1
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Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CFJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg 2024; 279:429-436. [PMID: 37991182 DOI: 10.1097/sla.0000000000006159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To characterize the current state of mental health within the surgical workforce in the United States. BACKGROUND Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown. METHODS Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed. RESULTS Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months. CONCLUSIONS Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.
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Affiliation(s)
- Reagan A Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Tianna Herman
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Rebecca A Snyder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anne Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, GA
| | | | | | - Diego Vicente
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cornelia L Griggs
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Imani E McElroy
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anji E Wall
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jaber Valinejad
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Andres Alban
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - J Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Mohammad S Jalali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - G Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Erika Rangel
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Karen Donelan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie Cunningham
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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2
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Xu KY, Gold JA, Szlyk HS, Rolin SA, Shields MC. Mental Illness and Violence Among People Experiencing Homelessness: An Evidence-Based Review. Mo Med 2024; 121:14-20. [PMID: 38404439 PMCID: PMC10887459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Division of Addiction Science, Prevention, and Treatment, Washington University, and in the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Hannah S Szlyk
- Health and Behavior Research Center, Division of Addiction Science, Prevention, and Treatment, Washington University, and in the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie A Rolin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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3
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Ulin L, Bernstein SA, Nunes JC, Gu A, Hammoud MM, Gold JA, Mirza KM. Improving Transparency in the Residency Application Process: Survey Study. JMIR Form Res 2023; 7:e45919. [PMID: 38145482 PMCID: PMC10775039 DOI: 10.2196/45919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Increasing numbers of residency applications create challenges for applicants and residency programs to assess if they are a good fit during the residency application and match process. Applicants face limited or conflicting information as they assess programs, leading to overapplying. A holistic review of residency applications is considered a gold standard for programs, but the current volumes and associated time constraints leave programs relying on numerical filters, which do not predict success in residency. Applicants could benefit from increased transparency in the residency application process. OBJECTIVE This study aims to determine the information applicants find most beneficial from residency programs when deciding where to apply, by type of medical school education background. METHODS Match 2023 applicants voluntarily completed an anonymous survey through the Twitter and Instagram social media platforms. We asked the respondents to select 3 top factors from a multiple-choice list of what information they would like from residency programs to help determine if the characteristics of their application align with program values. We examined differences in helpful factors selected by medical school backgrounds using ANOVA. RESULTS There were 4649 survey respondents. When responses were analyzed by United States-allopathic (US-MD), doctor of osteopathic medicine (DO), and international medical graduate (IMG) educational backgrounds, respondents chose different factors as most helpful: minimum United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Step 2 scores (565/3042, 18.57% US-MD; 485/3042, 15.9% DO; and 1992/3042, 65.48% IMG; P<.001), resident hometown region (281/1132, 24.82% US-MD; 189/1132, 16.7% DO; and 662/1132, 58.48% IMG; P=.02), resident medical school region (476/2179, 22% US-MD; 250/2179, 11.5% DO; and 1453/2179, 66.7% IMG; P=.002), and percent of residents or attendings underrepresented in medicine (417/1815, 22.98% US-MD; 158/1815, 8.71% DO; and 1240/1815, 68.32% IMG; P<.001). CONCLUSIONS When applying to residency programs, this study found that the factors that respondents consider most helpful from programs in deciding where to apply differ by educational background. Across all educational groups, respondents want transparency around standardized exam scores, geography, and the racial or ethnic backgrounds of residents and attendings.
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Affiliation(s)
- Lindsey Ulin
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Simone A Bernstein
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, United States
| | - Julio C Nunes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, United States
| | - Maya M Hammoud
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, United States
| | - Kamran M Mirza
- Department of Pathology and Clinical Laboratories, University of Michigan Medicine, Ann Arbor, MI, United States
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4
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Xu KY, Tedrick T, Gold JA. Screen Use and Social Media "Addiction" in the Era of TikTok: What Generalists Should Know. Mo Med 2023; 120:440-445. [PMID: 38144925 PMCID: PMC10743327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
While the term "screen addiction" or "social media addiction" is gaining steam in the popular media, preclinical, clinical, and population health research have not caught up with regards to the diagnosis and treatment of unhealthy screen use. The overarching goal of this article is to provide broad clinical tips to generalists, working outside the mental health specialty, on the evaluation and treatment of unhealthy screen exposure in children and young adults. We will clarify the difference between addiction and overuse, and why this distinction matters. Recognizing that screens are here to stay in the post-COVID era, we will provide guidance on how to reduce potential harms associated with screen exposure without necessarily requiring people to abstain or stop using screens.
