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Objectives: The study aimed to evaluate attitudes of Japanese medical students toward career development, including the acquisition of medical specialty and doctorate degree qualifications., Design: This involved a web-based questionnaire survey., Setting: We asked medical students about attitudes toward career development after graduation. We also asked them about their intentions to acquire a medical specialty and a doctorate degree using a 5-point Likert scale., Participants: All 699 medical students (from first to sixth grade) in our medical school., Results: The overall questionnaire response rate was 66.5% (465 of 699). Over 90.3% (420 of 465) of respondents desired the clinical discipline, while only 10 of 465 respondents (2.2%) did for basic research. Awareness of career development for ≥8 years after graduation was significantly lower compared with that for 1-2 years after graduation among fourth-sixth year students (fourth p=0.0023, fifth p<0.001, sixth p<0.001). Awareness of career development for 3-7 years after graduation was significantly lower compared with that for 1-2 years after graduation among third-sixth year students (third p<0.001, fourth p=0.003, fifth p<0.001, sixth p<0.001). In the sixth year medical students, only 10.3% showed strong awareness of career development for ≥8 years after graduation, while 39.7% of them did for 1-2 years after graduation. Intentions to acquire a doctorate degree were significantly weaker than those for a medical specialty in all years (p<0.001 in all grades)., Conclusion: Most Japanese medical students concentrated on the 2-year initial training period immediately after graduation, with vague plans for the subsequent years. Intentions to acquire a doctoral degree were significantly lower than those for a medical specialty. Our findings underscore the necessity for a comprehensive, longitudinal and systematic career development programme., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Chronic pain among active duty service members can negatively impact operational readiness and contributes to significant health care costs within military treatment facilities. Response to standard medical intervention (SMI) for chronic pain is highly variable. The objective of the current study was to examine whether mental health indicators predict individual variation in response to SMI for chronic pain in a military pain specialty clinic., Methods: This is a retrospective observational study of data previously collected at the Pain Medicine Center at Naval Medical Center San Diego (NMCSD) approved by the NMCSD Institutional Review Board. We included 286 ADSMs who completed the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) at two assessment points (mean = 118.45 days apart, SD = 37.22) as part of standard care. Hierarchical linear regression analyses were conducted to examine whether pretreatment mental health measures predict changes in the pain impact score (PIS)-a composite measure of pain intensity, pain interference, and physical functioning-over the course of treatment., Results: After controlling for pretreatment PIS, pretreatment PTSD symptoms, fatigue, and anger were all significant predictors of posttreatment PIS: Higher PTSD symptoms, higher fatigue, and lower anger predicted poorer response to treatment (all Ps < .05)., Conclusion: Higher pretreatment PTSD and fatigue symptoms may portend poorer response to SMI for chronic pain. Poor response to treatment may also be predicted by lower pretreatment anger. Further investigation is warranted to identify the best strategies for treating chronic pain in military treatment facilities when these conditions are identified during initial evaluation., (© The Association of Military Surgeons of the United States 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

While the term "screen addiction" or "social media addiction" is gaining steam in the popular media, preclinical, clinical, and population health research have not caught up with regards to the diagnosis and treatment of unhealthy screen use. The overarching goal of this article is to provide broad clinical tips to generalists, working outside the mental health specialty, on the evaluation and treatment of unhealthy screen exposure in children and young adults. We will clarify the difference between addiction and overuse, and why this distinction matters. Recognizing that screens are here to stay in the post-COVID era, we will provide guidance on how to reduce potential harms associated with screen exposure without necessarily requiring people to abstain or stop using screens., (Copyright 2023 by the Missouri State Medical Association.)

