Trends in frailty in brain tumor care during the COVID-19 pandemic in a nationwide hospital network in Germany.

PURPOSE: Among brain tumor patients, frailty is associated with poor outcomes. The COVID-19 pandemic has led to increased frailty in the general population. To date, evidence on changes in frailty among brain tumor patients during the pandemic is lacking. We aimed to compare frailty among brain tumor patients in Germany during the COVID-19 pandemic to the pre-pandemic era and to assess potential effects on brain tumor care. METHODS: In this retrospective observational study, we compared frailty among brain tumor patients hospitalized during the COVID-19 pandemic in years 2020 through 2022 to pre-pandemic years 2016 through 2019 based on administrative data from a nationwide network of 78 hospitals in Germany. Using the Hospital Frailty Risk Score (HFRS), frailty was categorized as low, intermediate, or high. We examined changes in frailty, patient demographics, the burden of comorbidity, rates of surgery, and mortality rates for different frailty groups during the pandemic and compared them to pre-pandemic levels. RESULTS: Of the 20,005 included hospitalizations for brain tumors, 7979 were during the pandemic (mean age 60.0 years (± 18.4); females: 49.8%), and 12,026 in the pre-pandemic period (mean age: 59.0 years [± 18.4]; females: 49.2%). Average daily admissions decreased from 8.2 (± 5.1) during pre-pandemic years to 7.3 (± 4.5) during the pandemic (p < 0.01). The overall median HFRS decreased from 3.1 (IQR: 0.9-7.3) during the pre-pandemic years to 2.6 (IQR: 0.3-6.8) during the pandemic (p < 0.01). At the same time, the Elixhauser Comorbidity Index (ECI) decreased from 17.0 (± 12.4) to 16.1 (± 12.0; p < 0.01), but to a larger degree among high compared to low frailty cases (by 1.8 vs. 0.3 points; p = 0.04). In the entire cohort, the mean length of stay was significantly shorter in the pandemic period (9.5 days [± 10.7]) compared with pre-pandemic levels (10.2 days [± 11.8]; p < 0.01) with similar differences in the three frailty groups. Rates of brain tumor resection increased from 29.9% in pre-pandemic years to 36.6% during the pandemic (p < 0.001) without differences between frailty levels. Rates of in-hospital mortality did not change during the pandemic (6.1% vs. 6.7%, p = 0.07), and there was no interaction with frailty. CONCLUSION: Even though our findings are limited in that the HFRS is validated only for patients ≥ 75 years of age, our study among patients of all ages hospitalized for brain tumors in Germany suggests a marked decrease in levels of frailty and in the burden of comorbidities during the COVID-19 pandemic.

Neurosurgical care for patients with high-grade gliomas during the coronavirus disease 2019 pandemic: Analysis of routine billing data of a German nationwide hospital network.

Background: Little is known about delivery of neurosurgical care, complication rate and outcome of patients with high-grade glioma (HGG) during the coronavirus disease 2019 (Covid-19) pandemic. Methods: This observational, retrospective cohort study analyzed routine administrative data of all patients admitted for neurosurgical treatment of an HGG within the Helios Hospital network in Germany. Data of the Covid-19 pandemic (March 1, 2020-May 31, 2022) were compared to the pre-pandemic period (January 1, 2016-February 29, 2020). Frequency of treatment and outcome (in-hospital mortality, length of hospital stay [LOHS], time in intensive care unit [TICU] and ventilation outside the operating room [OR]) were separately analyzed for patients with microsurgical resection (MR) or stereotactic biopsy (STBx). Results: A total of 1763 patients underwent MR of an HGG (648 patients during the Covid-19 pandemic; 1115 patients in the pre-pandemic period). 513 patients underwent STBx (182 [pandemic]; 331 patients [pre-pandemic]). No significant differences were found for treatment frequency (MR: 2.95 patients/week [Covid-19 pandemic] vs. 3.04 patients/week [pre-pandemic], IRR 0.98, 95% CI: 0.89-1.07; STBx (1.82 [Covid-19 pandemic] vs. 1.86 [pre-pandemic], IRR 0.96, 95% CI: 0.80-1.16, P > .05). Rates of in-hospital mortality, infection, postoperative hemorrhage, cerebral ischemia and ventilation outside the OR were similar in both periods. Overall LOHS was significantly shorter for patients with MR and STBx during the Covid-19 pandemic. Conclusions: The Covid-19 pandemic did not affect the frequency of neurosurgical treatment of patients with an HGG based on data of a large nationwide hospital network in Germany. LOHS was significantly shorter but quality of neurosurgical care and outcome was not altered during the Covid-19 pandemic.

Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study.

BACKGROUND: The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS). METHODS: In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany. RESULTS: Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7-60.4 years), the number of female patients (range: 33.3-57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2-20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0-100%), duration of in-hospital stay (range: 14.6-22.7 days), and in-hospital mortality rates (range: 11.8-55.6%). CONCLUSION: In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic.

Home-based physiology labs in the time of COVID-19 prove popular with medical students.

The COVID-19 pandemic and the resulting "lockdown" have forced many medical schools to shift from traditional "face-to-face" teaching methodologies and embrace full online delivery. Although lectures and tutorials are readily communicated by this approach, the execution of laboratory exercises is much more difficult. To overcome these challenges, face-to-face laboratory sessions were replaced by a blended learning approach in which students were provided instructional material online and then required to conduct the laboratory exercises at home. These laboratory exercises made use of easily accessible household materials and mobile applications. A self-report survey was designed to assess students' perception of their learning experience and attitudes to the home-based laboratory exercises. The survey consisted of 16 questions that students had to respond to using a 5-point Likert scale. Students were also allowed to provide open responses to select questions. Overall, the 80% of students that completed the survey expressed strong satisfaction with their learning experience and were enthusiastic toward home-based laboratory exercises. However, concerns about not being able to complete particular face-to-face exercises that required specialized equipment were expressed. Several students proposed a combined approach going forward. Our results show that home-based laboratory exercises offer a multimodal option that enriches the learning curriculum by engaging students in "hands-on" bespoke practicals using inexpensive household materials.

A cross-sectional study of neuromyths among teachers in a Caribbean nation.

BACKGROUND: The current COVID-19 pandemic and proliferation of misinformation regarding science highlights the importance of improving general science literacy. The continued preponderance of neuromyths among educators is of concern, especially in lower- and middle-income countries. METHOD: Using an adapted questionnaire, a cross-sectional survey was conducted among teachers in a small island developing state in the Caribbean. RESULTS: Two-thirds of the sample were unable to recognise at least 50% of the myths. Regression analysis demonstrated that higher scores in brain knowledge and exposure to prior teacher-training increased belief in neuromyths. On the other hand, specific in-service training pertaining to educational neuroscience improved scores. CONCLUSION: Neuromyths are prevalent among teachers and appear to inform their teaching practice. Further research needs to be conducted to explore not just the prevalence of these myths but in what ways they may be impacting teaching and learning outcomes in the classroom.

Exploring Virtual Empathy versus Real-life Empathy among Undergraduate University Students across Five Faculties

Empathy is important for effective social interactions since it helps people understand others' feelings, thinking, and intentions, and therefore aids in predicting behavior (Baron Cohen & Wheelwright, 2004). Additionally, the capacity to understand and feel another's pain often leads to compassionate responses (Riess, 2017). Virtual empathy has been described as an important competence for promoting learning given the increasing use of online forums in education (Garcia-Perez, Santos-Delgado, & Buzon-Garcia, 2006). It is particularly important for students to cultivate empathy since it benefits not only them but their future place of work (Gentry, Weber, & Sadr, 2007; Lilius, Kanov, Gutton, Worline, Maitlis, 2013). The current study further seeks to explore any links between real world empathy and empathy expressed online. There is existing evidence to suggest that a person's online social activity is reflective of their personailty (Gosling, Augustine, Vazire, Holtzman,m& Gaddis, 2011). Similar to real world tendencies, extroverts had higher online social networking engagement than introverts, and openess and conscientiousness in online settings were also reflective of that in the real world (Gosling, Augustine, Vazire, Holtzman,m& Gaddis, 2011). Following thiis pattern of reasoning, one can assume that a person's virtual empathy levels might mirror their empathy levels in the real world, For this reason, the authors of this current study sought to determine whether online sociazl media usr had any impact on a person's capacity for empathy. With this background the objective of the current study to explore empathy on social media and in the real world among undergraduates from five faculties (Law, Engineering, Medical Sciences, Humanities, and Education, Science and Technology) at the University of the West Indies.