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Affiliation(s)
- Kevin Y Xu
- Instructor, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Tiffany Tedrick
- Psychiartry Resident, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica A Gold
- Assistant Professor, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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5
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Bernstein SA, Levy MS, McNeilly S, Fishbach S, Jain S, Gold JA, Arora VM. Practice Location Preferences in Response to State Abortion Restrictions Among Physicians and Trainees on Social Media. J Gen Intern Med 2023; 38:2419-2423. [PMID: 36823418 PMCID: PMC10406982 DOI: 10.1007/s11606-023-08096-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Simone A Bernstein
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Morgan S Levy
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Shira Fishbach
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Shikha Jain
- Department of Medicine, University of Illinois Cancer Center, Chicago, IL, USA
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Vineet M Arora
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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6
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Bernstein SA, Hodgins GE, Abu-Hamad S, Gih DE, Gold JA. Understanding the Use of Program Resources During Virtual Recruitment by Psychiatry Residency Applicants. Acad Psychiatry 2023; 47:380-384. [PMID: 37237083 PMCID: PMC10218770 DOI: 10.1007/s40596-023-01804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study aims to understand the residency resources used by psychiatry applicants who applied during the first two virtual recruitment seasons, match 2021 and 2022. METHODS Between January 27, 2022, and February 24, 2022, a non-probabilistic sample of psychiatry residents from the match 2018 through match 2022 cycles were asked to complete a survey via email and social media. Due to the continuation of virtual recruitment post-pandemic, an analysis of psychiatry residents in the match 2021 and 2022 cycles was conducted. Questions assessed the use of recruitment resources, including websites, the Fellowship and Residency Electronic and Interactive Database, virtual open houses, video tours, away rotations, and social media platforms. Descriptive statistics and chi-square analyses were used. RESULTS Psychiatry residents from the match 2021 and 2022 cycles completed the survey (n = 605), with 288 US allopathic medicine doctors (47.6%), 178 (29.4%) international medical graduates, and 139 (23.0%) osteopathic medicine doctors. More than half of respondents (n = 347, 57.4%) reported that the virtual interview season increased the number of programs they intended to apply to. Most respondents (n = 594, 88.3%) reported attending one or more psychiatry virtual open houses and 84.6% (n = 512) followed psychiatry residency programs on at least one social media platform. Program websites were reported to be the most influential digital platform for both applying and ranking. CONCLUSION Understanding the influence of recruitment resources is essential for residents and program leadership to optimize time and resources to assist applicants with their decision-making.
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Affiliation(s)
| | | | - Samir Abu-Hamad
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Daniel E Gih
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Jessica A Gold
- Washington University School of Medicine, St. Louis, MO, USA
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7
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Bernstein SA, Huckenpahler AL, Nicol GE, Gold JA. Comparison of Electronic Health Record Messages to Mental Health Care Professionals Before vs After COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2325202. [PMID: 37486634 PMCID: PMC10366699 DOI: 10.1001/jamanetworkopen.2023.25202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
This qualitative improvement study examines the change in electronic health record messaging from patients to mental health professionals before vs after the COVID-19 pandemic.
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Affiliation(s)
- Simone A Bernstein
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Alison L Huckenpahler
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ginger E Nicol
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
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8
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Nicol GE, Douglas C, Gray T, Martin V, Guo Z, Kinghorn A, Colvin R, Reidhead M, Evanoff BA, Gold JA. Supporting the Resilience and Mental Health of Missouri Healthcare Workers Through COVID-19 and Beyond: the Gateway2Wellness Program. Mo Med 2023; 120:277-284. [PMID: 37609469 PMCID: PMC10441271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
The COVID-19 pandemic is over, but US healthcare workers (HCWs) continue to report high levels of work-related exhaustion and burnout but are unlikely to seek help. Digital tools offer a scalable solution. Between February and June 2022, we surveyed Missouri hospital administrators to assess HCW mental health and identify related evidence-based or evidence-informed resources. Simultaneously, we conducted a digital survey and focus groups with HCWs and leaders at Washington University School of Medicine (WUSOM) in St. Louis to evaluate HCW mental health needs, and preferences for digital support. Here, we describe the results and subsequent development of the Gateway to Wellness (G2W) program, a digital precision engagement platform that links HCWs to the most effective tailored resources for their mental health needs.
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Affiliation(s)
- Ginger E Nicol
- Healthy Mind Lab, the Center for Mental Health & Wellness, and in the Mobile Health Research Core, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Chris Douglas
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Teddi Gray
- Healthy Mind Lab, and the Center for Mental Health & Wellness, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Vicki Martin
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Zhaohua Guo
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Anna Kinghorn
- Division of General Medical Sciences, and the Center for Healthy Work, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan Colvin
- Division of General Medical Sciences, and the Center for Healthy Work, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mat Reidhead
- Missouri Hospital Association, Jefferson City, Missouri
| | - Bradley A Evanoff
- Division of General Medical Sciences, and the Center for Healthy Work, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica A Gold
- Center for Mental Health & Wellness, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Abstract
Federal and institutional policy changes have accelerated the use of telemental health to care for college students distant from their mental health providers during the early part of the COVID-19 pandemic. Temporary measures have made telemental health more readily available, including relaxing of regulations related to interstate licensure, controlled substance prescribing, patient privacy, and reimbursement. Though early efforts are underway to sustain these changes during and in the wake of the pandemic, there are important areas in which federal and institutional policy are still lacking. Additional steps are needed to successfully implement and sustain telemental health for college students include ensuring student access to technology and Internet; proactive outreach to optimize the student's home environment, addressing concerns about safety and confidentiality; developing the means to track rapidly shifting telemental health policy changes; and developing centralized resources that enable remote providers to become familiar with involuntary commitment laws and emergency protocols.