Introduction: Persistent psychosocial problems in people with lower-limb amputation due to vascular aetiology indicate a great need for long-lasting holistic rehabilitation. An in-depth understanding of the psychosocial problems is essential for the guidance of health professionals in meeting and normalising patients' experiences and emotions. Furthermore, identifying the psychological problems may help develop effective rehabilitation and counselling programmes. This meta-aggregation study aims to explore the psychosocial perspectives of individuals who have undergone a major lower-limb amputation due to vascular aetiology during the post-discharge rehabilitation phase., Methods and Analysis: A systematic meta-aggregation study will be performed to identify full-text, peer-reviewed journal articles reporting on patients' psychosocial perspectives on major lower-limb amputation due to vascular aetiology from post-discharge to several years afterward. The databases Embase, CINAHL Ultimate, APA PsycInfo, PubMed and Scopus will be searched with no limitations regarding the publication year. Studies that satisfy the eligibility criteria will be critically appraised using an acknowledged checklist and synthesised using the Joanna Briggs Institute three-phase approach for the synthesis of meta-aggregation studies. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation- Confidence in Evidence from Reviews of Qualitative research) tool will be used to determine the level of confidence in the qualitative evidence, and the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) reporting guidelines will be followed throughout the review process., Ethics and Dissemination: Ethical approval is not required for the study, as the review is built on pre-existing available data in the literature. Findings from the review will be disseminated through publication in a peer-review journal., Prospero Registration Number: CRD42022377114., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Mental-health-related stigma among physicians towards people with mental illnesses remains a barrier to quality care, yet few curricula provide training with a proactive focus to reduce the potential negative impacts of stigma. The aim of our study was to explore medical students' perspectives on what areas of learning should be targeted (where stigma presents) and how they could be supported to prevent the formation of negative attitudes., Methods: Six focus group discussions were conducted with second, third, and fourth-year postgraduate medical students (n = 34) enrolled at The University of Melbourne Medical School in September - October 2021. Transcripts were analysed using inductive thematic analysis., Results: In terms of where stigma presents, three main themes emerged - (1) through unpreparedness in dealing with patients with mental health conditions, (2) noticing mentors expressing stigma and (3) through the culture of medicine. The primary theme related to 'how best to support students to prevent negative attitudes from forming' was building stigma resistance to reduce the likelihood of perpetuating stigma towards patients with mental health conditions and therefore enhance patient care. The participants suggest six primary techniques to build stigma resistance, including (1) reflection, (2) skills building, (3) patient experiences, (4) examples and exemplars, (5) clinical application and (6) transforming structural barriers. We suggest these techniques combine to form the ReSPECT model for stigma resistance in the curriculum., Conclusions: The ReSPECT model derived from our research could provide a blueprint for medical educators to integrate stigma resistance throughout the curriculum from year one to better equip medical students with the potential to reduce interpersonal stigma and perhaps self-stigma. Ultimately, building stigma resistance could enhance care towards patients with mental health conditions and hopefully improve patient outcomes., (© 2023. BioMed Central Ltd., part of Springer Nature.)

The international conventions and national state educational standards specify mandatory practical training on shipboard for acquiring through programs of secondary professional education professional habits and skills by students of swimming specialties. For cadets, specified temporary regime of work and rest is established. Other items concerning organization of labor activity, apply to them same rights and obligations as to regular members of crew as declared in ship's role. Since during internship the age of cadets does not exceed 18 years, occurrence of possible disorders of their mental health is urgent concern and high-risk factor for shipowner. The article describes in detail rules of organizing practical training of cadets on shipboard. The responsible persons are identified. The responsibilities of shipowner in relation to trainees are revealed. The current problematic aspects are marked and appropriate preventive measures are proposed.

