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INTRODUCTION: Depression is a heterogeneous clinical syndrome prevalent in patients with Parkinson disease (PD) that remains incompletely understood. Further, the differences in biomarkers of depression in PD and in non-PD patients are unclear. The subcallosal cingulate cortex (SCC) and its connections has been implicated in the pathophysiology of major depressive disorder (MDD). Diffusion tensor imaging (DTI) provides a tool to quantify MDD-related structural abnormalities underlying depressive symptoms in PD. METHODS: Diffusion-weighted magnetic resonance imaging data were collected from thirty-one patients with PD. Depression symptom severity was measured using the Beck Depression Inventory (BDI-II), and assessed using three subscales: dysphoric mood, loss of interest/pleasure, and somatic symptoms. Probabilistic tractography methods were used to quantify the SCC connectivity to target regions in cortico-limbic-striatal network (ventral striatum (VS), medial prefrontal cortex (mPFC), dorsal anterior cingulate cortex (ACC), and uncinate fasciculus (UCF)) while fractional anisotropy (FA) was calculated in predefined white matter regions of interest. DTI data was correlated with severity of depression across three domains. RESULTS: SCC-mPFC connectivity in the left hemisphere was positively correlated with severity of dysphoric mood (Benjamini-Hochberg adjusted p = 0.02). ROI-based analyses demonstrated a significant and distinct topographic association between FA and dysphoric mood, loss of interest/pleasure, and somatic symptom severity, although these findings did not maintain significance after applying the false discovery rate correction. CONCLUSION: Abnormal SCC connectivity underlies depressive symptoms in both PD and MDD, suggesting that interventions used for MDD should be explored in treating depressive symptoms in PD, particularly depression dominated by dysphoric mood.

Background: Vaccine willingness among people living with multiple sclerosis (PwMS) requires assessment following the approval of the first COVID-19 vaccines, since there remains uncertainty on multiple aspects of COVID-19 vaccination in immunosuppressed patients. Objective: To understand COVID-19 and influenza vaccine willingness and its associations among PwMS, following the approval of the first two mRNA COVID-19 vaccines. Methods: A survey was distributed to PwMS via an online platform from December 2020 to February 2021. Logistic regression models were constructed to determine the relationship between (1) COVID-19 and (2) influenza vaccination willingness with demographic and clinical characteristics. Results: Of 701 responding PwMS, 76.6% were COVID-19 vaccine willing. COVID-19 vaccine willingness was significantly associated with influenza vaccine willingness ( p < 0.001). In multivariable models, older age increased the odds of COVID-19 and influenza vaccine willingness (odds ratios (ORs) > 1) and other race decreased the odds of COVID-19 and influenza vaccine willingness (ORs < 1); higher functional disability decreased the odds of COVID-19 vaccine willingness (OR = 0.88, 95% confidence interval = 0.80–0.96). Prevalent vaccine-related concerns include safety ( n = 244) and efficacy ( n = 122). Conclusion: Our findings identify demographic and clinical factors as well as concerns influencing vaccine hesitancy in PwMS. These results may inform effective public health interventions to improve vaccine acceptability in this at-risk group.

Background: Short-term medical missions prevail as the most common form of international medical volunteerism, but they are ill-suited for medical education and training local providers in resource-limited settings. Objective: The purpose of this study is to evaluate the effectiveness of a longitudinal educational program in training clinicians how to perform point-of-care ultrasound (POCUS) in resource-limited clinics. Design: A retrospective study of a four-month POCUS training program was conducted with clinicians from a rural hospital in Haiti. The model included one-on-one, in-person POCUS teaching sessions by volunteer instructors from the United States and Europe. The Haitian trainees were assessed at the start of the program and at its conclusion by a direct objective structured clinical examination (OSCE), administered by the visiting instructors, with similar pre- and post- program ultrasound competency assessments. Results: Post-intervention, a significant improvement in POCUS competency was observed across six different fundamental areas of ultrasound (p < 0.0001). According to our objective structured clinical examination (OSCE), the mean assessment score increased from 0.47 to 1.68 out of a maximum score of 2 points, and each trainee showed significant overall improvement in POCUS competency independent of the initial competency pre-training (p < 0.005). There was a statistically significant improvement in POCUS application for five of the six medically relevant assessment categories tested. Conclusion: Our results provide a proof-of-concept for the longitudinal education-centered healthcare delivery framework in a resource-limited setting. Our longitudinal model provides local healthcare providers the skills to detect and diagnose significant pathologies, thereby reducing avoidable morbidity and mortality at little or no addition cost or risk to the patient. Furthermore, training local physicians obviates the need for frequent volunteering trips, saving costs in healthcare training and delivery.