The Relationship Between Self-Esteem, Emotional Intelligence, and Empathy Among Students From Six Health Professional Programs.

Theory: Psychosocial skills such as communication, empathy, and emotional intelligence are now considered key attributes of health professionals. Self-esteem is another important construct that is less well studied. Self-esteem is important because low levels have been linked to depression, suicide, and eating disorders. Given that health professional students experience high levels of stress and are at increased risk for similar psychopathology, self-esteem may be an important variable in student well-being and performance after graduation. Hypotheses: This study sought to explore self-esteem during students' 1st year of training hypothesizing that several would demonstrate low self-esteem. It is also hypothesized that emotional intelligence and empathy would be associated with self-esteem. Method: A cross-sectional survey was conducted, and data were gathered from dental, medical, nursing, optometry, pharmacy and veterinary students. Self-report questionnaires assessing self-esteem, emotional intelligence, and empathy were completed and demographic information was collected. Scores were calculated and differences between groups analyzed with analysis of variance and chi-square testing. Pearson's correlation was used to assess associations between the constructs. Results: The mean self-esteem score was 26.2 ± 2.3 but 21% of the sample evidenced low self-esteem. There was no difference in the proportion of students demonstrating low self-esteem among programs. Gender did not have a significant effect on self-esteem scores, though ethnicity did. Emotional intelligence scores were higher among male individuals than among female. Emotional intelligence and empathy showed a small association with self-esteem. Conclusions: A significant proportion of health professional students suffer from low self-esteem during their 1st year of study. Such students may be more susceptible to the stresses associated with study and the development of psychopathology. More research needs to be conducted to explore the relationships between self-esteem, emotional intelligence, and empathy with a view to strengthening training in these areas and managing the challenges faced by health professional students.

Cafeteria-diet induced obesity results in impaired cognitive functioning in a rodent model.

OBJECTIVES: This study seeks to characterize the progressive course of physiological and behavioural outcomes in rodents following excessive caloric intake through the chronic consumption of a highly palatable diet, the cafeteria (CAF) diet. METHODS: Male Sprague Dawley rats were maintained on either CAF or chow (CON) diets for 20 weeks. Metabolic and physiological parameters were monitored throughout the feeding period. From week 18, rats were subjected to behavioural testing, which included the Morris water maze (MWM) and novel object recognition (NOR) tasks. RESULTS: CAF rats consistently showed higher food intakes and consumed six times the energy of chow-fed rats, being significantly heavier by week 5. CAF rats further exhibited greater abdominal widths, fat pads, and larger fatty livers, as well as compromised glucose tolerance. Hyperinsulinemia and dyslipidaemia with elevated serum cholesterol and triglyceride levels and reduced HDL cholesterol were also evident along with a pro-inflammatory profile in the CAF rats. Cognitive decline in CAF rats manifested as a decline in long-term retention memory in the MWM. Further, CAF rats exhibited deficits in recognition memory as they spent less time exploring the novel object than chow-fed rats in the NOR task. DISCUSSION: This model of obesity is a robust paradigm for producing an obese animal phenotype that closely mimics the evolution of human obesity, complete with metabolic dysfunctions that are indicative of pre-diabetes. Additionally, chronic CAF-diet induced obesity promotes cognitive impairments in hippocampal-dependent reference and working memory.

Attitudes toward mental illness among Caribbean medical students.