Introduction: The overall prevalence of alcohol use disorders and drug use disorders in adolescents has been declining in recent years, yet little is known about treatment use for these disorders among adolescents. This study aimed to examine the patterns and demographics of treatment of alcohol use disorders, drug use disorders, and both conditions among U.S. adolescents., Methods: This study used publicly available data for adolescents aged 12-17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health, 2011-2019. Data were analyzed between July 2021 and November 2022., Results: From 2011 to 2019, fewer than 11%, 15%, and 17% of adolescents with 12-month alcohol use disorders, drug use disorders, and both conditions received treatment, respectively, with significant decreases in treatment use for drug use disorders (OR=0.93; CI=0.89, 0.97; p=0.002). Overall, treatment use in outpatient rehabilitation facilities and self-help groups was most common but decreased over the course of the study period. Extensive disparities in treatment use were further identified on the basis of adolescents' gender, age, race, family structure, and mental health., Conclusions: To improve adolescent treatment use for alcohol and drug use disorders, assessments and engagement interventions that are gender specific, developmentally appropriate, culturally sensitive, and contextually informed are especially needed., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To identify which Veteran populations are routinely accessing video-based care., Data Sources and Study Setting: National, secondary administrative data from electronic health records at the Veterans Health Administration (VHA), 2019-2021., Study Design: This retrospective cohort analysis identified patient characteristics associated with the odds of using any video care; and then, among those with a previous video visit, the annual rate of video care utilization. Video care use was reported overall and stratified into care type (e.g., primary, mental health, and specialty video care) between March 10, 2020 and February 28, 2021., Data Collection: Veterans active in VA health care (>1 outpatient visit between March 11, 2019 and March 10, 2020) were included in this study., Principal Findings: Among 5,389,129 Veterans in this evaluation, approximately 27.4% of Veterans had at least one video visit. We found differences in video care utilization by type of video care: 14.7% of Veterans had at least one primary care video visit, 10.6% a mental health video visit, and 5.9% a specialty care video visit. Veterans with a history of housing instability had a higher overall rate of video care driven by their higher usage of video for mental health care compared with Veterans in stable housing. American Indian/Alaska Native Veterans had reduced odds of video visits, yet similar rates of video care when compared to White Veterans. Low-income Veterans had lower odds of using primary video care yet slightly elevated rates of primary video care among those with at least one video visit when compared to Veterans enrolled at VA without special considerations., Conclusions: Variation in video care utilization patterns by type of care identified Veteran populations that might require greater resources and support to initiate and sustain video care use. Our data support service specific outreach to homeless and American Indian/Alaska Native Veterans., (© 2022 Health Research and Educational Trust. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background: In Canada, the demand for mental health care exceeds the provision of services. This exploratory study aimed to assess the feasibility and impact of a new service delivery model for psychological consultations in primary care settings: the Single-Session Intervention (SSI), inspired by Advanced Access (AA) principles for appointment scheduling. The specific objectives were to examine whether the SSI increases accessibility to psychological consultations, to measure the effects of the intervention on different self-reported measures, and to assess users' consultation experiences., Methods: Participants were recruited in a University Family Medicine Group in Quebec (Canada), and the SSI was delivered by the on-site psychologist. No referral or formal diagnosis was needed to attend, and participants could promptly obtain an appointment. Participants rated the intensity of their problem, their level of psychological distress and their well-being, before and after the SSI. They also rated their satisfaction with their consultation experience. There was a follow-up 4 to 6 weeks later., Results: Of the N = 69 participants who received SSI, 91% were able to obtain an appointment in less than 7 working days. The number of patients who were able to benefit from a psychological consultation was about 7 times higher after the implementation of SSI compared to previous years, when a traditional model of service delivery was in place. After SSI, participants felt that the intensity of their problem and psychological distress were lower, and that their well-being was increased, as indicated by significant pre-post test clinical measures (p < 0.0001). The observed effects seemed to be sustained at follow-up. Moreover, 51% of participants said that one session was sufficient to help them with their problem. Participants rated SSI as a highly satisfying and helpful consultation experience (92,9% overall satisfaction)., Conclusions: SSI, offered in a timely manner, could be an innovative and cost-effective intervention to provide mental health services on a large scale in primary healthcare. Further research is needed to replicate the results, but these preliminary data seem to indicate that psychological distress may be quickly addressed by SSI, thereby preventing further deteriorations in patients' mental health., Trial Registration: 2019-393, 26 March 2019., (© 2022. The Author(s).)

Background: Normality is both a descriptive and a normative concept. Undoubtedly, the normal often operates normatively as an exclusionary tool of cultural authority. While it has prominently found its way into the field of medicine, it remains rather unclear in what sense it is used. Thus, our study sought to elucidate people's understanding of normality in medicine and to identify concepts that are linked to it., Methods: Using convenient sampling, we carried out a cross-sectional survey. Since the survey was advertised through social media, we employed an online survey. We performed descriptive and inferential analyses. Predictors were chosen in a theory-driven manner., Results: In total, 323 persons from 21 countries completed the survey. Analysis revealed that the overall acceptance of normality in medicine was associated with notions of injustice, authority, discrimination, and with having a medical profession. More precisely, for the field of mental health, injustice insensitivity, genderism and transphobia, and authority were positively associated with a person's acceptance of normality; and, for the field of physical health, injustice insensitivity and having a medical profession were positively associated with a person's acceptance of normality. Finally, participants' acceptance of the use of normality in the area of mental health was lower than in the area of physical health., Conclusions: What is considered normal has implications for clinical practice, both at an individual and at a policy-level. Acknowledging its normalistic condition, the discipline of medicine has to confront itself with its own contribution to the augmentation of social inequalities through the excessive reliance on the concept of normality. Research that centers the lived experiences of those who are being systematically marginalized because they are deemed abnormal is needed. By empirically elucidating the conceptual relationships between normality in medicine and other variables, we provide points of leverage to deprive normality of its normative power. For medicine, this is needed to first do no harm., (© 2022. The Author(s).)