BACKGROUNDShort-term medical missions prevail as the most common form of international medical volunteerism, but they are ill-suited for medical education and training local providers in resource-limited settings.OBJECTIVEThe purpose of this study is to evaluate the effectiveness of a longitudinal educational program in training clinicians how to perform point-of-care ultrasound (POCUS) in resource-limited clinics.DESIGNA retrospective study of such a four-month POCUS training program was conducted with clinicians from a rural hospital in Haiti. The model included one-on-one, in-person POCUS teaching sessions by volunteer instructors from the United States and Europe. The Haitian trainees were assessed at the start of the program and at its conclusion by a direct objective structured clinical examination (OSCE), administered by the visiting instructors, with similar pre- and post-program ultrasound competency assessments.RESULTSPost-intervention, a significant improvement was observed (p < 0.0001), and each trainee showed significant overall improvement in POCUS competency independent of the initial competency pre-training (p < 0.005). There was a statistically significant improvement in POCUS application for five of the six medically relevant assessment categories tested.CONCLUSIONOur results provide a proof-of-concept for the longitudinal education-centered healthcare delivery framework in a resource-limited setting. Our longitudinal model provides local healthcare providers the skills to detect and diagnose significant pathologies, thereby reducing avoidable morbidity and mortality at little or no addition cost or risk to the patient. Furthermore, training local physicians obviates the need for frequent volunteering trips, saving costs in healthcare training and delivery.

Background People with multiple sclerosis (PwMS) may be at increased risk for psychological distress during COVID-19. We study the self-reported mental health of U.S. PwMS during COVID-19, prior to vaccine rollout. Methods A cross-sectional survey was distributed online to PwMS through iConquerMS (12/18/2020–02/10/2021). Depressive and anxiety symptom burdens and general mental health status were measured via the Patient-Health Questionnaire-9, Generalized Anxiety Disorder-7, and PROMIS Global Mental Health scales. Linear regression models assessed associations between mental health variables and age, sex, disability status, comorbidities, and social determinants of health. Results Of 610 U.S. PwMS (mean age 56 years, standard deviation 11, range 20–85; female, 81%; relapsing remitting disease, 62%; previous depression diagnosis, 40%), the prevalences of moderate-to-severe depressive and anxiety symptom burden were 27.4% and 14.7%, respectively; 55.1% endorsed fair/poor general mental health. PwMS who tested positive for COVID-19 (n = 47, 7.7%) reported higher depressive and anxiety symptom burdens (p

Background Risk factors for COVID-19 infection among people with multiple sclerosis (PwMS) remain unconfirmed. While biological, socioeconomic and clinical risk factors have been identified among the general population, a comprehensive assessment of risk factors for COVID-19 infection among PwMS is lacking. Methods A survey assessing personal experiences with COVID-19 in the USA was distributed online via the iConquerMS platform from December 18, 2020 to February 10, 2021. We conducted a retrospective nested case–control study of PwMS who self-reported testing positive for COVID-19 versus not. Risk factors evaluated include age, occupational setting, social determinants of health index, physical disability via Patient-Determined Disease Steps, disease-modifying therapy (DMT) and progressive disease. Results Of 611 PwMS, 47 (7.7%) self-reported a positive COVID-19 test. DMT use (odds ratio [95% CI]: 2.10 [0.75–5.39]) and employment outside the home (2.79 [1.42–5.41]) increased risk of COVID-19 infection, while older age (0.97 [0.95–0.99]), increased disability (0.81 [0.69–0.94]) and progressive disease (0.42 [0.19–0.86]) decreased risk in univariate analyses. No risk factor remained significant in the multivariate model. Of the 47 PwMS with a positive test, seven were admitted to the hospital, of whom two required intensive care. Forty-three (91.5%) experienced common COVID-19 symptoms, and 23 (48.9%) reported concurrent new/worsening neurological symptoms. Conclusion The prevalence of COVID-19 infection in this online study of PwMS approximated the US population's prevalence. When incorporating biological, socioeconomic and clinical risk factors for COVID-19, we did not find any independent risk factors for infection among PwMS in the USA.