Background: There are limited empirical data on all matters pertaining to mental illness in the Caribbean but what little there is suggests significant levels of stigmatization exist. In this context, health professionals reveal at least equal to or only slightly improved attitudes to mental illness as compared to the general population. In addition, while there is evidence of improved attitudes among the population at large over the past decade this trend has not been observed among health professionals. This study, therefore, sought to assess medical students' knowledge about and attitudes toward mental illness as they traversed medical school. Methods: Preclinical medical students were surveyed and then retested in their final year of training. Students completed a knowledge scale, and the medical conditions regard scale comparing attitudes to four mental illness and three physical illness. Results: Knowledge about and attitudes toward mental illness showed significant improvement over the 5-year period. However, both preclinical and clinical students revealed significant levels of stigmatization toward mental illness despite improvements in knowledge. Students recognized the need to prioritize treatment for persons with mental illness but did not want to be personally involved in the treatment process. Discussion: Results highlight that significant negative attitudes still exist among medical students toward mental illness and these persist up until graduation. There is a need for further research into innovations and interventions to address this matter.

Sex differences in the effects of acute stress on behavior in the ultimatum game.

Acute stress affects human decision making. It has been argued that there are systematic sex differences in behavioral responses to acute stress, with males showing a 'fight or flight' and females showing a 'tend and befriend' response. A 'tend and befriend' response would suggest that women become more cooperative under acute stress, while men do not. We investigated the effects of acute stress on social behavior. We induced stress via the Trier Social Stress Test (TSST) and then immediately after measured how participants reacted to offers made in the ultimatum game by a male proposer. We found that female participants were less likely to reject offers under stress (n = 25) vs. no stress (n = 37), p = 0.009, independent of how fair these offers were, cooperative behavior consistent with the 'tend and befriend' hypothesis. Male participants when stressed (n = 30) did not show differences in rejections rates compared to the control condition (n = 26), p = 0.41. Our results provide support for a qualitatively different behavioral response to acute stress among men and women.

Effects of Jasminum multiflorum leaf extract on rodent models of epilepsy, motor coordination and anxiety.

Jasmine flowers and leaves are used extensively in folk medicine in different parts of the world to treat a variety of diseases. However, there are very few published reports on the neuropsychiatric effects of Jasmine extracts. Hence, the objectives of the present study were to examine the effects of an alcohol extract of Jasminum multiflorum leaves on topically-applied bicuculline (a model of acute simple partial epilepsy) and maximal electroshock (MES, a model of generalized tonic-clonic seizure) in male Sprague-Dawley rats. The objectives also included an examination of the anxiolytic properties of the extract using an elevated plus maze and the effect of the extract on motor coordination using a rotarod treadmill. Phytochemical analysis of the extract showed the presence of three flavonoids and four additional compounds belonging to the steroid, terpenoid, phenol or sugar classes of compounds. The Jasmine alcohol extract, diluted with water and given orally or intraperitoneally, reduced the number of bicuculline-induced epileptiform discharges in a dose-dependent manner. The extract did not cause a significant increase in the current needed to induce hind limb extension in MES experiments. The extract significantly affected motor coordination when injected at 500mg/kg but not at 200mg/kg. At the latter dose, the extract increased open-arm entries and duration in the elevated plus maze to a level comparable to that of diazepam at 2mg/kg. We conclude that Jasmine leaf extract has a beneficial effect against an animal model of acute partial complex epilepsy, and significant anxiolytic effect at a dose that does not affect motor co-ordination.

"It's All About How You Carry Yourself About": How Medical Students Conceptualize Professionalism in Trinidad & Tobago.

