Compassionate Othering: the construction of refugee patients in medical students' narratives - a qualitative study using story completion.

BACKGROUND: Refugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering. METHODS: Using story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective). RESULTS: We identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients' history of migration. An empathic depiction of patient B and the students' compassion for the patients facing substandard care were key motifs as well. CONCLUSION: The perception of the version B patients predominantly as refugees establishes their construction as an Other. The students' compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.

Radiation-Induced Cerebral Contrast Enhancements Strongly Share Ischemic Stroke Risk Factors.

PURPOSE: Radiation-induced cerebral contrast enhancements (RICE) are frequent after photon and particularly proton radiation therapy and are associated with a significant risk for neurologic morbidity. Nevertheless, risk factors are poorly understood. A more robust understanding of RICE risk factors is crucial to improve management and offer adaptive therapy at the outset and during follow-up. METHODS AND MATERIALS: We analyzed the comorbidities in detail of 190 consecutive adult patients treated at a single European national comprehensive cancer center with proton radiation therapy (54 Gy relative biological effectiveness) for LGG from 2010 to 2020 who were followed with serial clinical examinations and magnetic resonance imaging for a median 5.6 years. RESULTS: Classical vascular risk factors including age (≥50 vs <50 years: 1.6-fold; P = .0024), hypertension (2.7-fold; P = .00012), and diabetes (11.7-fold; P = .0066) were observed more frequently in the cohort that developed RICE. Dyslipidemia (2.1-fold), being overweight (2.0-fold), and smoking (2.6-fold), as well as history of previous stroke (1.7-fold), were also more frequently observed in the RICE cohort, although these factors did not reach the threshold for significance. Multivariable regression modeling supported the influence of age (P = .05), arterial hypertension (P = .01), and potentially male sex (P = .02), diabetes (P = .0008), and smoking (P = .001) on RICE occurrence over time, independent of each other and further vascular risk factors. If RICE occurred, bevacizumab treatment was 2-fold more frequently needed in the cohort with vascular risk factors, but RICE long-term prognosis did not differ between the RICE subcohorts with and without vascular risk factors. CONCLUSIONS: This is the first report in the literature demonstrating that RICE strongly shares vascular risk factors with ischemic stroke, which further enhances the nebulous understanding of the multifactorial pathophysiology of RICE. Classical vascular risk factors, especially age, hypertension, and diabetes, clearly correlated independently with RICE risk. Risk-adapted screening and management for RICE can be directly derived from these data to assist in clinical management.

Bacterial Co- or Superinfection in Patients Treated in Intensive Care Unit with COVID-19- and Influenza-Associated Pneumonia.

Viral pneumonia is frequently complicated by bacterial co- or superinfection (c/s) with adverse effects on patients' outcomes. However, the incidence of c/s and its impact on the outcomes of patients might be dependent on the type of viral pneumonia. We performed a retrospective observational study in patients with confirmed COVID-19 pneumonia (CP) or influenza pneumonia (IP) from 01/2009 to 04/2022, investigating the incidence of c/s using a competing risk model and its impact on mortality in these patients in a tertiary referral center using multivariate logistic regressions. Co-infection was defined as pulmonary pathogenic bacteria confirmed in tracheal aspirate or bronchoalveolar lavage within 48 h after hospitalization. Superinfection was defined as pulmonary pathogenic bacteria detected in tracheal aspirate or bronchoalveolar lavage 48 h after hospitalization. We examined 114 patients with CP and 76 patients with IP. Pulmonary bacterial co-infection was detected in 15 (13.2%), and superinfection was detected in 50 (43.9%) of CP patients. A total of 5 (6.6%) co-infections (p = 0.2269) and 28 (36.8%) superinfections (p = 0.3687) were detected in IP patients. The overall incidence of c/s did not differ between CP and IP patients, and c/s was not an independent predictor for mortality in a study cohort with a high disease severity. We found a significantly higher probability of superinfection for patients with CP compared to patients with IP (p = 0.0017).

Quantification of Kuramoto Coupling Between Intrinsic Brain Networks Applied to fMRI Data in Major Depressive Disorder.

Organized patterns of system-wide neural activity adapt fluently within the brain to adjust behavioral performance to environmental demands. In major depressive disorder (MD), markedly different co-activation patterns across the brain emerge from a rather similar structural substrate. Despite the application of advanced methods to describe the functional architecture, e.g., between intrinsic brain networks (IBNs), the underlying mechanisms mediating these differences remain elusive. Here we propose a novel complementary approach for quantifying the functional relations between IBNs based on the Kuramoto model. We directly estimate the Kuramoto coupling parameters (K) from IBN time courses derived from empirical fMRI data in 24 MD patients and 24 healthy controls. We find a large pattern with a significant number of Ks depending on the disease severity score Hamilton D, as assessed by permutation testing. We successfully reproduced the dependency in an independent test data set of 44 MD patients and 37 healthy controls. Comparing the results to functional connectivity from partial correlations (FC), to phase synchrony (PS) as well as to first order auto-regressive measures (AR) between the same IBNs did not show similar correlations. In subsequent validation experiments with artificial data we find that a ground truth of parametric dependencies on artificial regressors can be recovered. The results indicate that the calculation of Ks can be a useful addition to standard methods of quantifying the brain's functional architecture.

Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study.

Background: The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers' dental health is scarce. This work is intended to reduce this data gap. Methods: We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons who were registered with the social welfare office (SWO) in 2015 and received dental treatments. From the medical records, we derived information such as complaints, diagnoses, and treatments. Results: Out of 4107 asylum-seekers, the SWO received a bill for 568 people. On average, there were 1.44 treatment cases (95%-CI: 1.34-1.55) and 2.53 contacts with the dentist per patient (95%-CI: 2.33-2.74). Among those, the majority went to the dentist because of localized (43.2%, 95%-CI: 38.7-47.7) and non-localized pain (32.0%, 95%-CI: 27.8-36.2). The most widespread diagnosis was caries (n = 469, 98.7%, 95%-CI: 97.7-99.7). Conclusion: The utilization of dental care is lower among asylum-seekers than among regularly insured patients. We assume that the low prevalence rates in our data indicate existing access barriers to the German health care system.