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Picture of Dr. Chelsey Baldwin. Text: "National Thyroid Awareness Month with Dr. Chelsey Baldwin"

January is Thyroid Awareness Month. To observe it, Rotation author and Himmelfarb Librarian Ruth Bueter spoke with Dr. Chelsey Baldwin, MD to learn more about the thyroid. Dr. Baldwin is a board-certified endocrinologist at the GW Medical Faculty Associates (GW Medicine) where she treats patients with thyroid conditions. Dr. Baldwin is also an Assistant Professor of Medicine at SMHS and a thyroid expert. 

The Rotation: I’d like to start by saying thank you for meeting with me and helping our readers learn about the thyroid during Thyroid Awareness Month!

Dr. Baldwin: You’re welcome! I’m happy someone wants to talk about it!

Can you tell us a little about what inspired you to become an endocrinologist and how you became interested in the thyroid?

I thought I was going to be a primary care doctor. I enjoy the outpatient setting and I enjoy long-term relationships. I found that I really enjoyed having expertise and that I wanted to be an authority on some topic. I think that primary care is incredibly challenging because you’re in charge of so much, and this gave me a way to keep some of those things that I really wanted - those long-term relationships, and an outpatient setting - and I got to develop an expertise.

The physiology of endocrine is my favorite, so that’s what led me to choose endocrine. And then thyroid, interestingly enough, when I was a fellow I thought I was going to do pituitary. I enjoyed it, and it’s the control center of the endocrine system. But I had a mentor who was a thyroidologist and essentially took me under his wing as far as interest in research, and that’s how it developed, meeting the right person at the right time in my career.

What brought you to GW?

My husband works for the federal government and we were told that we were moving from New York City to DC. I knew I needed to find an academic institution to continue what I had begun at NYU, which is an academic career. I really enjoy seeing patients, but it really balanced things out for me to also have teaching, and to be around people who are thought leaders and are trying to push the envelope, find something new, and are thinking about how to make medicine better than it was 10 years ago. That’s what you find in academic medicine. I actually stayed behind in New York for a year and a half waiting for the right job to open for me, and that was GW.

We at GW are very glad to have you! 

Thank you, Ruth!

Many people outside of medicine might not be familiar with the thyroid. I wasn’t familiar with it until I was diagnosed with hypothyroidism a few years ago. Can you tell us a little bit about it, its role in the body, and how healthy thyroid function contributes to overall health?

Sure. So the thyroid is a relatively small gland, it’s about 15 grams, and it sits in the midline at the base of the neck. So this little gland produces thyroid hormone, and thyroid hormone travels via the blood to all cell types of the body. Of course, I’m a little biased, but what I like to say is that by being a thyroidologist, I have my hand in the physiology of almost every tissue type: the heart beating at the right rate, blood pressure maintenance, how fast the gut moves, or when there’s disease - too slow, too fast - weight management, mental health. The list goes on and on. It makes my job challenging, but also, it’s quite intriguing physiology. 

So again, for people who may not be as familiar with the thyroid, what are some of the things that can go wrong with the thyroid? What are the most common thyroid problems you see with your patients? 

When I’m giving an overview of things that can go wrong with the thyroid, we can think of hormonal problems and we can think about structural problems. For hormonal problems, the thyroid can either not function well enough - the hypothyroidism that you suggested - and again you just think of the metabolism of all of the cell types slowing down, not getting the correct signals. And then the opposite can happen where there’s too much thyroid hormone, and think about being in an overdrive state when it comes to metabolism. And so both [hypothyroidism and hyperthyroidism] are one, incredibly common, and as you shared, can happen to young patients. So I see a large diversity of patients, and interestingly enough, a lot of young patients. 

When we think about structural problems - nodule development. These nodules can be benign, the majority of nodules will be benign. But sometimes, they can one, overproduce hormone and we’re back into that overactive state. Or two, they’re just large enough that they’re causing symptoms due to the fact that the neck is a small space, and they either need to be removed or shrunk in order to alleviate symptoms.

And then finally, thyroid cancer. Thyroid cancer is a passion of mine. I truly am excited about all of the progress we are making in fine-tuning the treatment of thyroid cancer to individualize patient needs. And so that’s kind of a brief overview of what can go wrong with the thyroid.