Phenomenon: This paper concerns itself with the value system that informs and motivates medical students of the twenty-first century as distinct from earlier cohorts. It notes a shift from an era of altruism within which the medical professional was a 'pillar of society' always 'on duty' and always concerned foremost for the patient to an era in which he/she is just another member of the work force, subject to public scrutiny and criticism, to patient autonomy and to a self-serving ethos which characterizes the present age. Whilst concerns have been raised for a continuing and separate morality of medicine, young professionals in other studies have cited a range of characteristics including honesty, trustworthiness and respect alongside competence and medical skill. However, the notion of 'performance' has made a strong thrust into the literature, with students citing the putting on and taking off of dual personae as part of their complex identity in this present time. They are entitled to their own lives, to drop the act and just be themselves when off duty, picking it back up again with the duty call. APPROACH: The present study then investigated the views on this subject of two groups of medical students in Trinidad & Tobago in the Caribbean, one made up entirely of nationals and one including students from other parts of the Caribbean and the USA. They discussed the topic in focus groups of eight; their responses were then analysed thematically and subject to discourse analysis. FINDINGS: The study revealed diverse attitudes with some embracing the ethical standards of a high calling that whilst others were concerned that too much was expected, that they had a right to break free and be themselves as long as they did not transgress too far from their expected roles. There were two distinct groups both concerned with 'how' they 'carried themselves about' but this meant different things to each dependent on which of the two perspectives they embraced. As a whole, the study revealed an ongoing conflict of value systems with concern for patient welfare just remaining uppermost. Insights: As The University of the West Indies has now stepped into the field of medical professionalism actively it would hope to support students in resolving their conflicts more consciously in response to the range of philosophical stances which currently present themselves.

Medical Student Stress, Burnout and Depression in Trinidad and Tobago.

OBJECTIVE: Health-care workers in developed nations are well known to experience high levels of burnout and psychiatric morbidity, but little information is available from the Caribbean and other less well-developed regions. This study sought to explore the prevalence of stress, burnout, and depressive symptoms and associated risk factors among medical students in Trinidad and Tobago, the southernmost Caribbean island. METHODS: A cross-sectional survey design was used to sample students. Data was collected utilizing standardized questionnaires that assess stress, burnout, and depressive symptoms. Demographic data and information pertaining to potential risk factors was also gathered. Overall, 450 questionnaires were distributed and analysis was performed upon 381 completed surveys (response rate 85%). RESULTS: Students demonstrated high levels of stress and a significant prevalence of burnout (52%) and depressive symptoms (40%). Final year students demonstrated higher levels of burnout and depressive symptoms. Students who (i) felt they lacked emotional support, (ii) had little opportunity for relaxation and exercise, and (iii) did not feel they had control of their daily schedule all demonstrated higher levels of burnout and depressive symptoms. However, students who practiced from a faith base and considered their religion important demonstrated lower levels of both. CONCLUSIONS: Medical students in Trinidad and Tobago are experiencing high levels of stress with a large proportion suffering from burnout and depressive symptoms. These data suggest that immediate interventions are necessary to help students cope with the challenges faced during medical school. Additionally, more research is needed to explore the potential causal links between burnout and depression during medical school and the effectiveness of tailored interventions especially within the context of developing nations.

Public trust in the healthcare system in a developing country.

Broadly defined, trust in the healthcare system is concerned with how the public perceives the system and the actors therein as it pertains to their ability to both deliver services and seek the best interests of their clientele. Trust is important because it impacts upon a range of health behaviors including compliance and ultimately affects the ability of the healthcare system to meet its goals. While several studies exist on public trust within the developed world, few studies have explored this issue in developing countries. This paper therefore assesses public trust in the healthcare system of a developing small island nation, Trinidad and Tobago. A cross-sectional survey of adults was conducted using a questionnaire that has been successfully used across Europe. We report that trust levels in the healthcare system in Trinidad and Tobago are relatively low with less than 50% of persons indicating fair trust in the healthcare system. In addition, individual health professionals also did not score highly with lowest scores found for nurses and complementary therapists. Results on four out of five dimensions of trust also demonstrated scores significantly lower than those reported in more developed nations. Open-ended comments supported these findings with the majority of persons indicating a lack of confidence in the healthcare system. These results may reflect the reality in the wider developing world, and we suggest that bolstering trust is a needed area of focus in the delivery of healthcare services throughout the nation. Copyright © 2014 John Wiley & Sons, Ltd.

Ketone bodies attenuate excitotoxic cell injury in the rat hippocampal slice under conditions of reduced glucose availability.

