, mainly among females (OR 2.66, p-value 0.047) but not among males. Anxiety and depression also predicted higher levels of fatigue (OR 5.75, p-value 0.017). Spirituality did not moderate this relationship.
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Affiliation(s)
- Ghassan M Khairallah
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nisrine N Makarem
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Diana V Rahme
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Dayana Brome
- Department of Psychology, American University of Beirut Medical Center, Beirut, Lebanon
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van Beukering IE, Smits SJC, Janssens KME, Bogaers RI, Joosen MCW, Bakker M, van Weeghel J, Brouwers EPM. In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:365-379. [PMID: 34487290 PMCID: PMC9576674 DOI: 10.1007/s10926-021-09998-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 05/26/2023]
Abstract
PURPOSE Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities. METHODS Using a multiphase screening process, this review is based on a comprehensive literature search (2000-2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar. RESULTS 7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found. CONCLUSION Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.
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Affiliation(s)
- I E van Beukering
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Inspectorate SZW, Den Haag, The Netherlands.
- , P.O. Box 90513, 5000 LE, Tilburg, The Netherlands.
| | - S J C Smits
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Summa College, Eindhoven, The Netherlands
| | - K M E Janssens
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - R I Bogaers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Brain Research and Innovation Centre, Ministry of Defense, Den Haag, The Netherlands
| | - M C W Joosen
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - M Bakker
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - J van Weeghel
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Phrenos Center of Expertise, Utrecht, The Netherlands
| | - E P M Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Identification of Workplace Bullying: Reliability and Validity of Indonesian Version of the Negative Acts Questionnaire-Revised (NAQ-R). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083985. [PMID: 33920092 PMCID: PMC8070247 DOI: 10.3390/ijerph18083985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
Bullying can pose a risk to health and safety, including the risk for damage to the emotional, psychosocial, mental, or physical health of employees in the workplace. Since bullying has a detrimental impact on victims and organizations, several studies on this issue had been conducted using the Negative Acts Questionnaire-Revised (NAQ-R), which is one of the most widely used tools to assess and minimize the occurrence of workplace bullying. However, this tool has not been validated for the Indonesian contexts. In this study, the author tested the reliability and constructed validity of the Indonesian version of NAQ-R. A total of 3140 participants were recruited in this study from various companies from different industries. NAQ-R, Psychosocial Distress (K10), and Satisfaction with Life Scale (SWLS) were administrated through an online survey. The results showed that 22 items yielded three model factors, i.e., person-related bullying, work-related bullying, and intimidation towards a person. Cronbach’s alpha coefficients for the total and sub-scales of the Indonesian NAQ-R was acceptable, ranging from 0.721 to 0.897. This study confirmed that the Indonesian version of NAQ-R has an internal consistency reliability, and the concurrent and construct validity are at acceptable levels. Thus, this tool can be used as the screening instrument in assessing workplace bullying.
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Winston A, Wurcel AG, Gordon C, Goyal N. Viral hepatitis in patients on hemodialysis. Semin Dial 2020; 33:254-262. [PMID: 32394502 DOI: 10.1111/sdi.12882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatitis B and hepatitis C (HCV) prevalence are higher in people on hemodialysis (HD) than the general population. Through implementation of prevention interventions including vaccines, serologic screening, and post-exposure management, transmissions linked to HD have decreased dramatically. In this manuscript, we review epidemiology of viral hepatitis, summarize current screening and vaccine recommendations, and appraise the available data about efforts to decrease incidence within HD facilities, including isolation of people with viral hepatitis within HD units. Also included is a discussion of the highly effective all-oral HCV treatment options and treatment for HCV in people awaiting kidney transplant.
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Affiliation(s)
- Anna Winston
- Tufts University School of Medicine, Boston, Massachusetts
| | - Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Craig Gordon
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Nitender Goyal
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Mohamed AA, Saad M, Magdy MA. The construction and validation of a new Hepatitis C Virus social stigma in the workplace scale. PSYCHOLOGY, COMMUNITY & HEALTH 2019. [DOI: 10.5964/pch.v8i1.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim
The purpose of this study was to develop a new scale to measure the social stigma of hepatitis C virus (HCV) in the workplace using a refined version of Link and colleagues’ (Link & Phelan, 2001, https://doi.org/10.1146/annurev.soc.27.1.363; Link, Yang, Phelan, & Collins, 2004, https://doi.org/10.1093/oxfordjournals.schbul.a007098) definition of social stigma.
Methods
The new scale was developed over a multistage process that was guided by existing scales and focus groups. Two studies were conducted to validate the scale. The first, collected data from 224 employees and used exploratory factor analysis to remove unsatisfactory items. The second study collected data from 254 employees and used confirmatory factor analysis.
Results
Results indicated that the new 32 item scale had acceptable reliability and validity. These results support the conceptualization of stigma as a latent construct that abstracts stereotyping, prejudice and intention to discriminate.
Conclusion
Findings elucidate that HCV stigma can be operationalized as a general factor behind stereotyping, prejudice and intentions to discriminate in the workplace. This is an important conclusion because it may bring parsimony and coherence to a complex and dispersed literature. Additionally, the new scale may be used to study HCV stigma in the workplace.