You talked a little bit about thyroid cancer being a passion of yours. So what are some things that you can do to help patients with thyroid cancer? Are there new treatments, or something that you’re excited about in that area?

Well, interestingly enough, it’s not necessarily new treatments, at least for a majority of patients, it’s learning when treatment isn’t necessary. We’re learning more and more that some of these small cancers and early cancers do not have an aggressive course. And maybe we went a little overboard in the past giving patients treatments that didn’t necessarily change the outcome and took on risk. We’re getting much better at fine-tuning that, making sure that, as one of the famous thyroidologists once said “make sure that the punishment fits the crime.” 

That has been a huge change in thyroid cancer culture, and making sure that the expertise disseminates that practitioners are more comfortable not being aggressive. Because that can actually be really hard on the clinician too, you feel like you’re not doing every little thing you can to prevent recurrence and/or progression. But the bottom line is that knowing when to hold back is truly important.

And then, advancements in thyroid cancers that are new: There are some really rare, aggressive thyroid cancers. Being at a tertiary care center like we are, I, unfortunately, get to see those more often than many clinicians will. And it is so exciting to see that based on molecular or genetic therapies, we are able to make huge impacts on patient survival. There’s a cancer called anaplastic thyroid cancer, that had a dismal overall survival of about 6 months. We are drastically changing that outcome by being able to target these molecular targets within the tumor. It’s really exciting! We published a paper on a case just like that last year. So again, I’m just excited to be a part of that shift and see real progress.

Are there things that we can do to help maintain healthy thyroid function as patients?

This question is usually the one that is the most difficult. There isn’t a whole lot to do for preventative measures when it comes to the most common hormonal problems which are autoimmune. Unfortunately, those are genetic predisposition risks, and as I tell my patients, there’s nothing you’re gonna do about that. You were born with that code. 

And then that second factor, we’re not totally sure what it is that triggers autoimmune disease. Was it a virus? Was it something environmental? But we don’t know what that is to tell people to avoid it. And maybe can’t even avoid it if it’s something common, like a virus or a cold.

Dietarily, the United States and many developed countries iodinate their salt, so iodine is no longer a concern, which at one point was a nutritional problem with the thyroid. But that is really limited to countries that don’t have a national iodination program and are mountainous. Otherwise, natural iodine from the sea protects populations closer to the ocean.

As far as thyroid cancer risks, those tend to be radiation exposures, are things that we know. Those tend to be things like disasters that are non-intentional. So I’m not sure a patient can do much to avoid that. The tough answer there is that there are not a whole lot of preventative measures. But of course, regular exercise and a good diet are the things that I harp on because those are important for everyone’s health.

What has been the most rewarding aspect of treating patients with thyroid disease? And/or what is your favorite aspect of your work?

I think one that struck me yesterday was when I was seeing a young patient with a recent diagnosis of thyroid cancer, and rightfully so, they were nervous, they were anxious about how is this going to look for them, and what is this going to be. It’s really nice to be that guide for that patient. Essentially setting up expectations, what are we going to do to get the very best outcome? I find that part of my job incredibly rewarding.

And two, while I’m giving this talk to the patient, I’ve got a resident and a fellow with me who are learning how to do the same thing for their patients. So it’s kind of full circle - you serve the patient in front of you, and then you additionally serve patients that benefit from your students.

So you touched a little on some thyroid research you’ve done related to thyroid cancer, but can you tell us about some of the thyroid research you have done?

We did talk about that thyroid cancer paper where we published the first case of using targeted therapies, Dabrafenib and Trametinib, to target a patient with differentiated thyroid cancer that was unresectable harboring a BRAF mutation, using those targeted therapies. The uniqueness of this was that it wasn’t an anaplastic cancer, it was a differentiated thyroid cancer, but we used the prior research to apply there.

Some other projects that I work on, I do a lot with minimally invasive techniques for thyroid structural disease, so that means those big nodules that are bothersome, those nodules that overproduce hormones, and very small thyroid cancers. Within the last 5-10 years, there has been a new modality on the block, minimally invasive techniques like laser therapy, and radio frequency, which is my expertise. Coming down the road even newer things like nanopulsed therapy. I do a lot of work there. 