Objective: Veterinary medical providers face many of the same stressors related to the therapeutic relationship that human medical providers face, and have reported high rates of emotional distress as an aspect of Veterinary practice. Balint Group work is relatively novel in Veterinary Medicine, and the Balint method has yet to be evaluated in the veterinary community. We hypothesized that applying the Balint method in veterinary medicine would be feasible and offer similar benefits to veterinary providers., Method: The authors offered monthly in-person Balint groups, co-led by two American Balint Society trained leaders and evaluated feedback from Balint group attendees to determine the value and feasibility of adapting Balint groups from Human Medicine to veterinary professionals. Balint groups were offered to the veterinary community at a non-profit urban specialty and emergency hospital. During the pandemic, the group transitioned to an online format. All participants were sent an anonymous email survey to collect feedback about their experience., Results: Monthly Balint Groups were offered to veterinary professionals, with traditional Balint structure and parameters and co-led by ABS trained leaders. Feedback was obtained, indicating that Balint Group discussions were helpful to Veterinarians., Conclusions: Balint Groups are a useful tool for veterinary professionals and are likely to provide similar benefits to those enjoyed by human healthcare providers.

Background: Broad consensus supports the use of primary care to address unmet need for mental health treatment., Objective: To better understand whether primary care filled the gap when individuals were unable to access specialty mental health care., Design: 2018 mixed methods study with a national US internet survey (completion rate 66%) and follow-up interviews., Participants: Privately insured English-speaking adults ages 18-64 reporting serious psychological distress that used an outpatient mental health provider in the last year or attempted to use a mental health provider but did not ultimately use specialty services (N = 428). Follow-up interviews were conducted with 30 survey respondents., Main Measures: Whether survey respondents obtained mental health care from their primary care provider (PCP), and if so, the rating of that care on a 1 to 10 scale, with ratings of 9 or 10 considered highly rated. Interviews explored patient-reported barriers and facilitators to engagement and satisfaction with care provided by PCPs., Key Results: Of the 22% that reported they tried to but did not access specialty mental health care, 53% reported receiving mental health care from a PCP. Respondents receiving care only from their PCP were less likely to rate their PCP care highly (21% versus 48%; p = 0.01). Interviewees reported experiences with PCP-provided mental health care related to three major themes: PCP engagement, relationship with the PCP, and PCP role., Conclusions: Primary care is partially filling the gap for mental health treatment when specialty care is not available. Patient experiences reinforce the need for screening and follow-up in primary care, clinician training, and referral to a trusted specialty consultant when needed., (© 2021. Society of General Internal Medicine.)

Due to increasing pressure from social media, influencers, friends, society, and even our own self-expectations to look beautiful, women and girls are in the stranglehold of a sickening mental health crisis. As practitioners of nonsurgical aesthetic medicine, we can help our patients to navigate and overcome the common belief that happiness comes from inside an injectable syringe., Competing Interests: The author reports no conflict of interest., (Copyright © 2022 International Society of Plastic and Aesthetic Nurses. All rights reserved.)

Poor parental mental health and stress have been associated with children's mental disorders, including attention-deficit/hyperactivity disorder (ADHD), through social, genetic, and neurobiological pathways. To determine the strength of the associations between parental mental health and child ADHD, we conducted a set of meta-analyses to examine the association of parent mental health indicators (e.g., parental depression, antidepressant usage, antisocial personality disorder, and stress and anxiety) with subsequent ADHD outcomes in children. Eligible ADHD outcomes included diagnosis or symptoms. Fifty-eight articles published from 1980 to 2019 were included. We calculated pooled effect sizes, accounting for each study's conditional variance, separately for test statistics based on ADHD as a dichotomous (e.g., diagnosis or clinical cutoffs) or continuous measurement (e.g., symptoms of ADHD subtypes of inattentiveness and hyperactivity/impulsivity). Parental stress and parental depression were significantly associated with increased risk for ADHD overall and both symptoms and diagnosis. Specifically, maternal stress and anxiety, maternal prenatal stress, maternal depression, maternal post-partum depression, and paternal depression were positively associated with ADHD. In addition, parental depression was associated with symptoms of ADHD inattentive and hyperactive/impulsive subtypes. Parental antisocial personality disorder was also positively associated with ADHD overall and specifically ADHD diagnosis. Prenatal antidepressant usage was associated with ADHD when measured dichotomously only. These findings raise the possibility that prevention strategies promoting parental mental health and addressing parental stress could have the potential for positive long-term impacts on child health, well-being, and behavioral outcomes.