Calorie restriction and the ketogenic diet have been successfully used in models of neuroprotection. However, there are limitations in clinical application of these diets and attention has turned to understanding their mechanism of action. Ketone bodies are produced in both diets and maybe involved in their ability to attenuate neuronal injury. This study seeks to assess the effects of ketone bodies on neuronal transmission and their efficacy in reducing the impact of known excitotoxins. We made use of extracellular recordings from rat hippocampal slices and demonstrate that ketone bodies had no effect on neuronal transmission or induction of long-term potentiation (LTP). Perfusion of slices with N-methyl-d-aspartate (NMDA, 15 µM) produced neuronal depression suggestive of cell injury (antidromic recording also demonstrated similar depression), such that recovery of population spike potentials after 60 minutes was 27% in normal (10 mM) glucose but only 7% during reduced (2·5 mM) glucose availability. Experiments in ketone bodies demonstrated improved recovery (31%) but only under conditions of low glucose. Similarly, there was enhanced recovery of slices treated with kainic acid (KA, 30 µM) in reduced glucose media (13-27%), but no difference in normal glucose. These findings suggest that ketone bodies do not alter neuronal function but can alter the response to excitotoxins when energy supplies are impaired, probably by acting as an alternative energy substrate.

An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean.

OBJECTIVE: This study explored the empathy profile of students across five years of medical training. In addition the study examined whether the Jefferson Scale for Physician Empathy correlated with a measure of cognitive empathy, the Reading the Mind in the Eyes Test and a measure of affective empathy, the Toronto Empathy Questionnaire. METHODS: The study was a comparative cross-sectional design at one Caribbean medical school. Students were contacted in class, participation was voluntary and empathy was assessed using all three instruments Descriptive statistics were calculated and differences between groups evaluated using non-parametric tests. RESULTS: Overall 669 students participated (response rate, 67%). There was a significant correlation between the Jefferson Scale of Physician Empathy and the Toronto Empathy Questionnaire (ρ = 0.48), both scales indicating a decline in medical student empathy scores over time. There was, however, little correlation between scores from the Reading the Mind in the Eyes Test and the Jefferson Scale of Physician Empathy. Female students demonstrated significantly higher scores on all three measures. CONCLUSIONS: Medical students' lower empathy scores during their final years of training appear to be due to a change in the affective component of empathy. These findings may reflect an adaptive neurobiological response to the stressors associated with encountering new clinical situations. Attention should be paid not only to providing empathy training for students but also to teaching strategies for improved cognitive processing capacity when they are encountering new and challenging circumstances.

Knowledge and attitudes towards mental illness among college students: insights into the wider English-speaking Caribbean population.

BACKGROUND: Mental illness is a significant contributor to global disease burden and this is expected to increase over the coming decades. Traditionally mental illness has not been well understood by the general public, resulting in poor attitudes towards persons with mental illness and stigmatization. Such conditions are common in the Caribbean where less than 5% of the health budget is allocated to mental illness. AIMS: To assess knowledge and attitudes towards mental illness among college students within the English-speaking Caribbean. METHODS: A self-report questionnaire was adapted from previous studies designed to measure knowledge and attitudes of mental illness. Students were sampled from the University of the West Indies campuses in Jamaica, Barbados and Trinidad & Tobago. RESULTS: Responses were collected from 673 persons with a response rate of 84%. While participants were agreed that particular diseases were mental illnesses, overall knowledge scores were low. Knowledge was higher among those persons who knew someone with a mental illness. Attitude scores were suggestive of stigmatization, with drug abuse and schizophrenia seen in a particularly poor light. CONCLUSIONS: These results suggest that widespread educational campaigns need to be implemented across the region, designed to both increase knowledge about mental illness and reduce discrimination towards persons suffering with mental illness.

Stress alters personal moral decision making.