Currently, we’re working on a project looking at thyroid ultrasonography, and predictive factors for whether or not a patient will end up hypothyroid after removing half of the thyroid. Additionally, I’m working with Dr. Khati in radiology and Dr. Joshi, one of our surgeons. We’re looking at the reliability of a system called TI-RADS - it’s a radiology system for grading thyroid nodules, and how do we make that reproducible not only between providers but interdisciplinary providers, because that has been a critique of the system in the past. We’re trying to say that at GW, we figured out how to make this a reliable system. Those are some of the projects that I’ve worked on and that are still ongoing.

In addition to your clinical duties, you teach first and second-year medical students here at GW. You said you also work with fellows and residents. Can you tell us why you enjoy sharing your passion for medicine and endocrinology with medical students? 

Sure. When teaching, you get to go back over that physiology for endocrine, which is really fun, and it’s fun to see the students kind of find that same passion again. Beyond that, I enjoy working with students, residents, and fellows because they remind me of how important it is to be a lifelong learner, constantly being curious, and constantly being willing to explore and go outside of your comfort zone, especially the students. They’re so altruistic still, and I hope that they continue that, and it actually reignites altruism in me. There are multiple benefits to teaching.

When you aren’t treating patients or teaching medical students, what do you enjoy doing in your free time?

I have a dog that takes up as much time as I can give her. And I’m learning French, so that is something that I’ve been trying to do for self-growth. My husband, whenever he’s not traveling for work, we try to make sure we’re out and about exploring the town. And so I keep myself quite busy outside of work as well.

What advice do you have for students just starting in medicine?

Be curious! Ask any question. There aren’t dumb questions. I remember looking back and being so scared to ask something. Like maybe that wasn’t a good enough question. You wonder what stones you left unturned. And this is that time in your life when you get to ask anything and be curious, and you never know what you might find that sparks your interest, and your passion, and leads you down the path that could be the most rewarding career in medicine.

Is there anything else you’d like to share?

I think I’ve said it all!

Thank you so much for taking the time to speak with us today! Happy Thyroid Awareness Month!

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Graphic on Glaucoma Awareness Month from NIH
Glaucoma Awareness Month (National Eye Institute)

January is Glaucoma Awareness Month, a good time to take a look at recently published research from the field. A forthcoming study in the Journal of Alzheimer’s Disease uses data from a prospective cohort study called Adult Changes in Thought (ACT), which follows cognitively normal older adults until Alzheimer’s disease and related dementia development. Those included in the group were study participants with a diagnosis of glaucoma who filled prescriptions for glaucoma medications (including alpha-adrenergic agonists, beta-adrenergic antagonists, miotics, carbonic anhydrase inhibitors, and prostaglandins) for at least ten years.

Davidson et al. cite sensory impairment as one modifiable potential source of dementia risk. Glaucoma is a common cause of visual impairment in older adults, and several past studies have suggested glaucoma may be associated with a higher risk of dementia, although this is not yet proven. Additionally, glaucoma and dementia may potentially share molecular pathways and clinical features which are associated with neurodegeneration.

Treatment of glaucoma focuses on reduction of intraocular pressure through daily use of topical eye drops. Because both glaucoma and dementia are highly prevalent in older adults, therefore Davidson et al. feel it is important to study the potential connections between the two.

Patients included in this study are older adults at risk of dementia from Kaiser Permanente Washington (state). Participants are followed by ACT until they develop Alzheimer’s disease and related dementia. The study looked at age and dementia risk, first glaucoma medication fill, in addition to other factors. 521 participants in the ACT study were ultimately included in this analysis. 62% were female, and beta-adrenergic antagonists were the most frequently prescribed type of medication. The mean exposure time for each study participant to beta-adrenergic antagonists was 1.4 years.

The study concluded that with each year of alpha-adrenergic agonists (AAA), there was a 33% higher risk of dementia (but not Alzheimer ’s-type dementia). The findings of Davidson et al showed that beyond AAA, there was no other glaucoma medication class associated with dementia or Alzheimer’s-type dementia. This constitutes a new finding, because exposure to glaucoma medication use has not been studied extensively, nor has use of AAA previously been linked to an increased risk of dementia. It is important to note that some studies have also pointed to adrenergic dysregulation as playing a role in cognitive decline. Topical use of AAA drops induces central adrenergic activity in some patients, which the authors hypothesize could be a mechanism leading to adrenergic dysregulation.

