Mental Health and Service Impacts During COVID-19 for Individuals with Serious Mental Illnesses Recently Released from Prison and Jail

The Journal of Behavioral Health Services & Research - Individuals recently released from jail or prison with serious mental illnesses may be vulnerable to the coronavirus pandemic. This study...     

Beyond the barriers: family medicine residents' attitudes towards providing Aboriginal health care

Medical Education 2011: 45 : 400–406 Context Health care is one of many under‐resourced areas in Aboriginal communities in Canada. Aboriginal people have substandard health compared with the general population, yet have less access to health care services. Not only is there a paucity of Aboriginal doctors, but it also appears that few non‐Aboriginal doctors are willing or able to work in Aboriginal contexts. Objectives This study examines the attitudes of family medicine residents towards providing health care to Aboriginal patients. The goal of this study was to assess the willingness of family medicine residents to work in Aboriginal health care and to elucidate the major factors that inform these attitudes. Methods We conducted a cross‐sectional survey of an urban cohort of family medicine residents using a convenience sample. Our survey instrument consisted of a questionnaire comprising a mixture of open‐ended and closed questions. Results Although a majority (52%, n = 27) of the family medicine residents were willing to work in Aboriginal contexts, many felt underprepared to do so (40%, n = 21). Residents who have had some exposure to Aboriginal issues and have had community experiences are more likely to state an intention to work in Aboriginal settings. Conclusions The results of this study encourage the creation of educational experiences for medical residents that may promote a desire to work in Aboriginal communities.     

Brief Report: Perception of Genuine and Posed Smiles by Individuals with Autism

Individuals with autism are impaired in the recognition of fear, which may be due to their reduced tendency to look at the eyes. Here we investigated another potential perceptual and social consequence of reduced eye fixation. The eye region of the face is critical for identifying genuine, or sincere, smiles. We therefore investigated this ability in adults with autism. We used eye-tracking to measure gaze behaviour to faces displaying posed and genuine smiles. Adults with autism were impaired on the posed/genuine smile task and looked at the eyes significantly less than did controls. Also, within the autism group, task performance correlated with social interaction ability. We conclude that reduced eye contact in autism leads to reduced ability to discriminate genuine from posed smiles with downstream effects on social interaction.     

Early combination disease modifying antirheumatic drug treatment for rheumatoid arthritis

Most people presenting with rheumatoid arthritis today can expect to achieve disease suppression, can avoid or substantially delay joint damage and deformities, and can maintain a good quality of life. Optimal management requires early diagnosis and treatment, usually with combinations of conventional disease modifying antirheumatic drugs (DMARDs). If these do not effect remission, biological DMARDs may be beneficial. Lack of recognition of the early signs of rheumatoid arthritis, ignorance of the benefits of early application of modern treatment regimens, and avoidable delays in securing specialist appointments may hinder achievement of best outcomes for many patients. Triage for recognising possible early rheumatoid arthritis must begin in primary care settings with the following pattern of presentation as a guide: involvement of three or more joints; early-morning joint stiffness of greater than 30 minutes; or bilateral squeeze tenderness at metacarpophalangeal or metatarsophalangeal joints.     

Effectiveness of biologics in Australian patients with rheumatoid arthritis: a large observational study: REAL

Background

The comparative effectiveness of biologic treatment regimens in a real world Australian population is unknown.

Aim

To assess the effectiveness of biological disease‐modifying anti‐rheumatic drugs (bDMARD) as monotherapy or in combination with methotrexate and/or other conventional DMARD (cDMARD) for the treatment of rheumatoid arthritis (RA).

Methods

A retrospective, non‐interventional study was conducted that investigated the use of bDMARD in adult patients with RA in routine clinical practice. Data were extracted from the Optimising Patient Outcomes in Australian Rheumatology – Quality Use of Medicines Initiative database. Real‐world effectiveness was measured using the 28‐joint disease activity score (DAS28) and clinical disease activity index (CDAI) by treatment group at baseline, weeks 12 and 24.

Results

A total of 2970 patients was included with a median (min–max) age of 60.0 (19.0–94.0) years and median (min–max) duration of RA before first bDMARD treatment of 6.0 (0.2–58.3) years. A total of 1177 patients received more than one bDMARD during the analysis period of 1 January 1997 to 15 August 2015. Patients had 4922 treatment ‘episodes’ (defined as a cycle of continuous individual bDMARD prescribing in a single patient). Patients received a mean (SD) of 1.7 (1.0) episodes of treatment with median (min–max) treatment duration of 0.7 (0–11.8) years; median treatment duration was higher with the first treatment episode. bDMARD were most commonly initiated in combination with methotrexate (73.9% of episodes) and least commonly as monotherapy (9.9% of episodes). Median (min–max) baseline DAS28 decreased from 5.3 (0–8.7) with the first bDMARD to 3.7 (0–8.8) with the second. Median baseline CDAI similarly decreased.

Conclusions

Patients tended to persist longer on their first bDMARD treatment. bDMARD as monotherapy or in combination appear to be accepted treatment strategies in the real world.     

Microcystic Adnexal Carcinoma in the Axilla of an 18‐Year‐Old Woman

Microcystic adnexal carcinoma (MAC) is an uncommon adnexal neoplasm with a predilection for the head and neck. The tumor rarely metastasizes but is locally aggressive and commonly demonstrates perineural invasion. MAC occurs most often in older adults. This report describes a young woman with a MAC in her left axilla who required two stages of Mohs micrographic surgery followed by a wide local excision because of persistent perineural invasion in close proximity to the brachial plexus. Other cases presenting in the pediatric age group are discussed.