While early studies of moral decision making highlighted the role of rational, conscious executive processes involving frontal lobe activation more recent work has suggested that emotions and gut reactions have a key part to play in moral reasoning. Given that stress can activate many of the same brain regions that are important for and connected to brain centres involved in emotional processing we sought to evaluate if stress could influence moral decision making. Sixty-five undergraduate volunteers were randomly assigned to control (n=33) and experimental groups (n=32). The latter underwent the Trier Social Stress Test (TSST) and induction of stress was assessed by measurement of salivary cortisol levels. Subjects were then required to provide a response to thirty moral dilemmas via a computer interface that recorded both their decision and reaction time. Three types of dilemmas were used: non-moral, impersonal moral and personal moral. Using a binary logistic model there were no significant predicators of utilitarian response in non-moral and impersonal moral dilemmas. However the stressed group and females were found to predict utilitarian responses to personal moral dilemmas. When comparing percentage utilitarian responses there were no significant differences noted for the non-moral and impersonal moral dilemmas but the stressed group showed significantly less utilitarian responses compared to control subjects. The stress response was significantly negatively correlated with utilitarian responses. Females also showed significantly less utilitarian responses than males. We conclude that activation of the stress response predisposed participants to less utilitarian responses when faced with high conflict personal moral dilemmas and suggest that this offers further support for dual process theory of moral judgment. We also conclude that females tend to make less utilitarian personal moral decisions compared to males, providing further evidence that there are gender differences in moral reasoning.

Neurophobia and its implications: evidence from a Caribbean medical school.

BACKGROUND: Neurology is regarded as a difficult component of the medical curriculum. This has been so marked that the term neurophobia and its effects are being investigated. Given the impact of neurological disorders worldwide, neurophobia has the potential to affect the diagnosis and management of such cases. METHODS: A cross-sectional survey was done among clinical fourth and fifth year students at the Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago. A survey tool successfully used in other schools was adapted to assess perceived level of difficulty, knowledge and interest in various medical sub-specialties including, neurology, cardiology, psychiatry, geriatrics, endocrinology, respiratory medicine, gastroenterology and pediatrics. Questions asked included: "What is your current level of interest in the following medical specialties?"; "What is your current level of knowledge in the given medical specialties?"; "Do you think the subject is easy or difficult?" and "Why do you think neurology is difficult?" Students were required to answer using a Likert scale and results were tabulated into mean scores and standard errors. RESULTS: The response rate was 65% (167/255). Neurology was identified as the subject which students found most difficult (score 3.89 +/- 0.068) and had least knowledge of (2.32 +/- 0.075). These scores were significantly different from those observed for the other disciplines (p < 0.001). The need to know basic neuroscience was identified as the biggest contributor to the difficulty associated with neurology (3.89 +/- 0.072) followed closely by the complex clinical examination associated with neurology (3.69 +/- 0.072). Greater clinical and practical exposure, more time being spent on the subject, and improved teaching skills of lecturers were put forward as suggestions for improving the teaching of neurology. CONCLUSION: This study provides empirical evidence that 'neurophobia' may indeed exist among the student population of the school. It suggests the need to re-visit the approach to neuroscience and neurology education and is consistent with similar trends worldwide.

Knowledge of, attitudes toward, and perceptions of epilepsy among college students in Trinidad and Tobago.

Epilepsy is poorly understood by the public and has been associated with numerous myths. This, coupled with its sometimes dramatic clinical manifestations, has often resulted in stigmatization of persons with epilepsy. A questionnaire to measure knowledge of, attitudes toward, and perceptions of epilepsy (KAPE) was adapted from previous studies and administered to students of the University of the West Indies, St. Augustine, Trinidad and Tobago. The response rate was 91% (355 students). Knowledge was limited, especially with respect to epilepsy's cause, its incidence, and management of an acute emergency. Attitudes toward epilepsy were generally positive. Students who knew someone with epilepsy scored significantly higher on knowledge and attitude questions. A stigma score was calculated to assess perceived stigmatization. There were no differences between the genders, but persons from rural areas and persons of mixed ethnicity perceived less stigmatization. Hindus perceived greater stigmatization than people of other religions. Overall, students still feel persons with epilepsy are discriminated against and experience stigmatization.