The authors note that their findings were unexpected, and they cannot fully rule out that the association between AAA glaucoma medication and dementia is related to patients who have more severe glaucoma. (Data on the severity of the glaucoma was unavailable to researchers.) AAA was not a first-line medication, but rather one prescribed to patients after beta blockers or prostaglandins are unsuccessful. In the cohort being studied, AAA was the third most prescribed medication for glaucoma.

While Davidson et al. acknowledge study limitations, this finding indicates an important area for future research, to look at medication exposure time and other factors such as other drugs patients have been taking concurrently with glaucoma medications.

References

Davidson, O., Lee, M. L., Kam, J. P., Brush, M., Rajesh, A., Blazes, M., Arterburn, D. E., Duerr, E., Gibbons, L. E., Crane, P. K., Lee, C. S., & Eye ACT study group (2025). Associations between dementia and exposure to topical glaucoma medications. Journal of Alzheimer's disease: JAD, 13872877241305745. Advance online publication. https://doi.org/10.1177/13872877241305745

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In 1981, the CDC first reported on a rare lung infection that would eventually be called Acquired Immune Deficiency Syndrome. The subsequent discovery of HIV in 1984 paved the way for effective treatment of HIV through antiretroviral therapy (ART). Additionally, prevention strategies such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are helping prevent people from getting HIV.

Blue letters on white background read U=U undetectable equals untransmittable
Image source: CDC

The knowledge that a higher viral load indicated higher transmissibility of HIV was apparent to researchers prior to 1996 (Murphy, 2023). While the Swiss Federal AIDS Commission announced in 2008 that a person who is seropositive, but has had an undetectable viral load for at least six months, does not risk transmitting HIV to a seronegative partner.

Today, the majority of research on U=U is conducted in the public health sector, to examine how – and how accurately – knowledge of U=U is disseminated across the world. In a November 2024 Personal View published in The Lancet. HIV, an international team of authors surveyed evidence relating to viral load suppression and the U=U message – which has been translated to different wordings across cultures and languages – with a view towards ending HIV as a public health crisis by 2030 (Okamoto et al., 2024). Among the chief aims of U=U is enabling people with HIV to thrive, and addressing barriers to thriving – namely, stigma, discrimination, and criminalization. There are 80 countries that have HIV-specific criminal laws, and sexual transmission of HIV is prosecuted – even where no actual transmission has taken place (Okamoto et al. 2024).

Figure from the 2024 article. ttps://doi.org/10.1016/S2352-3018(24)00241-8
From: Okamoto, E. E., Anam, F. R., Batiste, S., Dukashe, M., Castellanos, E., Poonkasetwattana, M., & Richman, B. (2024). Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk. The Lancet. HIV, 11(11), e783–e790. https://doi.org/10.1016/S2352-3018(24)00241-8

Making evidence-based education a priority is a key to the success of U=U. Yet awareness of U=U remains critically low among individuals, healthcare providers, and communities. Another challenge to U=U arises in barriers to viral load-testing access. Without access to such testing, individuals are unable to confirm their virus status. When regular adherence to ART is a challenge, this can lead back to stigmatization in individuals who are HIV positive.

Despite U=U having been understood for decades, there remain challenges – systemic, legislative, and cultural – to it being widely accepted and adopted by the public. But it is a key to ending HIV as a public health crisis, so we will likely continue to see evidence being generated on public awareness and implementation of U=U.

References

Murphy, T. (2023). A brief history of U=U. Retrieved Dec 9, 2024, from https://www.poz.com/article/brief-history-uu

Okamoto, E. E., Anam, F. R., Batiste, S., Dukashe, M., Castellanos, E., Poonkasetwattana, M., & Richman, B. (2024). Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk. The Lancet. HIV, 11(11), e783–e790. https://doi.org/10.1016/S2352-3018(24)00241-8

Today is World Diabetes Day, with the theme of "Diabetes and Wellness." This year, learn with the Mayo Clinic how to help live your best life.
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Today is World Diabetes Day, a day meant to support and raise awareness for the 537 million diabetics around the world. This year, the theme set by the International Diabetes Foundation is “Diabetes and wellness.” Healthy eating and exercise can make a profound impact on preventing and controlling diabetes. While many factors influence diabetes, their hope is to empower people to take agency over the disease or to encourage others to do the same. 

infographic from the Lexington-Fayette County Health Department

As the Mayo Clinic points out, the benefits of exercise extend to holistic improvement of health, both physically and mentally. For adults, they recommend “150 minutes a week of heart-pumping aerobic activity.” This might sound like a lot, but 2 and a half hours divided over seven days is about 21 minutes of activity a day. In other words, a total investment in health could be accomplished with a few jogs, walking to the metro, biking around, or – as the signs all around Ross Hall remind us – taking the stairs when possible. 