Background: Scientific research has reported various stressors that could be related to the development of burnout in resident physicians., Objective: To identify the perceived stressors associated with burnout in residents of various medical specialties in Mexico's northwest., Material and Methods: A cross-sectional, explanatory, observational, and analytical study was carried out. The sampling was non-probabilistic. Resident physicians from two hospitals in southern Sonora participated. The Occupational Burnout Scale (OED) and the Stressors Check List with intensity were used., Results: 189 resident physicians were included. 87% presented high levels of burnout. Specifically, the work overload and job dissatisfaction stressors were the ones with the greatest predictive power of burnout and dissatisfaction with achievement in resident physicians. By dimensions, physical problems were predictors of the pain dimension in the occupational burnout state. Professional exercise and physical problems predicted burnout in occupational burnout state. And physical problems were predictors for the presence of depression., Conclusions: The data obtained confirm the need to attend physical and mental health of resident doctors, and promote optimal work environments that have a positive impact on the well-being of their members., (© 2022 Revista Medica del Instituto Mexicano del Seguro Social.)

In the practice of medicine, resilience has gained attention as on of the ways to address burnout. Qualitative studies have explored the concept of physician resilience in several contexts. However, individual qualitative studies have limited generalizability, making it difficult to understand the resilience concept in a wider context. This study aims to develop a concept of resilience in the context of physicians' experience through a meta-synthesis of relevant qualitative studies. Using a predetermined search strategy, we identified nine qualitative studies among 450 participants that reported themes of resilience in developed and developing countries, various specialties, and stages of training. We utilized the meta-ethnography method to generate themes and a line-of-argument synthesis. We identified six key themes of resilience: tenacity, resources, reflective ability, coping skills, control, and growth. The line-of-argument synthesis identified resilient physicians as individuals who are determined in their undertakings, have control in their professional lives, reflect on adversity, utilize adaptive coping strategies, and believe that adversity provides an opportunity for growth. Resilient physicians are supported by individual and organizational resources that include nurturing work culture, teamwork, and support from the medical community and at home. Our findings suggest that resilience in physicians is dynamic and must be supported not only by physician-directed interventions but also by organization-directed interventions.