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Affiliation(s)
- Yash S Huilgol
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of California, Berkeley, California, USA
- School of Medicine, University of California, San Francisco, California, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew L Goldman
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
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10
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Engelson BJ, Bernstein SA, Moutier CY, Gold JA. Content Notice: Guidelines to Discuss Suicide on Social Media. Mo Med 2023; 120:15-20. [PMID: 36860598 PMCID: PMC9970321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Brianna J Engelson
- Department of Psychiatry, University of Minnesota Minneapolis, Minnesota
| | | | | | - Jessica A Gold
- Department of Psychiatry, Washington University, St. Louis, Missouri
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11
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Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? Mo Med 2022; 119:467-473. [PMID: 36337990 PMCID: PMC9616454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) has seen a consistent rise in recent years. These numbers spark a debate over the reason for the observed trends, with some concerned about over diagnosis and over prescription of stimulant medications, and others raising the issue of diagnostic disparities, particularly in underrepresented populations. In this paper we look at both sides, starting with the history of ADHD and its diagnostic criteria changes, from early concepts of alterations in attention and hyperactivity in the 19th and 20th century, to its introduction in the Diagnostical and Statistical Manual of Mental Disorders (DSM), and its evolution into how it is defined today. The general broadening of ADHD diagnostically over time plays a role in the increased prevalence over the years, but it is not the only reason. Increased awareness of physicians and the public is also believed to play a big role, particularly in underrepresented minorities and women. However, there continues to be disparities in detection of ADHD in these groups. There are significant consequences to a patient's social, interpersonal, and professional life when ADHD is left unrecognized and untreated. Thoughtful evaluation, accurate diagnosis, and adequate treatment can make a big difference.
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Affiliation(s)
- Elie Abdelnour
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Madeline O Jansen
- Department of Psychiatry, Child and Adolescent Division, University of California-Los Angeles, Los Angeles, California
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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12
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Bernstein SA, Gold JA. Interns Are Increasingly Using Mental Health Services, but More Can Still Be Done. Ann Intern Med 2022; 175:131-132. [PMID: 34781712 DOI: 10.7326/m21-4077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Simone A Bernstein
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
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13
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Pearson C, Siegel J, Gold JA. Psilocybin-assisted psychotherapy for depression: Emerging research on a psychedelic compound with a rich history. J Neurol Sci 2021; 434:120096. [PMID: 34942586 DOI: 10.1016/j.jns.2021.120096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/22/2021] [Accepted: 12/12/2021] [Indexed: 12/13/2022]
Abstract
There is a serious need for novel therapies that treat individuals with depression, including major depressive disorder (MDD) and treatment-resistant depression (TRD). An emerging body of research has demonstrated that psychedelic drugs such as psilocybin, combined with supportive psychotherapy, exert rapid and sustained antidepressant effects. The use of psychedelics is not new: they have a rich history with evidence of their use in ritual and medical settings. However, due to political, social, and cultural pressures, their use was limited until modern clinical trials began to emerge in the 2010s. This review provides a comprehensive look at the potential use of psilocybin in the treatment of depression and TRD. It includes an overview of the history, pharmacology, and proposed mechanism of psilocybin, and describes several published studies in the last decade which have provided evidence of the efficacy and safety of psilocybin-assisted psychotherapy for individuals with depression. It also includes a discussion of the limitations and barriers of current research on psychedelics. The results of these studies are contextualized within the current treatment landscape through an overview of the pathophysiology of depression and the treatments currently in use, as well as the clinical needs these novel therapies have the promise to fulfill.
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Affiliation(s)
- Craig Pearson
- Washington University School of Medicine, St. Louis, MO 63108, United States of America
| | - Joshua Siegel
- Washington University School of Medicine, St. Louis, MO 63108, United States of America
| | - Jessica A Gold
- Washington University School of Medicine, St. Louis, MO 63108, United States of America.
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14
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Bernstein SA, Harmon TG, Cabañez K, Wei C, Gold JA. Utilization of Instagram by Psychiatry Residency Programs in a Virtual Recruitment World. Acad Psychiatry 2021; 45:746-750. [PMID: 34665449 PMCID: PMC8525059 DOI: 10.1007/s40596-021-01548-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/30/2021] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Many psychiatry residency programs use Instagram to provide information about their program. This study assesses the content and engagement on psychiatry residency program Instagram accounts. METHODS A full list of psychiatry programs was gathered from the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA). FREIDA was used to collect demographic information about a program. Program Instagram accounts were reviewed and assessed for content, and engagement scores were analyzed. Univariate and multivariate regression was used to analyze the information collected from the Instagram accounts. RESULTS There are 109 (42.9%) psychiatry residency programs with Instagram accounts; 99 (90.8%) accounts were opened in 2020. Analysis of the content of posts revealed posts with the following themes: 50.5% were departmental, 21.9% were social, 14.9% were other, 10.1% were academic and professional, and 2.6% were educational. Using multivariate regression, a higher total number of followers was correlated with the total number of accounts followed (p ≤ 0.001) and Instagram stories (p = 0.047) (R2 = 0.579). Engagement score was correlated with a total number of followers (p ≤ 0.001), program size (p = 0.048), and whether an account was active (p = 0.003) (R2 = 0.450). CONCLUSION Results demonstrate that 2020 led to an increase in the number of psychiatry residency program Instagram accounts and engagement with followers. Instagram provides a way to further promote a program, yet there is room for improvement to diversify the content.
