RESUMO
BACKGROUND: The medical culture is defined by mental illness stigma, non-disclosure, and avoidance of professional treatment. Little research has explored attitudes and help-seeking behaviors of psychiatry trainees if they were to become mentally ill. METHOD: Psychiatry residents (n = 106) from training centres across Ontario, Canada completed a postal survey on their attitudes, barriers to disclosure, and help-seeking preferences in the context of hypothetically becoming mentally ill. RESULTS: Thirty-three percent of respondents reported personal history of mental illness and the frequency of mental illness by year of training did not significantly differ. The most popular first contact for disclosure of mental illness was family and friends (n = 61, 57.5%). Frequent barriers to disclosure included career implications (n = 39, 36.8%), stigma (n = 11, 10.4%), and professional standing (n = 15, 14.2%). Personal history of mental illness was the only factor associated with in-patient treatment choice, with those with history opting for more formal advice versus informal advice. CONCLUSIONS: At the level of residency training, psychiatrists are reporting barriers to disclosure and help-seeking if they were to experience mental illness. A majority of psychiatry residents would only disclose to informal supports. Those with a history of mental illness would prefer formal treatment services over informal services.
RESUMO
Coronary artery stents mechanically buttress the arterial wall and prevent negative remodeling, leading to increased lumen gain and less angiographic and clinical restenosis as compared with balloon angioplasty alone. Although stents prevent negative remodeling, they do not eliminate restenosis, as they cause complex arterial injury triggering responses that culminate in the induction of neointimal hyperplasia. For many years after the development of balloon angioplasty and stenting, many unsuccessful attempts were made to find methods to prevent neointimal hyperplasia. In 1995, Sollot and colleagues were first to recognize the ability of the antineoplastic compound paclitaxel to limit neointimal hyperplasia formation. In 1997, Axel and colleagues were the first to demonstrate that paclitaxel locally delivered locally to the arterial wall limited neointimal hyperplasia in an animal model. After success in preclinical and human trials, the FDA approved the use of paclitaxel-eluting coronary stents in 2004 on the strength of the pivotal TAXUS trials, which demonstrated that stents utilizing a polymer coating as a paclitaxel delivery vector were effective in the prevention of restenosis. Subsequent trials have confirmed the effectiveness of paclitaxel in restenosis prevention. In these trials, paclitaxel was delivered using both polymer-coated stents and stents directly impregnated with drug, and on different stent platforms by different manufacturers. Paclitaxel eluting stents have been shown to be effective in a variety of cardiovascular lesion and patient subsets in randomized trial and registry data sets. Although there are concerns that locally delivered paclitaxel and/or its polymer delivery vehicle may lead to impaired vascular healing that may predispose to the development of stent thrombosis, pooled data analyses have confirmed an acceptable safety profile for paclitaxel-eluting coronary stents. The current generation of paclitaxel eluting stents have different performance profiles shen compared to first generation and second generation coronary stents eluting sirolimus or related compounds, especially in regard to target lesion revascularization rates. However, whether these difference translates into clinically relevant benefits remains debatable. In addition, newer paclitaxel elution techniques and newer paclitaxel-eluting stent architecture may improve the performance of paclitaxel-eluting stents. As the only approved non-limus based antiproliferative agent currently available, paclitaxel is uniquely positioned in the future of interventional vascular medicine.