Burnout is reported to be epidemic among physicians and medical trainees, and wellness has been the predominant target for intervention in academic medicine over the past several years. However, both burnout and wellness suffer from a lack of standardized definition, often making interventions difficult to generalize and extrapolate to different sites. Although well-meaning, current frameworks surrounding wellness and burnout have limitations in fully addressing the challenges of improving physician mental health. Wellness as a framework does not inherently acknowledge the adversity inevitably experienced in the practice of medicine and in the lives of medical trainees. During a crisis such as the current pandemic, wellness curricula often do not offer adequate frameworks to address the personal, organizational, or societal crises that may ensue. This leaves academic institutions and their leadership ill-equipped to appropriately address the factors that contribute to burnout. More recently, resilience has been explored as another framework to positively influence physician wellness and burnout. Resilience acknowledges the inevitable adversity individuals encounter in their life and work, allowing for a more open discussion on the tensions and flexibility between facets of life. However, emphasizing personal resiliency without addressing organizational resiliency may leave physicians feeling alienated or marginalized from critical support and resources that organizations can and should provide., Despite intense focus on wellness and burnout, there have not been significant positive changes in physicians' mental health. Many interventions have aimed at the individual level with mindfulness or other reflective exercises; unfortunately these have demonstrated only marginal benefit. Systems level approaches have demonstrated more benefit but the ability of organizations to carry out any specific intervention is likely to be limited by their own unique constraints and may limit the spread of innovation. We believe the current use of these conceptual lenses (wellness and burnout) has been clouded by lack of uniformity of definitions, an array of measurement tools with no agreed-upon standard, a lack of understanding of the complex interaction between the constructs involved, and an over-emphasis on personal rather than organizational interventions and solutions., If the frameworks of burnout and wellness are limited, and personal resilience by itself is inadequate, what framework would be helpful? We believe that focusing on organizational resilience and the connecting dimensions between organizations and their physicians could be an additional framework helpful in addressing physician mental health. An organization connects with its members along multiple dimensions, including communication, recognition of gifts, shared vision, and sense of belonging. By finding ways to positively affect these dimensions, organizations can create change in the culture and mental health of physicians and trainees. Educational institutions specifically would be well-served to consider organizational resilience and its relationship to individuals.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Benjamin Rush's twin 1786 letters on the different species of phobia and mania sit at an extended historical juncture at which an early modern quasi-medical troping of mental disorder in American social commentary sobered up to mental medicine. The letters' satirical drive hinged on a perennial problem still occupying George Beard almost a century onward: which idiosyncratic trepidation or ill-grounded idea warranted the nomination of national and epochal ill? Rush's mania letter exemplified an established genre identifying popular and especially political crazes; at the same time, it foreshadowed the early 19th-century rise and mid-century fall of monomania as forensic-nosological stopgap. The phobia text established the term's dictionary (OED) sense of specific morbid fears, but did so in the form of a mobilisation of nosological jargon for social diagnostics purposes: an ambivalent prelude to Rush's later formal engagement with unreasonable fears and follies. Both letters draw attention to a pervasive duality in early modern and Enlightenment conceptions of hydrophobia, aerophobia, syphilophobia and lyssophobia, between public-health and mental-hygienic follies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Methods: A systematic analysis was performed of the medical specialization academic programs of 20 different countries to establish which medical specialties take into account mental health issues in the specialty curricular design and which mental health content these programs address. The criteria that were explored in the educational programs include: 1) name of the medical specialties that take into account mental health content in curriculum design, 2) name of the mental health issues addressed by these programs. After independent review and data extraction, paired investigators compared the findings and reached consensus on all discrepancies before the final presentation of the data. Descriptive statistics evaluated the frequency of the data presented., Results: Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs. In four countries: Bangladesh, Serbia, the Netherlands and France, 50%of all graduate specialty training programs include mental health content. In ten countries: Germany, Sweden, the United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel and Spain, between 20% and 49% of all graduate specialty training programs include mental health content. In six countries - Brazil, Chile, Colombia, Croatia, Kenya, and the United States-less than 20% of all graduate specialty training programs include mental health content., Discussion: The proposal that we have made in this article should be taken into account by decision-makers, in order to complement the different postgraduate training programs with mental health issues that are frequently present with other physical symptoms. It is not our intention that the different specialists know how to treat psychiatric comorbidities, but rather pay attention to their existence and implications in the diagnosis, evolution and prognosis of many other diseases. The current fragmentation of medicine into ever finer specialties makes the management of comorbidity ever more difficult: a reorientation of post- graduate training might improve the situation.

An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners' mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health--including suicide risk--were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner's surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.

In this paper authors described some of the principles and theses of Hippocratic medicine. They emphasized that regardless existing controversial opinions as to whether Hippocrates stated some theses or not, and controversial views on some of his principles, he is often called the "father" of medicine, who laid the foundations in medicine as a science. Hippocrates gave recommendations on the doctor's behavior towards the patient, which is relevant up today. His holistic approach to medicine is becoming more and more relevant in the modern medicine. The application of the Hippocratic Oath today depends on the legislation of individual states, related to how legal solutions in some states are pro or contra to it. Authors opened and discussed his attitudes that mental illnesses are a sign of a diseased brain, his consideration the food as medicine and that the disease came from the intestines. Also issue of prognosis of the disease was opened and discussed as well as and Hippocrates's consideration of work and physical activity as the most appropriate medicine. Furthermore, authors considered importance of Hippocratic medicine related to Creative psychopharmacotherapy based on therapeutic communication and the creative satisfaction of needs in the therapeutic relationship with patients and in the recovery itself. Finally, an example of creatively use of the principle of Hippocratic medicine: "work as the most appropriate medicine" in therapeutic communication with patients through an ecological approach called "Ecopsychiatry", under the slogan presented in the media to the general public: "Cleansing nature improves your mental health" was described.

