Neuropsychiatric comorbidity among adolescents with psoriasis

Psoriasis is a common skin disease, typically presenting as a red scaly rash. In mild cases it can be treated with creams, while in patients with so called “moderate to severe psoriasis”, where it is extensive or cannot be controlled with creams only, a systemic treatment, such as pills and phototherapy, is necessary. Psoriasis affects about 2% of adults. It commonly develops in adulthood, but can also be seen in children and adolescents. As might be expected, psoriasis may be physically and emotionally disabling. Growing data suggests that psoriasis patients are at risk of suffering from multiple medical conditions, including mental health disorders (e.g depression) and neurological disorders (e.g migraine). This study, from Israel, aimed to find out whether psoriasis carries a risk of suffering from mental health and neurological disorders, focusing on adolescents, an age group which was previously less studied for these conditions. Data were retrieved from records of recruits evaluated for military service. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate to severe psoriasis, respectively, and compared them to 884653 healthy adolescents. Differences in the prevalence of the following medical conditions were found between adolescents with moderate to severe psoriasis and healthy adolescents: Overall chronic headaches (8.1% vs. 3.4%), intermediate frequency migraine (4.8% vs. 1.6%), low frequency migraine and non‐migraine headaches (3.4% vs. 1.8%), anxiety (2.1% vs. 0.7%) and social adjustment disabilities (7.5% vs. 4.2%). Interestingly, mild psoriasis was not shown to carry a risk for these conditions. The authors conclude that adolescents with psoriasis, especially those with a moderate to severe disease, are at risk of neurological and mental health disorders. The authors call for physicians’ awareness of these conditions, alongside the need for psychological counselling.     

High-throughput sequencing analysis of nuclear-encoded mitochondrial genes reveals a genetic signature of human longevity

GeroScience - Mitochondrial dysfunction is a well-known contributor to aging and age-related diseases. The precise mechanisms through which mitochondria impact human lifespan, however, remain...     

Surprising pandemic experiences: A confrontation between principle-based and virtue ethics,and a plea for virtue ethics training for medical students and residents. A rudimentary outline of a four-step model

Background

In past years, physicians have, with a certain continuity, reported increasing numbers of burnout, depression and compassion fatigue in their daily practice. These problems were attributed, not only but also, to a loss of public trust and an increase in violent behaviour of patients and family members towards medical professionals in all walks of life. Recently, however, during the breakout of the coronavirus disease 2019 (COVID-19) pandemic in 2020, there were public expressions of appreciation and respect for health care workers that almost universally have been assessed as indications of a re-establishment of public trust in physicians and appreciation for the medical professions' commitments. In other words, shared experiences of what society was in need of: the experience of a ‘common good’. Those responses during the COVID-19 pandemic increased positive feelings among practicing physicians, such as commitment, solidarity, competency, and experiences concerning obligations for the common good and a sense of belonging to one and the same community for all. Essentially, these responses of raised self-awareness of commitment and solidarity between (potential) patients and medical personal point towards the social importance and power of these values and virtues. This shared domain in ethical sources of behaviour seems to hold a promise of overcoming gaps between the different spheres of doctors and patients. That promise justifies stressing the relevance of this shared domain of Virtue Ethics in the training of physicians.

Methods

In this article, therefore, we shall make a plea for the relevance of Virtue Ethics before proposing an outline of an educational programme for Virtue Ethics training for medical students and residents. Let us start by very briefly presenting on Aristotelian virtues and its relevance to modern medicine in general, and during the current pandemic in particular.

Results

We shall follow up this short presentation by a Virtue Ethics Training Model and the respective settings in which it takes place. This model has four steps as follows: (a) include moral character literacy in the formal curriculum; (b) provide ethics role modelling and informal training in moral character in the healthcare setting by senior staff; (c) create and apply regulatory guidelines regarding virtues and rules; and (d) assess success of training by evaluation of moral character of physicians.

Conclusion

Applying the four-step model may contribute to strengthening the development of moral character in medical students and residents, and decrease the negative consequences of moral distress, burnout and compassion fatigue in health care personnel. In the future, this model should be empirically studied.     

Psychological and somatic symptoms among breast cancer patients in four European countries: A cross-lagged panel model

Psychological and physical health among women with breast cancer are linked. However, more research is needed to test the interrelations between psychological and somatic symptoms, over time and throughout the different phases of breast cancer treatment, to determine when and which interventions should be prioritized. Six hundred and eighty nine women from four countries (Finland, Israel, Italy and Portugal) completed questionnaires during their first clinical consultation following diagnosis with breast cancer, and again after 3 and 6 months. The questionnaires included self-reported measures of psychological symptoms (Hospital Anxiety and Depression Scale; the Positive and Negative Affect Schedule Short Form) and somatic symptoms [selected items from the International European Organization for Research and Treatment of Cancer (EORTC) questionnaires]. Psychological and somatic symptoms were relatively stable across the three time-points. Cross-lagged paths leading from somatic to psychological symptoms (beta coefficients of 0.08–0.10), as well as vice-versa (beta 0.11–0.12), were found to be significant. No evidence was found for cross-cultural differences in mutual effects of psychological and somatic symptoms. The findings of this study call for tailoring personal interventions for breast cancer patients—either from a somatic perspective or a psychological perspective—and adjust them to the specific experiences of the individual patient.