Publications

PURPOSE

To determine the prevalence and requirements of structured, longitudinal, nondegree global health (GH) programs (e.g., certificates, tracks, concentrations) in U.S. MD-granting medical schools.

METHOD

In March 2011, two reviewers independently searched the Web sites of all 133 U.S. MD-granting medical schools and reviewed Google search results seeking evidence of, information about, and the requirements of structured GH programs. The authors excluded programs that were not open to medical students, granted a degree, and/or required medical students to extend training time.

RESULTS

Of 133 institutions analyzed, 32 (24%) had evidence of a structured GH program. Of the 30 (94%) programs for which the authors could find further information online, 16/30 (53%) were administered by the medical school, whereas 13/30 (43%) were administered by a different entity within the university; 1/30 (3%) was jointly administered. All 30 of the programs required additional didactic course work. The median number of courses was 4 (range: 1-12). Of the 30 schools with GH programs, 22 (73%) required an international experiential component, but only 12/30 (40%) specifically required an international clinical experience. Only 1 school (3%) directly addressed language or cultural proficiency.

CONCLUSIONS

Although structured GH programs were offered at one-quarter of U.S. medical schools, little standardization across programs existed in terms of requirements for didactic, clinical, scholarly, and cultural components. Online GH program information is not easily accessible, but it may be valuable in the development of new structured programs, the refinement of programs that already exist, and students' selection of medical schools.

Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis, first characterized in 2005, is a neurological disease with prominent psychiatric features that frequently involves the consultation of psychiatrists. Since its discovery, the rate of diagnosis of new cases has increased rapidly and several epidemiological studies now confirm that NMDA-R encephalitis may be as common as many other prominent infectious etiologies of encephalitis. We describe a case of a young woman presenting initially with psychotic and mood symptoms who was found to have anti-NMDA-R encephalitis. We further provide details of her treatment and prolonged recovery process after hospital discharge with a review of the literature and discussion of the epidemiology, symptomology, diagnosis, and management of both the neurologic and psychiatric manifestations of this condition. Last, we contextualize the importance of anti-NMDA-R encephalitis for psychiatrists, highlighting the role for psychiatrists in establishing the initial diagnosis as well as in providing ongoing psychiatric care.

During the past two decades, research in the field of depression and cardiovascular disorders has exploded. Multiple studies have demonstrated that depression is more prevalent in populations with cardiovascular disease, is a robust risk factor for the development of cardiovascular disease in healthy populations, and is predictive of adverse outcomes (such as myocardial infarction and death) among populations with preexisting cardiovascular disease. Mechanistic studies have shown that poor health behaviors, such as physical inactivity, medication nonadherence, and smoking, strongly contribute to this association. Small randomized trials have found that antidepressant therapies may improve cardiac outcomes. Based on this accumulating evidence, the American Heart Association has recommended routine screening for depression in all patients with coronary heart disease. This review examines the key epidemiological literature on depression and cardiovascular disorders and discusses our current understanding of the mechanisms responsible for this association. We also examine current recommendations for screening, diagnosis, and management of depression. We conclude by highlighting new research areas and discussing therapeutic management of depression in patients with cardiovascular disorders.

The need for lengthy treatment to cure tuberculosis stems from phenotypic drug resistance, also known as drug tolerance, which has been previously attributed to slowed bacterial growth in vivo. We discuss recent findings that challenge this model and instead implicate macrophage-induced mycobacterial efflux pumps in antimicrobial tolerance. Although mycobacterial efflux pumps may have originally served to protect against environmental toxins, in the pathogenic mycobacteria, they appear to have been repurposed for intracellular growth. In this light, we discuss the potential of efflux pump inhibitors such as verapamil to shorten tuberculosis treatment by their dual inhibition of tolerance and growth.