[Review] Alcohol and illicit substance abuse in people with diabetes

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As the prevalence of type 1 and type 2 diabetes increases and population-level patterns of alcohol and illicit drug use evolve, clinicians will continue to encounter people with diabetes whose substance use is affecting health outcomes. Substance use contributes substantially to the population-level prevalence of cardiovascular events, cerebrovascular events, cancers, mental health conditions, road trauma, and domestic violence. Alcohol and drug use also have a measurable effect on diabetes incidence and the development of both acute and chronic diabetes-related complications.

Growth Factors, Oxidative Damage, and Inflammation in Exfoliation Syndrome

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Exfoliation syndrome (XFS) produces deleterious ocular aging and has protean systemic manifestations. Local ocular production of TGFβ1 is of central importance in XFS. TGFβ1 appears to induce the expression of LOXL1 and the production of other extracellular matrix components which are known to be present in exfoliation material. Furthermore, results from several studies find that the aqueous humor of exfoliation glaucoma patients exhibits a decreased antioxidant defense and increased oxidative stress systems. Finally, studies show that the levels of interleukin-6 and interleukin-8 in the aqueous humor of XFS patients were 3-fold higher than in controls. Overall TGFβ1, as well as a prooxidative and proinflammatory environment seems to play an important role in XFS.

From depression to dementia, inflammation is medication’s new frontier|Edward Bullmore

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The barrier between mind and body appears to be crumbling. Clinical practice and public perception need to catch up

Unlikely as it may seem, #inflammation has become a hashtag. It seems to be everywhere suddenly, up to all sorts of tricks. Rather than simply being on our side, fighting infections and healing wounds, it turns out to have a dark side as well: the role it plays in causing us harm.

It’s now clear that inflammation is part of the problem in many, if not all, diseases of the body. And targeting immune or inflammatory causes of disease has led to a series of breakthroughs, from new treatments for rheumatoid arthritis and other auto-immune diseases in the 1990s, through to the advent of immunotherapy for some cancers in the 2010s. Even more pervasively, low-grade inflammation, detectable only by blood tests, is increasingly considered to be part of the reason why common life experiences such as poverty, stress, obesity or ageing are bad for public health.

Related: Joining a choir helped me combat anxiety and find a meditative state of pure joy

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Help APA Understand How Burnout Affects Different Groups

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APA’s Committee on Well-being and Burnout wants to know more about psychiatrists’ experiences with burnout and/or depression.

APA members are urged to complete a new survey/self-assessment tool developed by the committee that includes questions about demographics (age, gender, geographic location, minority status, and other variables) and practice setting (private practice, group practice, community mental health center, academic medical center, etc.). The survey also includes questions about burnout using the Oldenburg Burnout Inventory and the Patient Health Questionnaire-9 (PHQ-9) to screen for depression. The survey can be completed in under 20 minutes.

All data will be kept anonymous.

“We hope to learn more about well-being and burnout among psychiatrists in general and among minority and underrepresented psychiatrists, specifically,” said Uchenna Okoye, M.D., M.P.H., a member of the committee.

An earlier online survey created by the committee established that burnout was a significant issue among APA members. In a 2018 report to the Board of Trustees, the committee stated that of the more than 1,900 psychiatrists who had taken the survey, 73% scored above 35 on the Oldenburg Burnout Inventory—indicating they were at risk for burnout. The survey also found that 15% of the respondents had a PHQ-9 score greater than 10, which indicates the presence of moderate to severe depression. Burnout scores were correlated with gender (women typically had higher scores), recent medical school graduation, and perceived inability to control one’s schedule. Among non-depressed respondents, burnout scores were slightly lower for psychiatrists who worked in academic and academic-affiliated practice settings.

The new survey will help drill down further to understand whether burnout affects members of minority groups differently. “We know a lot about burnout, but we don’t know much about the rates or causes of burnout in minority and underrepresented psychiatrists,” Okoye said. “If you belong to one or more minority or underrepresented groups—for example, if you are a woman, belong to a racial or ethnic minority, are an international medical graduate, identify as LGBTQ+, or belong to another group—your voice may not have been heard in this national conversation.”

Past APA President Carol Bernstein, M.D., also a member of the committee, said research on how burnout affects particular groups will help all psychiatrists affected by the problem. “I urge members to log onto the survey,” she said. “Understanding more about this issue and developing potential strategies to address it are important for the field of psychiatry, and for all of us in it.”

Click here to learn more about what APA is doing to address burnout.

(Image: Adam Scott)

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