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Affiliation(s)
- Simone A Bernstein
- Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA.
| | | | | | - Chapman Wei
- Staten Island University Hospital, Staten Island, NY, USA
| | - Jessica A Gold
- Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA
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15
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Wooten L, Jordan A, Simon KM, Gold JA. This Is Us: a Case Examination on Black Men in Therapy. Acad Psychiatry 2021; 45:763-767. [PMID: 34494205 DOI: 10.1007/s40596-021-01528-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Lawren Wooten
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ayana Jordan
- Yale University School of Medicine, New Haven, CT, USA
| | - Kevin M Simon
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica A Gold
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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16
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Slat EA, Parsley IC, Gold JA. Recognizing Decline in Physician Wellbeing: When to Seek Help or Intervene. Mo Med 2021; 118:494-498. [PMID: 34924610 PMCID: PMC8672954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Emily A Slat
- Department of Psychiatry, Washington University, St. Louis, Missouri
| | - Ian C Parsley
- Department of Psychiatry, Washington University, St. Louis, Missouri
| | - Jessica A Gold
- Department of Psychiatry, Washington University, St. Louis, Missouri
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Bernstein SA, Gu A, Bernstein SL, Wei C, Vogel AC, Gold JA. Child and Adolescent Psychiatry Fellowship Program Website Content and Accessibility. Acad Psychiatry 2021; 45:425-428. [PMID: 33502698 PMCID: PMC7839618 DOI: 10.1007/s40596-021-01406-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE When child and adolescent psychiatry fellowship applicants are applying to programs, many will use fellowship websites to gather information. This study assesses the accessibility and content available on child and adolescent fellowship websites. METHODS Using the Electronic Residency Application Service (ERAS) list of child and adolescent fellowship programs for 2020, 139 child and adolescent fellowship training websites were compiled. Information on websites was evaluated within the following three categories: program overview, application information and recruitment, and educational opportunities. A total of 22 criteria were evaluated within these three categories. Descriptive statistics were used to analyze the websites. RESULTS A list provided by ERAS and a Google search identified child and adolescent fellowship program websites. Analysis of content revealed most websites included an overview of the program (97.8%), but fewer included information such as the number of fellowship spots (51.5%), salary (45.5%), application deadline (41.0%), and call responsibility (19.4%). CONCLUSION Results suggest there is room for improvement in the comprehensiveness and accessibility of child and adolescent fellowship websites. Especially during a time when much of the programmatic information will be obtained virtually due to COVID-19, it is critical that fellowship websites are uniformly curated so applicants can more easily find information about programs.
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Affiliation(s)
- Simone A Bernstein
- Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA.
| | - Alex Gu
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sophie L Bernstein
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Chapman Wei
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alecia C Vogel
- Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Jessica A Gold
- Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA
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18
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Denduluri MS, Gold JA, Serrano WC, Spelber D, Bentzley J, Forte C, De Golia SG. Group Training for Psychiatric Residents: Support Group Facilitation and Supervision with Didactics. Acad Psychiatry 2021; 45:339-344. [PMID: 33106952 DOI: 10.1007/s40596-020-01338-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Group psychotherapy merits dedicated training during psychiatry residency yet is challenging to implement given competing educational requirements. The authors implemented a voluntary support group training intervention for psychiatry residents consisting of a 6-h didactic series followed by at least 6 months of in vivo group facilitation and supervision. We hypothesized participation would improve residents' self-reported skill and knowledge in group facilitation. METHODS Psychiatry residents (PGY I-IV) voluntarily participated in this novel intervention that included a didactic series followed by experiential group facilitation and supervision. To assess confidence and self-reported skill level in group facilitation, residents completed two brief self-report surveys: before the didactic series (pre-intervention) and after group facilitation for at least 6 months (post-intervention). Surveys included Likert scales and open-ended questions. Quantitative data were analyzed with descriptive statistics and open-ended qualitative data were analyzed using thematic analysis. RESULTS Twenty-three residents attended 4 to 6 h of didactics between 2016 and 2018. Of these 23 residents, 12 facilitated groups and attended supervision for at least 6 months. Twenty residents responded to pre-intervention surveys and 14 responded to post-intervention surveys. After the intervention, respondents reported a significant increase in knowledge and skills in group facilitation of 88% (15/17) on Likert scale questions. CONCLUSIONS This study implemented a novel educational intervention to train psychiatric residents in group dynamics and group facilitation. Participation increased residents' self-reported knowledge and skills in group facilitation. Future directions include incorporating feedback about group curriculum, evaluating resident knowledge and skills using assessment measures, recruiting more group participants, and focusing on peer-to-peer mentoring.
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Saddawi-Konefka D, Brown A, Eisenhart I, Hicks K, Barrett E, Gold JA. Consistency Between State Medical License Applications and Recommendations Regarding Physician Mental Health. JAMA 2021; 325:2017-2018. [PMID: 34003231 PMCID: PMC8132137 DOI: 10.1001/jama.2021.2275] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines the consistency of medical license applications with recommendations from the Federation of State Medical Boards on physician wellness and burnout.