Personally, I am always an advocate for running, as it’s (nearly) free and can improve sleep, cardiovascular health, and mental health. And although research is still nascent, a connection between exercise and increased insulin sensitivity is beginning to emerge. Moreover, the amount of running necessary to improve health (20 minutes a day) is possible to fit into many different schedules, unlike other cardio exercises like swimming or kayaking. 

Of course, for diabetics, especially those suffering from hypoglycemia, extra precaution is necessary. The Mayo Clinic recommends checking blood sugar before exercise and gives guidance on when to avoid exercise. They recommend consulting with a doctor about activities before engaging with them. 

Ultimately, managing diabetes is a lifestyle change, one that requires support. The American Diabetes Association has many resources, as well as a local chapter in the DC Capital area. 

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A healthcare professional looking at a clipboard

Physician Assistant Week occurs from October 6-12 each year. This is an opportunity to celebrate PAs across the globe and in our own community. The Physician Assistant program at GW was founded in 1972, and the joint PA/MPH degree was launched in 1986. GW’s program was the first joint degree program for PA students in the US, according to program director Bart Gillum.

The PA program, ranked in the top five in the US, lasts 24 months, the PA/MPH program is 36 months. The Washington, DC location of the program makes the PA program an excellent place for PAs in training to take part in an annual leadership and advocacy summit sponsored by the AAPA, and to avail themselves of other opportunities to visit Capitol Hill to advocate on health policy.

When asked about three things that people might not know about the PA profession, Bart Gillum shared the following thoughts:

  1. "We are now "Physician Associates." In 2021 the American Academy of PAs voted to change the name from physician assistant to physician associate. While some states and institutions have already adopted the name, the new title is still in progress. Adopting the new name has been slow due to the requirement of state laws and healthcare institutions to be updated. In the meantime, you might continue to hear physician assistant and physician associate or even just PA  interchangeably."
  2. "Unlike physicians who undergo residency training for a specific specialty, PAs have the unique ability to move between medical specialties without additional formal training. A PA can work in areas such as cardiology, emergency medicine, or dermatology and switch to another field. This provides more flexibility for those who want to work in a variety of settings throughout their career."
  3. "While PAs are most prevalent in the US. PAs or PA-like professionals are present in about 15-20 other countries, including Canada, the UK, Australia, The Netherlands, Germany, South Africa, and New Zealand. Other countries are currently exploring incorporating PAs in their healthcare systems."
Infographic on physician assistants from AAPA.org
Physician Assistants at a glance (https://www.aapa.org/download/80021/)

Himmelfarb Library has many resources available to support PA students, beginning with the Physician Assistants research guide. Here you will find links to textbooks and videos, resources for diagnosis, a guide especially for PA/MPH students on doing a literature review, PANCE prep materials, resources for clerkship, and much more.

Don't forget to thank a physician assistant this week -- their important work expands patient access to healthcare. Tune in to both Good Morning America and the TODAY show on Friday morning, October 11, for a chance to see PAs representing their profession!

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White background with pink scrabble tiles that spell cancer.
Photo by Anna Tarazevich

September is a big month for cancer awareness - it’s Blood Cancer Awareness Month, Childhood Cancer Awareness Month, Gynecologic Cancer Awareness Month, Ovarian Cancer Awareness Month, Leukemia, Lymphoma, and Hodgkin’s Lymphoma Awareness Month, Prostate Cancer Awareness Month, and Thyroid Cancer Awareness Month! Rather than trying to highlight each of these different types of cancers, we’ll highlight some of Himmelfarb’s cancer resources in this post.

Himmelfarb Library provides clinical, evidence-based medicine resources including DynaMed and epocrates+ which provide information to support cancer care. DynaMed is a point-of-care tool designed to facilitate efficient and evidence-based patient care information including drug and disease information. DynaMed provides information including background, history and physical, diagnosis, disease management, prognosis, prevention, and screening information on medical conditions. DynaMed’s easy-to-read topic pages cover a wide range of conditions and diseases, including cancers such as acute lymphoblastic leukemia/lymphoblastic lymphoma in children as seen in the screenshot below.  