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Abstract
In palliative care, a biopsychosocial-spiritual model is essential to address the patient in totality. Spirituality is often a relevant issue in such settings, yet there is a need to differentiate spirituality from religion. Spirituality in palliative care focuses on the psychological and spiritual aspects of care, helping to relieve the physical, emotional, social and spiritual distresses of the patient, family members and healthcare professionals, produced in such conditions. Psychologists, according to their ethical responsibilities, may include the assessment of their patients' spiritual needs in therapy, as it will help to identify the patients' values, belief systems, spiritual history, distress and needs. All patients have different needs, some may need religious/spiritual guidance, in collaboration with spiritual care workers, and others may not demonstrate needs regarding these issues. The essential is that each patient is treated as a 'whole', addressing his physical, psychological, social and spiritual needs.
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Seo K, Song Y. Self-stigma among Korean patients with diabetes: A concept analysis. J Clin Nurs 2019; 28:1794-1807. [PMID: 30667129 DOI: 10.1111/jocn.14789] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/01/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To conduct a concept analysis of self-stigma among patients with diabetes and introduce an operational definition of self-stigma. BACKGROUND Due to fears of being monitored, patients with diabetes often conceal their disease and/or withdraw from social relationships. These behaviours negatively affect patients' self-care and socialisation. DESIGN A concept analysis was conducted using a three-phase (theoretical phase, fieldwork phase and final analysis phase) hybrid method by Schwartz-Barcott and Kim (Nursing research methodology: Issues and implementations, 1986, Rockville, MD: Aspen). METHODS During the theoretical phase, a literature search was conducted using PubMed and CINAHL. Using COREQ guidelines, in the fieldwork phase, in-depth interviews were conducted with nine participants with diabetes. The recorded data were analysed using a grounded theory approach. Results from both were included in the analytic phase. RESULTS In the fieldwork phase, nine patients with diabetes (four men and five women; mean age = 57.00 ± 21.93 years) participated in the interview. The mean duration of diabetes was 21.44 ± 12.39 years. The self-stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self-esteem and self-efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural factors (social withdrawal and avoiding disease disclosure). The nine attributes included 23 indicators. CONCLUSIONS Self-stigma among patients with diabetes is defined as a state in which patients develop negative self-feelings as they deal with the disease. This can cause diminished self-esteem and self-efficacy, as well as a tendency to avoid disclosing the illness along with social withdrawal. RELEVANCE TO CLINICAL PRACTICE Based on this self-stigma concept analysis, we clarified the attributes of diabetes self-stigma and distinguished it from social stigma in nurse professionals during patient education and clinical assessment.
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Affiliation(s)
- Kawoun Seo
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Department of Nursing, Joongbu University, Chungnam, Republic of Korea
| | - Youngshin Song
- College of Nursing, Chungnam National University, Daejeon, South Korea
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Suarez AE. Is disclosure a privilege? Race and disclosure patterns of hepatitis C. J Health Psychol 2017; 24:1646-1657. [PMID: 28810416 DOI: 10.1177/1359105317694485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Research suggests that decisions to disclose hepatitis C status are affected by individual and interpersonal factors. However, no existing studies have examined the role of race in disclosure, despite the potential implications of being doubly marginalized on the basis of both race and hepatitis C status. Drawing on qualitative research with 53 persons with hepatitis C in the Southeastern United States, findings indicate that participants practiced four patterns of disclosure: activist disclosure, open disclosure, limited disclosure, and reluctant disclosure. The majority of African Americans in this research practiced limited and reluctant disclosure, while Whites' disclosure patterns were more varied. These findings suggest that race shapes patterns of disclosure of hepatitis C, which has important implications for prevention, help seeking, social support, exposure to discrimination, and addressing racial disparities in health.
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Illness Experience of Patients with Chronic Hepatitis C Participating in Clinical Trials. Osong Public Health Res Perspect 2016; 7:394-399. [PMID: 28053846 PMCID: PMC5194226 DOI: 10.1016/j.phrp.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/20/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023] Open
Abstract
Objectives To understand the illness experience of patients with chronic hepatitis C participating in clinical trials in the sociocultural context of Korea in an in-depth and comprehensive manner. Methods A focused ethnography approach was used to discover the pattern of illness experience of patients with chronic hepatitis C in the cultural background of Korea. Interviews were conducted with 11 patients with chronic hepatitis C participating in clinical trials and the collected data were analyzed with the domain analysis, taxonomical analysis, componential analysis, and theme analysis proposed by Spradley. Results With the cultural theme of “less-known illness, less-familiar illness,” four categories were derived: “my illness discovered by accident,” “shaken life,” “scary but inevitable treatment method,” and “precious life that can't be wasted,” along with 12 properties. Conclusion Public campaigns or education programs are needed to meet the needs for information on the disease for patients with chronic hepatitis C participating in clinical trials and help the general public acquire knowledge or change view on this disease.
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Taft TH, Keefer L. A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease. Clin Exp Gastroenterol 2016; 9:49-58. [PMID: 27022294 PMCID: PMC4789833 DOI: 10.2147/ceg.s83533] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic illness stigma is a global public health issue. Most widely studied in HIV/AIDS and mental illness, stigmatization of patients living with inflammatory bowel disease (IBD), chronic autoimmune conditions affecting the digestive tract, has garnered increasing attention in recent years. In this paper, we systematically review the scientific literature on stigma as it relates to IBD across its three domains: perception, internalization, and discrimination experiences. We aim to document the current state of research, identify gaps in our knowledge, recognize unique challenges that IBD patients may face as they relate to stigmatization, and offer suggestions for future research directions. Based on the current review, patients living with IBD may encounter stigmatization and this may, in turn, impact several patient outcomes including quality of life, psychological functioning, and treatment adherence. Significant gaps exist related to the understanding of IBD stigma, providing opportunity for future studies to address this important public health issue.
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Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurie Keefer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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