Prescribing nature-based health interventions (green prescribing)-such as therapeutic horticulture or conservation activities-is an emerging transdisciplinary strategy focussed on reducing noncommunicable diseases. However, little is known about the practice of, and socioecological constraints/opportunities associated with, green prescribing in the UK. Furthermore, the distribution of green prescribing has yet to be comprehensively mapped. In this study, we conducted a socioecological exploration of green prescribing. We deployed online questionnaires to collect data from general practitioners (GPs) and nature-based organisations (NBOs) around the UK and conducted spatial analyses. Our results indicate that GPs and NBOs perceive and express some common and distinct constraints to green prescribing. This highlights the need to promote cross-disciplinary communication pathways. Greenspace presence and abundance within close proximity (100 and 250 m) to GP surgeries (but not greenness-as a proxy for vegetation cover) and NBO presence within 5 km were associated with higher levels of green prescribing provision. Lower levels of deprivation were associated with higher frequency of NBOs. This suggests that the availability of greenspaces and NBOs could be important for green prescribing provision, but there could be greater opportunities in less deprived areas. Important foci for future research should be to establish transdisciplinary collaborative pathways, efficient infrastructure management and a common vocabulary in green prescribing-with the overall aim of reducing inequalities and enhancing planetary health., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Background: The American Psychological Association reports that Generation Z are suffering mentally and physically more than any other group. Purpose: Measure the effects of a 16-week, online college-level "Complementary Therapies in Health Course" through the lens of the biopsychosocial-spiritual model on measures of health and aspects of well-being in college students. Methods: A mixed method, controlled, repeated measures study delivered in an online synchronous college-level health course. The course curriculum included the science and practice of compassion, happiness, mindfulness, meditation, yoga, service, gratitude, longevity, movement, and more. Results: 42 students 18-23 participated. A significant between subjects cross-over effect demonstrating improvements in the intervention group and deterioration in the control group was found using the Self Compassion Scale (p < 0.005), Self-Compassion subscale of Judgment (p < 0.001), Spiritual Well-being Scale (p < 0.047), and the Pemberton Happiness Index (p < 0.007). The Self Compassion Scale also revealed a within subjects significant effect (p < 0.001). Qualitative data revealed improvements in compassion, feelings of happiness, sleep, exercise and health habits, gratitude, mindfulness, spiritual feelings, and more. Discussion: Health education predicated on the biopsychosocial-spiritual model is efficacious. Translation to Health Education Practices: A whole person, complementary health approach to education programming has widespread, positive effects on college students.

Rationale, Aims and Objectives: Although several studies have compared patient outcomes by provider specialty in the treatment of back and joint pain, little is known about the cost-effectiveness of improving patient outcomes across specialties. This study uses a large-scale, nationally representative database to evaluate the cost-effectiveness of being treated by specific provider specialists for back and joint pain in the United States., Method: The 2002-2012 Medical Expenditure Panel Surveys were used to examine patients diagnosed with back and/or joint problems seeking treatment from doctors (internal medicine, family/general, osteopathic medicine, orthopaedics, rheumatology, neurology) or other providers (chiropractor, physical therapist, acupuncturist, massage therapist). A total of 16,546 respondents aged 18 to 85 and clinically diagnosed with back/joint pain were examined. Self-reported measures of physical and mental health and general quality of life (measured by the EuroQol-5D) were compared with average total costs of treatment across medical providers., Results: Total annual treatment costs per person ranged from $397 for family/general doctors to $1205 for rheumatologists. Cost-effectiveness analysis suggests that osteopathic, family/general, internal medicine doctors and chiropractors and massage therapists were more cost-effective than other specialties in improving physical function to back pain patients. For mental health measures, family/general and orthopaedic doctors and physical therapists were more cost-effective compared with other specialties. Similar to results on physical function, family/general, osteopathic and internal medicine doctors dominated other specialties. However, only massage therapy was cost-effective among non-doctor providers in improving quality of life measures., Conclusions: Patients seeking care for back and joint-related health problems face a wide range of treatments, costs and outcomes depending on which specialist provider they see. This study provides important insight on the relationship between health care costs and patients' perceived physical and mental health status from receiving treatment for diagnosed back/joint problems., (© 2015 John Wiley & Sons, Ltd.)

If mental health has become a reactionary concept, much like the notion of public health in the age of the COVID-19 pandemic, then how can critical theory best elaborate a concern for well-being which includes both a psychic and social dimension? This article proposes the concept of existential health to grasp the salubrious zest for life that has been extinguished from social life since March 2020, due to rolling lockdowns and the rise of totalitarian impulses within the medical-industrial complex. It draws on the relational art practice of Lygia Clark along with developments in the psychedelic treatment of addiction to articulate a vision of existential health in an age of mental illness that is irreducible to the specialised domain of psychologists signified by the 'mental' in mental health.