Screenshot of DynaMed entry for Acute Lymphoblastic Leukemia.

epocrates+ is Himmelfarb’s other evidence-based point-of-care database that provides disease and drug information. epocrates+ provides a step-by-step approach, covering prevention, risk factors, history and exam, diagnosis, treatment, and prognosis. Like DynaMed, epocrates+ covers coverage of a wide range of medical conditions, including cancers. Epcorates also offers a quick reference area that covers the basics of a condition, as seen in the cervical cancer quick reference screenshot below.

Screenshot of epocrates+ Quick Reference entry for Cervical Cancer.

If you’re looking for the latest in cancer research, Himmelfarb provides access to many cancer journals! The following list is just a sample of the cancer-related titles you can access through Himmelfarb’s journal collection:

  • Cancer: An American Cancer Society journal that started publication in 1948, Cancer is one of the oldest peer-reviewed oncology journals. This journal focuses on highly relevant, timely information on the etiology, course, and treatment of human cancer.
  • JAMA Oncology: This definitive oncology journal publishes important clinical research, major cancer breakthroughs, actionable discoveries, and innovative cancer treatments.
  • Nature Reviews: Clinical Oncology: This journal publishes in-depth reviews on the entire spectrum of clinical oncology.
  • Cancer Cell: This journal provides access to major advances in cancer research including clinical investigations that establish new paradigms in treatment, diagnosis, or prevention of cancers.
  • Gynecologic Oncology: This journal publishes clinical and investigative articles about tumors of the female reproductive tract and the etiology, diagnosis, and treatment of female cancers.
  • Journal of the National Cancer Institute: This journal publishes significant cancer research findings focused on clinical, epidemiologic, behavioral, and health outcomes studies.
  • Journal of the National Comprehensive Cancer Network: JNCCN publishes the latest information on clinical practices, oncology health services research, and translational medicine, as well as updates to the NCCN Clinical Practice Guidelines in Oncology.

If you’re interested in finding health statistics about cancer, we have information on that too! Check out our Health Statistics: Cancer Guide. This guide provides links to resources to find general cancer statistics, as well as breast cancer, prostate cancer, and colon cancer. Resources to find cancer mortality maps and graphs are also included.

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Image of diverse group of people talking. Text about raising awareness for suicide prevention & treatment.
Image from the National Alliance on Mental Illness: https://www.nami.org/get-involved/awareness-events/awareness-resources/

September is Suicide Prevention Month - making it a good opportunity to raise awareness about suicide and suicidal ideation. If you or someone you know has thoughts of suicide, immediate help is available. Call, text, or chat 988 to speak to a trained crisis counselor.

Just like other mental health conditions, suicidal thoughts can impact anyone. According to the Centers for Disease Control (CDC), over 49,000 people died by suicide in 2022, equating to one death every eleven minutes (CDC, 2024a). Between 2000 and 2018, suicide rates increased by 37%, and returned to their peak in 2022 following a brief decline between 2018 to 2020 (CDC, 2024a). 

Knowing the risk factors of suicidal ideation and behavior is important for everyone. According to a 2016 review published in The Lancet, “approximately 45% of individuals who die by suicide consult a primary care physician within one month of death, yet there is rarely documentation of physician inquiry or patient disclosure” of suicidal ideation or behavior (Turecki, & Brent, 2016). 

While many individuals with suicidal ideation do not attempt suicide (Dlonsky, et al., 2016), recognizing the risk factors can help you identify someone in need of help and help you find the help they need. According to the CDC, factors that contribute to suicide risk range from individual, relationship, community, and societal factors and can include, but are not limited to the following:

Individual Risk Factors:

  • Previous suicide attempt
  • History of depression and other mental illness
  • Serious illness 
  • Job or financial problems
  • Impulsive or aggressive tendencies
  • Sense of hopelessness

Relationship Risk Factors:

  • Bullying
  • Family or loved one’s history of suicide
  • Loss of relationships
  • Social isolation
  • High-conflict or violent relationships

Community Risk Factors:

  • Lack of access to healthcare
  • Community violence
  • Historical trauma
  • Discrimination

Societal Risk Factors:

  • Stigma associated with seeking help and mental illness
  • Easy access to lethal means of suicide 
  • Unsafe media portrayals of suicide