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Affiliation(s)
- Daniel Saddawi-Konefka
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
| | - Ariel Brown
- The Emotional PPE Project Inc, Arlington, Massachusetts
| | | | | | - Eileen Barrett
- Department of Medicine, University of New Mexico, Albuquerque
| | - Jessica A. Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
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20
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Bernstein SA, Bhat NR, Harmon TG, Nguyen B, Gu A, Marks LA, Gold JA. Evaluating psychiatry residency program website content. International Journal of Mental Health 2021. [DOI: 10.1080/00207411.2021.1897375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Simone A. Bernstein
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Nisha R. Bhat
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Bambi Nguyen
- St. Bonaventure University, St. Bonaventure, NY, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lauren A. Marks
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Jessica A. Gold
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, USA
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21
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Gold JA, Jia L, Bentzley JP, Bonnet KA, Franciscus AM, Denduluri MS, Zappert LT. WISE: A Support Group for Graduate and Post-Graduate Women in STEM. Int J Group Psychother 2021; 71:81-115. [PMID: 38449140 DOI: 10.1080/00207284.2020.1722674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Women remain underrepresented in many science, technology, engineering, and mathematics (STEM) fields. Women in Science and Engineering (WISE) support groups were developed in 2001 as an intervention to foster community in graduate and postgraduate women in STEM at a large academic research institution. Since the WISE program's inception, over 1,500 women have participated. From 2011 to 2018, anonymous, voluntary surveys were distributed at the end of every academic year to WISE group members. Surveys consisted of quantitative and qualitative data regarding participants' perceptions of and experiences in the WISE groups. From 2011 to 2018, 76.4% of survey respondents (n = 416) reported that WISE groups were an excellent experience overall. Thematic analysis of the qualitative data demonstrated four major benefits of WISE group participation: creation of community, having a safe space, emotional support, and peer mentorship. Suggestions for improvement included increasing access to groups. The WISE group program was a well-liked intervention that may support graduate and postgraduate women in STEM. Study limitations, as well as implications for future research, practice, and advocacy are noted.
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Abstract
This cross-sectional study examines the gender distribution of endowed chairs in departments of medicine and the association of gender with holding an endowed chair.
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Danielle Roubinov
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Lena S Jia
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
| | - Kent A Griffith
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
| | - John M Carethers
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
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Bernstein SA, Gold JA. Mental Health on the Frontlines: Before, During, and After COVID-19. Mo Med 2020; 117:421-425. [PMID: 33311743 PMCID: PMC7723142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Simone A Bernstein
- MSMA member since 2020, Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Jessica A Gold
- MSMA member since 2020, Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
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25
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO 63130-4899, USA
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26
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Calhoun AJ, Gold JA. "I Feel Like I Know Them": the Positive Effect of Celebrity Self-disclosure of Mental Illness. Acad Psychiatry 2020; 44:237-241. [PMID: 32100256 DOI: 10.1007/s40596-020-01200-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
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27
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Chi T, Gold JA. A review of emerging therapeutic potential of psychedelic drugs in the treatment of psychiatric illnesses. J Neurol Sci 2020; 411:116715. [PMID: 32044687 DOI: 10.1016/j.jns.2020.116715] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/03/2019] [Accepted: 01/29/2020] [Indexed: 12/22/2022]
Abstract
Though there was initial interest in the use of psychedelic drugs for psychiatric treatment, bad outcomes and subsequent passage of the Substance Act of 1970, which placed psychedelic drugs in the Schedule I category, significantly limited potential progress. More recently, however, there has been renewal in interest and promise of psychedelic research. The purpose of this review is to highlight contemporary human studies on the use of select psychedelic drugs, such as psilocybin, LSD, MDMA and ayahuasca, in the treatment of various psychiatric illnesses, including but not limited to treatment-resistant depression, post-traumatic stress disorder, end-of-life anxiety, and substance use disorders. The safety and efficacy as reported from human and animal studies will also be discussed. Accumulated research to date has suggested the potential for psychedelics to emerge as breakthrough therapies for psychiatric conditions refractory to conventional treatments. However, given the unique history and high potential for misuse with popular distribution, special care and considerations must be undertaken to safeguard their use as viable medical treatments rather than drugs of abuse.
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Affiliation(s)
- Tingying Chi
- Department of Psychiatry, Washington University School of Medicine, USA.
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, USA.