Adult education is concerned with the redistribution of resources and the recognition of rights held by citizens and to have these rights respected (Honneth, 1995). Mental health is an important domain of rights that are disrespected and unprotected by the state. This article reflects on herbal medicine as a practice in adult education in response to the mental health needs of citizens. It argues that adult educators need to pay more attention to the limitation of biomedicine in the defining and treatment of mental health. Herbal medicine has potential to offer adult educators a critically reflexive space, to critique issues of power, medicine and wellbeing.

Longevity health sciences and mental health are fields of public health and of preventive and integrative medicine. The antagonism between health construction and human pathology is substantiated by two opposite fundamental pathways: the health-longevity tetrad versus the aging-disease cascade. It is necessary that the current paradigm of contemporary medicine be replaced by the advanced paradigm of future medicine. A societal cost-benefit rate is decisive for health-longevity promotion. This is why the WHO public health strategy keeps forwarding the societal medical target into the global health-longevity field.

Acne is a hallmark of adolescence, affecting 85% of youth between the ages of 12 and 25 worldwide. Perhaps because of its ubiquity and minimal impact on physical functioning, acne is often dismissed as a time-delimited cosmetic nuisance and has been summarily neglected by developmental scientists. However, emerging evidence suggests that acne is associated with clinically significant psychological adjustment problems, including depression and anxiety. Adopting an interdisciplinary approach that bridges developmental and dermatological science, we reposition acne as a prominent source of psychological maladjustment and health disparities in adolescence. Specifically, we propose that females and youth with darker skin may be disproportionately affected by the pernicious psychological effects of acne. Reconceptualizing adolescent acne as a developmentally and psychologically meaningful dermatologic disease with effects shaped by culture and health care disparities will advance our understanding of youth's mental health.

The prevalence and causes of 'burnout' and psychiatric disorder among senior oncologists and palliative care specialists have been measured in a national questionnaire-based survey. All consultant non-surgical oncologists in the UK were asked to participate. Sources of work-related stress and satisfaction were measured using study-specific questions which were aggregated into factors. Psychiatric disorder was estimated using the 12-item General Health Questionnaire. The three components of 'burnout'--emotional exhaustion, depersonalisation and low personal accomplishment--were assessed using the Maslach Burnout Inventory. Three hundred and ninety-three out of 476 (83%) consultants returned their questionnaires. The estimated prevalence of psychiatric disorder in cancer clinicians was 28%, and this is similar to the rate among British junior house officers. The study group had equivalent levels of emotional exhaustion and low personal accomplishment to those found in American doctors and nurses, but lower levels of depersonalisation. Among cancer clinicians, 'burnout' was more prevalent among clinical oncologists than among medical oncologists and palliative care specialists. Psychiatric disorder was independently associated with the stress of feeling overloaded (P < 0.0001), dealing with treatment toxicity/errors (P < 0.004) and deriving little satisfaction from professional status/esteem (P = 0.002). 'Burnout' was also related to these factors, and in addition was associated with high stress and low satisfaction from dealing with patients, and with low satisfaction from having adequate resources (each at a level of P < or = 0.002). Clinicians who felt insufficiently trained in communication and management skills had significantly higher levels of distress than those who felt sufficiently trained. If 'burnout' and psychiatric disorder among cancer clinicians are to be reduced, increased resources will be required to lessen overload and to improve training in communication and management skills.

Despite elevated rates of suicide and evidence of poor mental health among medical professionals, there is a paucity of research in the UK into the mental health of students destined for these careers. This study estimated and compared the prevalence of mental ill-health in students studying veterinary medicine, medicine, dentistry and pharmacy in the United Kingdom. A group of law students was also included, who, although subject to similar stressors as undergraduates, do not go on to share a heightened risk of suicide as professionals. A total of 1744 respondents completed a questionnaire with validated measures to assess wellbeing, psychological distress, depression and suicidal ideation and attempts. Results indicated that law students experienced the poorest mental health of the student groups studied. Wellbeing was highest among veterinary and medical students. However, the medical students were the most likely to have previously attempted suicide. These findings highlight the importance of directly comparing student groups and of appropriately supporting students as they progress through training and into the professions.