(CDC, 2024b)

Some factors can protect people from experiencing suicidal ideation and behavior. These include, but are not limited to the following:

  • Effective coping and problem-solving skills
  • Strong sense of cultural identity
  • Support from loved ones
  • Feeling connected to others
  • Feeling connected to school, community, and social institutions
  • Availability of high-quality physical and behavioral healthcare

If you are interested in learning more about suicide prevention, Himmelfarb Library has a Suicide and Suicidology Collection that includes numerous books on this topic. Notable books from this collection include: 

References:

Centers for Disease Control and Prevention (CDC). (2024a). Suicide data and statistics. https://www.cdc.gov/suicide/facts/data.html

Centers for Disease Control and Prevention (CDC). (2024b). Risk and protective factors for suicide. https://www.cdc.gov/suicide/risk-factors/index.html

Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual review of clinical psychology, 12, 307–330. https://doi.org/10.1146/annurev-clinpsy-021815-093204

Turecki, G., & Brent, D. A. (2016). Suicide and suicidal behaviour. Lancet (London, England), 387(10024), 1227–1239. https://doi.org/10.1016/S0140-6736(15)00234-2

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Light beams in tribute to the victims of 9/11/01 terrorist attacks
Tribute in Light, photographed by Jack Cohen, licensed for free on Unsplash

The terrorist attacks of September 11, 2001, are now 23 years behind us. In a general sense, they have receded from our collective memory. However, the human health effects of the events of that day linger, and continue to be the subject of research across a variety of disciplines. A MeSH search of the PubMed database between 2022 and 2024 produces 93 results, with publications focusing on a variety of topics, including PTSD, specific health outcomes, and racial and ethnic mortality disparities. In this post, we will focus on a 2024 publication focused on the longitudinal effects and treatment of PTSD on those most affected by this event.

An account of a randomized controlled trial on internet-based therapies for World Trade Center workers and survivors with persistent PTSD was published this year in the open-access journal Psychiatry Research. PTSD is prevalent among those exposed to the World Trade Center attacks, with almost half of individuals reporting poor quality of life and life satisfaction, in addition to unmet needs for mental health care (Feder et al, 2024). Despite the availability of expanded mental health services offered by the CDC’s World Trade Center Health Program, many barriers to access to care remain.

In selecting the two interventions to test, the authors found that while trauma-focused cognitive behavioral therapy (CBT) is one of the most effective and empirically-supported treatments for PTSD, it has a number of limitations, including geographic constraints, stigma, and the limited number of expert practitioners of this type of therapy. Another type of therapy, integrative testimonial therapy (ITT), which presents none of the challenges of trauma-focused CBT, is an Internet-based form of CBT which is conducted via asynchronous patient-therapist written communications. ITT involves patients constructing a chronological narrative of their lives. Prior RCTs found that ITT yielded significant reductions in PTSD among trauma survivors of other historical events.

For the purposes of this study, ITT was compared to therapist-assisted Internet-based modified present-centered therapy (I-MPCT). I-MPCT is a modification of present-centered therapy (PCT), which has been found to be modestly less or as effective as trauma-focused PTSD therapies, with lower dropout rates. The authors hypothesized that ITT would have a greater impact on the reduction of PTSD symptoms of those affected by the events of September 11, 2001. Participants in the trial came from several categories, including both traditional responders (e.g. police officers and firefighters), non-traditional responders (e.g. construction workers and volunteers), and survivors.

Both therapies included three modules of guided writing exercises (or “narratives”) which were interspersed with written feedback from the therapist. Both types of therapy had patients write eleven narratives in total, each taking 45 minutes to complete. For each therapy modality, patients contributed biographical information, wrote about their current life circumstances, and/or discussed problems. The effectiveness of each therapy modality was assessed through a self-reported scale.

Both therapy modalities showed significant reduction in chronic PTSD symptoms and depressive symptoms, and improved quality of life across the board. In post-treatment, both therapies showed significant impact on PTSD, and represent promising treatment options for this particular population.

