Cameron Kohji Ormiston

Substance use among medical students is high, has had fatal consequences, and continues postgraduation, with substance use rates among physicians being higher than the general population. Unfortunately, many institutions lack specific policies on substance use, have policies centered on punitive and disclosure-prohibitive approaches, or students are unaware of such policies. Notably, though physical and mental wellness are typical components of medical school curricula and policy, student substance use is often glaringly absent. As a result, schools can be unprepared to address substance use and students can be left feeling unsupported as they grapple with their evolving role in medicine—some of whom may use drugs during this time. Reasons for the shortcomings in addressing student substance use are multifactorial, with stigma, dwindling preclinical time, and overconfidence possibly playing a role. To address this problem, schools must integrate into their undergraduate medical wellness curricula a harm reduction framework that (1) includes student perspectives and input, (2) changes school culture, and (3) improves access to harm reduction education and resources as well as substance use and mental health treatment. Preparing students for their own interactions with alcohol or drugs must be a priority, especially as they enter a profession with a multitude of overlapping risk factors for unhealthy alcohol and drug use, and this must be done in a destigmatizing, supportive, and compassionate way.

Statins play an instrumental role in reducing and managing atherosclerotic cardiovascular disease (ASCVD) but can be difficult to tolerate due to muscle‐associated side effects. There remains an unmet need for strategies that improve statin tolerance and synergize their effect on atherogenic lipids. (−)‐Epicatechin (Epi) is a natural flavonoid that can improve lipid biomarkers and mitochondrial function. This study explored the capacity of Epi to augment statin's beneficial effects on lipid profile and ASCVD risk parameters. In total, 19 patients completed a randomized, double‐blind placebo‐controlled trial. The study consisted of two cohorts. Cohort 1 consisted of healthy patients with elevated low‐density lipoprotein (LDL) > 100 mg/dL and was used to determine appropriate Epi dosing. Cohort 2 consisted of patients with metabolic syndrome. Patients were randomized into statin‐only (n = 8; 5 in Cohort 2) or statin + Epi (n = 11; 8 in Cohort 2) for 3 months. VO₂ max and lipid biomarkers were assessed at baseline and at the end of 3 months. Final analysis included Cohort 2 only. The statin + Epi group saw significant beneficial changes in total cholesterol (p = 0.002) and non‐HDL cholesterol (p = 0.007). There was a significantly larger increase in HDL (p = 0.037) and significantly greater decrease in LDL particle number (p = 0.0003) and small LDL particle number (p = 0.003) among the statin + Epi group compared to statin‐only. Ten‐year ASCVD risk was significantly lower at end‐of‐study for the statin + Epi arm compared to statin‐only (p < 0.05). No VO₂ max differences were found. This is the first proof‐of‐concept study to show combination therapy of a statin with Epi is safe and effective in augmenting statin‐associated improvements in lipid biomarkers.Trial Registration: ClinicalTrials.gov: NCT02490527

Background: Opioid use disorder (OUD) is often under-addressed in hospitalized patients. In the absence of formal addiction consult services, volunteer physician-led models can increase access to inpatient OUD treatment. This paper describes a novel, volunteer physician-led interprofessional approach to identifying patients with OUD, initiating buprenorphine, and linking to office-based opioid treatment. Methods: The intervention took place from April 2018 to August 2020 at a large, urban, tertiary care center and teaching hospital in New York, NY that does not have an addiction consult service. Hospitalized patients with OUD were identified by provider-driven referrals or an automated daily patient list generated by a bioinformatics search algorithm. Eligible patients with OUD were started on buprenorphine during their hospitalization and linked to primary care-based buprenorphine treatment. Patients were followed longitudinally via chart review to assess follow-up clinic rates at >30 days, >60 days, >90 days, >6 months, >12 months, and >24 months after discharge. Results: Over a 2-year period, 178 patients were evaluated, 88 were eligible for inpatient buprenorphine, and 47 were started on buprenorphine while hospitalized. Sixty-seven patients were referred to a post-discharge visit at a primary care practice, 29 (43%) of whom attended an appointment at least 30 days after discharge. Of these, 22 (76%) returned at >60 days and 20 (69%) at 6 months. At the 1-year time point, 16 of a possible 17 patients (94%) and 15 of a possible 16 patients (94%) were still engaged in care at 2 years. Conclusion: This intervention represents a proof of principle, adaptable model for identifying patients with OUD and engaging patients in primary care-based buprenorphine treatment. Limitations to consider include the sustainability of a volunteer-based initiative and that retention rates for 1 to 2 years post-discharge may be more indicative of the strengths of office-based opioid treatment itself as opposed to in-hospital engagement and the intervention.