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Carol A Bernstein
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Kali D Cyrus
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Elizabeth Fitelson
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Alicia Lieberman
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Christina Mangurian
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
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29
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Gold JA, Bentzley JP, Franciscus AM, Forte C, De Golia SG. An Intervention in Social Connection: Medical Student Reflection Groups. Acad Psychiatry 2019; 43:375-380. [PMID: 30963416 DOI: 10.1007/s40596-019-01058-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Rates of medical student depression and suicide are higher than aged-matched peers. Although medical schools have implemented wellness interventions, no program has reported on interventions targeting social support. As one potential intervention, reflection groups for medical students led by psychiatry residents were designed and implemented. It was hypothesized that groups would encourage connectedness among peers, teach coping and emotional self-awareness skills, increase empathy, and decrease loneliness. METHODS Voluntary, biweekly support groups were implemented between 2017 and 2018 at Stanford University School of Medicine for first- and second-year medical students. Participants were surveyed at baseline and 6 months. Surveys included qualitative assessments of groups and validated surveys to assess empathy, wellness, and loneliness. Separate surveys assessed attrition. Analyses included statistical analyses (descriptive statistics) and thematic analysis. RESULTS In both cohorts, a total number of 30 students participated in groups, and 18 completed post-surveys. Students reported groups improved well-being (55.6% strongly agreed, 27.8% agreed), enhanced self-awareness (44.4% strongly agreed, 38.9% agreed) and ability to empathize (50.0% strongly agreed, 27.8% agreed), and promoted connection (61.1% strongly agreed, 33.3% agreed). Initial attrition was high, with 84% of students not continuing due to feeling too overwhelmed by classes. CONCLUSIONS Thematic analysis demonstrated groups may benefit students in improving impostor syndrome and connection with others (decreased loneliness), allowing exposure and tolerance to diverse perspectives, increasing insight into the importance of self-care and emotional self-awareness, allowing practice for collaborative skills, and increasing thoughtful approaches to patient care. There is preliminary evidence reflection groups may be a feasible, effective intervention to improve loneliness and social belonging in medical school.
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Affiliation(s)
| | - Jessica P Bentzley
- Stanford University, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, USA
| | - Amanda M Franciscus
- Stanford University, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, USA
| | - Craig Forte
- Stanford University, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, USA
| | - Sallie G De Golia
- Stanford University, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, USA
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30
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Gold JA, Hu X, Huang G, Li WZ, Wu YF, Gao S, Liu ZN, Trockel M, Li WZ, Wu YF, Gao S, Liu ZN, Rohrbaugh RM, Wilkins KM. Medical student depression and its correlates across three international medical schools. World J Psychiatry 2019; 9:65-77. [PMID: 31799151 PMCID: PMC6885454 DOI: 10.5498/wjp.v9.i4.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/26/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.
AIM To examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.
METHODS Convenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.
RESULTS Medical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.
CONCLUSION Depression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO 63110, United States
| | - Xinran Hu
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Gan Huang
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Wan-Zhen Li
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Yi-Fan Wu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Shan Gao
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Zhe-Ning Liu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Mickey Trockel
- Department of Psychiatry, Stanford University, Stanford, CA 94305, United States
| | | | | | | | | | - Robert M Rohrbaugh
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Kirsten M Wilkins
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
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Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician Suicide: A Call to Action. Mo Med 2019; 116:211-216. [PMID: 31527944 PMCID: PMC6690303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Physician suicide is topic of growing professional and public health concern. Despite working to improve the health of others, physicians often sacrifice their own well-being to do so. Furthermore, there are systemic barriers in place that discourage self-care and help-seeking behaviors among physicians. This article will discuss the relevant epidemiology, risk factors, and barriers to treatment, then explore solutions to address this alarming trend.
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Affiliation(s)
- Molly C Kalmoe
- Molly C. Kalmoe, MD, and Matthew Chapman, MD, are Psychiatry Residents; Jessica A. Gold, MD, MS, is Assistant Professor; and Andrea M. Giedinghagen, MD, is Instructor; Department of Psychiatry, Washington University in St. Louis, Missouri
| | - Matthew B Chapman
- Molly C. Kalmoe, MD, and Matthew Chapman, MD, are Psychiatry Residents; Jessica A. Gold, MD, MS, is Assistant Professor; and Andrea M. Giedinghagen, MD, is Instructor; Department of Psychiatry, Washington University in St. Louis, Missouri
| | - Jessica A Gold
- Molly C. Kalmoe, MD, and Matthew Chapman, MD, are Psychiatry Residents; Jessica A. Gold, MD, MS, is Assistant Professor; and Andrea M. Giedinghagen, MD, is Instructor; Department of Psychiatry, Washington University in St. Louis, Missouri
| | - Andrea M Giedinghagen
- Molly C. Kalmoe, MD, and Matthew Chapman, MD, are Psychiatry Residents; Jessica A. Gold, MD, MS, is Assistant Professor; and Andrea M. Giedinghagen, MD, is Instructor; Department of Psychiatry, Washington University in St. Louis, Missouri
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Morris NP, Johansen SL, May M, Gold JA. Media-Related Education in Psychiatry Residency Programs. Acad Psychiatry 2018; 42:679-685. [PMID: 30155603 DOI: 10.1007/s40596-018-0973-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Margaret May
- Stanford University School of Medicine, California, USA
| | - Jessica A Gold
- Washington University School of Medicine, St. Louis, MO, USA
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Gold JA, Bandstra BS, DeGolia SG. Early Outpatient Experience for Psychiatry Interns: The Evaluation Clinic. Acad Psychiatry 2016; 40:944-946. [PMID: 27328983 DOI: 10.1007/s40596-016-0581-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Jessica A Gold
- Stanford University School of Medicine, Stanford, CA, USA.
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Gold JA. The Checkered Divide. Acad Psychiatry 2016; 40:956-957. [PMID: 27718166 DOI: 10.1007/s40596-016-0615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/01/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Jessica A Gold
- Stanford University School of Medicine, Stanford, CA, USA.
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Gold JA, Sher Y, Maldonado JR. Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations. Psychosomatics 2016; 57:445-64. [DOI: 10.1016/j.psym.2016.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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Gold JA, Johnson B, Leydon G, Rohrbaugh RM, Wilkins KM. Mental health self-care in medical students: a comprehensive look at help-seeking. Acad Psychiatry 2015; 39:37-46. [PMID: 25082721 DOI: 10.1007/s40596-014-0202-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/04/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The authors characterize medical student help-seeking behaviors and examine the relationship with stress, burnout, stigma, depression, and personal health behaviors. METHODS In 2013, the authors administered an electronic survey of all enrolled students at Yale School of Medicine (183 responders, response rate=35 %), inquiring about students' primary medical and mental health care, personal health behaviors, support systems, and help-seeking behaviors. Students completed the Attitudes to Mental Health Questionnaire, the Patient Health Questionnaire-2, and a modified Maslach Burnout Inventory. The authors analyzed the results with logistic regression, the Wilcoxon rank-sum test, the Kruskal-Wallis test, or a test for significance of Kendall rank correlation. RESULTS Most students reported having a primary care provider (PCP), yet few reported seeking care when sick (33 %). Nineteen percent of students reported having a mental health provider, fewer than reported having a PCP (p<0.0001). Twenty-five percent of students reported increased mental health needs since beginning medical school, and these students were more likely to agree that their needs were untreated. The majority of students endorsed stress, which correlated with increased and unmet mental health needs (p<0.001). Burnout peaked in second- and third-year students and correlated with stress and increased and untreated needs. Most students reported comfort with asking for academic help; those uncomfortable were more likely to have mental health needs for which they did not seek treatment (p=0.004). Mental health stigma was low. CONCLUSIONS Medical students had a significant unmet need for health care, influenced by barriers to accessing care, stress, burnout, and depression. Academic help seeking and supportive faculty relationships appear related to mental health treatment seeking. Targeted interventions for stress and burnout reduction, as well as incorporation of reflective practice, may have an impact on overall care seeking among medical students. Future studies should expand to other medical and professional schools.
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Affiliation(s)
- Jessica A Gold
- Stanford University School of Medicine, Stanford, CA, USA,
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Gold JA, Grill M, Peterson J, Pilcher C, Lee E, Hecht FM, Fuchs D, Yiannoutsos CT, Price RW, Robertson K, Spudich S. Longitudinal characterization of depression and mood states beginning in primary HIV infection. AIDS Behav 2014; 18:1124-32. [PMID: 24385231 DOI: 10.1007/s10461-013-0688-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Though depression is known to frequently afflict those with chronic HIV, mood during the early course of HIV is not well characterized. In a prospective study we assessed mood during primary HIV infection [primary HIV infection (PHI), <1 year duration], its association with neuropsychological performance and markers of neurological disease, and its longitudinal course including effects of antiretroviral therapy (ART). The Beck Depression Inventory (BDI) and Profile of Mood States (POMS) subscales were longitudinally administered prior to and after ART in PHI subjects. This evaluation of mood was done concurrently with blood, cerebrospinal fluid (CSF) and neuropsychological [total z and global deficit score (GDS)] evaluation at each visit. Analysis employed Spearman's rho, logistic regression, and linear mixed models. 47.7 % of the 65 men recruited at a median 3.5 months HIV duration met BDI criteria for clinical depression at baseline, classified as 'mild' (n = 11), 'moderate' (n = 11), or 'severe' (n = 9). Drug, alcohol, and depression history did not associate with BDI score. Proportional somatic-performance scores were worse than cognitive-affective scores (p = .0045). Vigor subscore of POMS was reduced compared to norms and correlated with total z (r = 0.33, p = 0.013) and GDS (r = -0.32, p = 0.016). BDI and POMS correlated with one another (r = 0.85, p < .0001), but not with CSF or plasma HIV RNA, WBC, albumin ratio or neopterin. Improvement was not observed in BDI and POMS over 330 total follow-up visits, even after initiation of ART. Depression was prevalent during PHI in our subjects, associated with abnormal somatic-performance and vigor scores. Neither neuropsychological performance nor disease biomarkers correlated with depressed mood. Mood indices did not improve over time in the presence of ART.
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Affiliation(s)
- Jessica A Gold
- Department of Neurology, Yale University School of Medicine, 300 George Street, Room 8300c, New Haven, CT, USA,
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Abstract
Background and Objectives: Despite the need for more primary care physicians, the number of medical students choosing primary care careers remains lower than other specialties. While undergraduate premedical education is an essential component in the development of future physicians, little is known about undergraduate students’ perspectives on becoming primary care physicians. To better understand the early factors in career selection, we asked premed and former premed students their perceptions of primary care. Methods: Open-ended, semistructured interviews were conducted with 58 undergraduate students who represented three different groups: those who were currently premed and science majors, those who were nonscience majors and were currently premed, and those who were formerly premed. Specifically, we asked, “Why do you think there is a shortage of people who go into primary care?” Results: Undergraduates cited financial reasons, lack of “glamour,” and the career being “uninteresting.” Many believed that primary care lacked prestige, and others felt it had a negative stigma attached. Most had never even considered a career in primary care. A number of students also misunderstood what a career in primary care actually entailed. Conclusions: As early as freshman year in college, undergraduate students harbor misconceptions and negative opinions about primary care. Many of those who express interest in such a career seem to drop out of the premedical program. It is important to consider the early onset of these attitudes and a way to target this interested population when trying to address the shortage of primary care physicians.