Knowledge of Mexican immigrant sleep health is limited. We investigated the association between acculturation, depression, and having trouble sleeping among a nationally representative sample of Mexican immigrant adults. We used a logistic regression model on cross-sectional data from the 2005–2018 National Health and Nutrition Examination Survey on 2,670 non-U.S.-born Mexican adults aged ≥18 years old. Living in the U.S. for ≥10 years (Adjusted Odds Ratio (AOR) = 2.18; 95% Confidence Interval (CI) = 1.39–3.41), speaking majority English (AOR = 1.62; 95% CI = 1.00–2.64), and mild (AOR = 2.70; 95% CI = 1.82–4.02), moderate (AOR = 3.96; 95% CI = 2.53–6.19), and moderately severe/severe (AOR = 5.75; 95% CI = 3.08–10.75) depression levels were associated with having trouble sleeping. Non-U.S. citizenship status was associated with lower odds of having trouble sleeping (AOR = 0.62; 95% CI = 0.43–0.88). Greater acculturation and depression are associated with higher odds of having trouble sleeping. We provide new knowledge on how citizenship status may be linked to the sleep health of Mexican immigrant communities.

Background: Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. Objective: This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. Methods: Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. Results: Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. Conclusions: Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity.

In the United States, Asian and Pacific Islander (A/PI) communities have faced significant discrimination and stigma during the COVID-19 pandemic. We assessed the association between discrimination and depression, anxiety, and loneliness symptoms among Asian or Pacific Islander adults (n = 543) using data from a 116-item nationally distributed online survey of adults (≥ 18 years old) in the United States conducted between 5/2021–1/2022. Discrimination was assessed using the 5-item Everyday Discrimination Scale. Anxiety, depression, and loneliness symptoms were assessed using the 2-item Generalized Anxiety Disorder, 2-item Patient Health Questionnaire, and UCLA Loneliness Scale—Short form, respectively. We used multivariable logistic regression to estimate the association between discrimination and mental health. Overall, 42.7% of participants reported experiencing discrimination once a month or more. Compared with no discrimination, experiencing discrimination once a month was associated with increased odds of anxiety (Adjusted Odds Ratio [aOR] = 2.60, 95% CI = 1.38–4.77), depression (aOR = 2.58, 95% CI = 1.46–4.56), and loneliness (aOR = 2.86, 95% CI = 1.75–4.67). Experiencing discrimination once a week or more was associated with even higher odds of anxiety (aOR = 6.90, 95% CI = 3.71–12.83), depression, (aOR = 6.96, 95% CI = 3.80–12.74), and loneliness (aOR = 6.91, 95% CI = 3.38–13.00). Discrimination is detrimental to mental health, even at relatively low frequencies; however, more frequent discrimination was associated with worse mental health symptoms. Public health interventions and programs targeting anti-A/PI hate and reducing A/PI mental health burden are urgently needed.

Suicide remains one of the leading causes of death among adolescents in the US. From 2018 to 2021, suicide was the second leading cause of death for adolescents aged 10 to 14 years and the third leading cause of death among those aged 15 to 19 years.¹ Suicide is linked to numerous, overlapping factors and paths of marginalization, including mental health conditions, historical and intergenerational trauma, discrimination, neighborhood deprivation, accessibility to lethal means, exposure to violence and abuse, and, more recently, the COVID-19 pandemic.^2-6 Although older and male adolescents have historically had higher suicide rates than younger and female adolescents, respectively,^7,8 recent evidence suggests these gaps may be closing as suicide rates are increasing more rapidly for female adolescents than male adolescents.^9,10 Previous reports identified racial and ethnic differences in adolescent suicide; in recent years, the adolescent suicide rate among Black and Asian and Pacific Islander individuals has increased rapidly, whereas the rate among White individuals has decreased.^11-13 Race and ethnicity are social constructs; hence, racial and ethnic differences in health may be driven by social determinants, environment, and systems of oppression and marginalization that produce disparities in health and longevity.¹⁴