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Affiliation(s)
| | - Frances K. Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine, Philadelphia, PA, USA
| | - Katherine Margo
- Department of Family Medicine and Community Health, Perelman School of Medicine, Philadelphia, PA, USA
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Gold JA, Wong KR. Shortening medical education. JAMA 2012; 308:134-5; author reply 136. [PMID: 22782408 DOI: 10.1001/jama.2012.7016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Garavelli L, Leask K, Zanacca C, Pedori S, Albertini G, Della Giustina E, Croci GF, Magnani C, Banchini G, Clayton-Smith J, Bocian M, Firth H, Gold JA, Hurst J. MRI and neurological findings in macrocephaly-cutis marmorata telangiectatica congenita syndrome: report of ten cases and review of the literature. Genet Couns 2005; 16:117-28. [PMID: 16080291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
MRI and neurological findings in macrocephaly-cutis marmorata telangiectatica congenita syndrome: report of ten cases and review of the literature: We describe the clinical history and magnetic resonance imaging (MRI) findings in 10 children with the Macrocephaly-Cutis Marmorata Telangiectatica Congenita syndrome (M-CMTC--MIM 602501). This syndrome has recently been delineated within the general group of patients with Cutis Marmorata Telangiectatica (CMTC) as a distinct and easily recognisable entity. In contrast to most children with CMTC, patients with M-CMTC syndrome have a high risk of neurological abnormalities, such as hydrocephalus, megalencephaly, developmental delay and mental retardation. An MRI scan showed structural cerebral abnormalities in all of our patients, including megalencephaly, asymmetry of the cerebral hemispheres and abnormally increased signal of white matter. Seven patients also had Chiari type I malformation. Reviewing all reported cases, we propose appropriate surveillance for known complications.
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Affiliation(s)
- L Garavelli
- Department of Paediatrics and Genetics Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy.
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Gold JA, Blustein J, Michalowski K, Stone D, Spurlin D. Increasing lipid testing in African-Americans with diabetes. WMJ 2002; 100:69-70. [PMID: 11579804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Gold JA, Spurlin D. Ask, assess, advise, assist, arrange are keys to smoking cessation. WMJ 2001; 100:77-8. [PMID: 11491040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Gold JA, Frisch J, Spurlin D. Increasing the use of ACE inhibitors in heart failure treatment. WMJ 2001; 100:44. [PMID: 11315447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Gold JA, Spurlin D. New guidelines published for managing community-acquired pneumonia. WMJ 2000; 99:59. [PMID: 11220199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Gold JA, Frisch J, Pepple S, Spurlin D. A systems approach works best for smoking cessation. WMJ 2000; 99:59. [PMID: 11149263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Gold JA, Spurlin D, Frisch J. MetaStar launches initiative to increase dilated eye exam rate among Medicare beneficiaries with diabetes. WMJ 2000; 99:49. [PMID: 11089451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Abstract
We report an illustrative case of advanced "hut lung," or domestically acquired particulate lung disease (DAPLD), in a recently emigrated nonsmoking Bangladeshi woman with a history of 171 hour-years of exposure to biomass smoke. She presented with symptoms of chronic cough, dyspnea, and early parenchymal lung disease. High-resolution computed tomography (CT) of the chest demonstrated numerous 2- to 3-mm nodules, sparing the pleural surface. To our knowledge, this is the first such report of CT findings in the literature. Bronchoscopy yielded typical anthracotic plaques and diffuse anthracosis with interstitial inflammation on histopathologic examination of biopsy specimens. DAPLD is potentially the largest environmentally attributable disorder in the world, with an estimated 3 billion people at risk. Caused by the inhalation of particles liberated from the combustion of biomass fuel, DAPLD results in significant morbidity from infancy to adulthood. Clinically, DAPLD manifests a broad range of disorders from chronic bronchitis and dyspnea to advanced interstitial lung disease and malignancy. While a detailed environmental history is essential for making the diagnosis in most individuals, for patients with advanced DAPLD, invasive modalities such as bronchoscopy with transbronchial biopsy and examination of bronchoalveolar lavage fluid help differentiate it from other diseases. Recognition of this syndrome and removal of the patient from the environment is the only treatment. The development of well-controlled interventional trials and the commitment of sufficient resources to educate local populaces and develop alternative fuel sources, stove designs, and ventilation are essential toward reducing the magnitude of DAPLD.
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Affiliation(s)
- J A Gold
- Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, Bellevue Chest Service, New York 10016, USA
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Gold JA, Spurlin D. MetaStar sets Right Meds, Right Time workshops. WMJ 2000; 99:80-1. [PMID: 10927989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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