References

Feder, A., Kowalchyk, M. L., Brinkman, H. R., Cahn, L., Aaronson, C. J., Böttche, M., Presseau, C., Fred-Torres, S., Markowitz, J. C., Litz, B. T., Yehuda, R., Knaevelsrud, C., & Pietrzak, R. H. (2024). Randomized controlled trial of two internet-based written therapies for World Trade Center workers and survivors with persistent PTSD symptoms. Psychiatry Research, 336, 115885–115885. https://doi.org/10.1016/j.psychres.2024.115885

Published on

Comic books have enjoyed popularity for well over a century, and according to a March 2024 report by the market research firm IBIS World, graphic novels are the most popular product in the $2 billion-a-year comic book publishing sector. 

Within the graphic novel sector is a subgenre known as Graphic Medicine, a term coined in 2007 by Dr. Ian Williams, a cartoonist and the founder of a website of the same name. Graphic Medicine provides comprehensive information about the genre, including reviews of new publications and podcasts. Since 2010, they have also sponsored an annual conference – the 2024 conference just wrapped in Athlone, Ireland.

Graphic medicine is also a subset of the field of narrative medicine, which centers patient narratives in clinical practice, research, and medical education. One practitioner within this field is Dr. Benjamin Schwartz, who completed his medical training, but is now a cartoonist for the New Yorker, and a professor of narrative medicine at Columbia University. You can read an interview with him at the website, Doctors Who Create. You can view some of Schwartz’s work for the New Yorker here.

Some graphic works in Himmelfarb's collection include: Graphic guide to infectious disease, The Infographic guide to medicine, and Clinical Ethics: A Graphic Medicine Casebook.

Did you know you can also search for graphic medicine in PubMed? A search of the medical subject heading, “Graphic Novels as Topic” will help you find both comics published within journals, as well as articles which, for example, examine the impact of comics on public health.

Himmelfarb’s Reference and Instruction Librarian Rebecca Kyser, herself a cartoonist, suggests the following titles to help you delve into the world of graphic medicine:

Kid Gloves: Nine Months of Careful Chaos, by Lucy Knisley (available to borrow through our local consortium) follows the cartoonist as she goes through the process of trying to become pregnant, being pregnant, and her birth experience. As she chronicles her own experiences with miscarriage, morning sickness, and preeclampsia, Knisley also explores the history of pregnancy, women’s health, myths and superstitions around miscarriage and pregnancy, and the decisions that factor into the choice to have kids in the first place. Entertaining, emotional, and well-researched, this is a great book for anyone, regardless if they plan to have kids, have kids, or never intend to have kids at all.

The Nib (website): The Nib used to be a magazine publisher of anthology comics, usually all revolving around a specific issue, as well as daily comics. While the magazine stopped publishing last year, the entire site is still live for those who wish to buy back issues or view any of the older strips, which sometimes feature medical themes. There’s plenty to check out such as a comic regarding the Covid-19 pandemic’s impact on the Navajo Nation, living with OCD during Covid-19, and the high maternal mortality Black women face.

Comics for Choice, Second Edition  (anthology, currently on New Books Shelf) Published after 2021, this anthology takes a look at the history of abortion in the United States from a range of perspectives. From personal stories about their own abortions to narratives about those who sought to provide access even when the procedure was entirely illegal, this collection showcases the multiple ways reproductive choice and access impact everyone.

Memento Mori by Tiitu Takalo (coming soon to DC Public Library). Takalo, a cartoonist from Finland, tackles her own experience dealing with a cerebral hemorrhage with honesty and a dynamic drawing style. Using color to reflect her own emotions, Takalo takes us through her frightening medical emergency, the monotony of the hospital, and her struggle to access proper health care upon her release. It’s an engaging story bringing to light the reality of an experience most people rarely face themselves

Lighter Than My Shadow by Katie Green (available at DC Public Library). Mental health conditions can be hard to understand, especially given that the symptoms are often internal. By using comics as her medium of choice, Green gives physicality to her own battle with an eating disorder in her teens and college years. Black scribbles follow her from page to page, growing more busy and large as her anorexia worsens. Later, a mouth on her stomach grows and grows as she struggles against the urge to binge food. It’s a difficult read at times – as it should be given what Green was facing – but it explores her own battle with empathy and thoughtfulness.

For a break from studying, or for a way to see the health professions from a different perspective, dive into some graphic medicine!

References

Comic book publishing in the US - market size, industry analysis, trends and forecasts (2024-2029): IBISWorld. IBISWorld Industry Reports. (March 2024). https://www.ibisworld.com/united-states/market-research-reports/comic-book-publishing-industry/#IndustryStatisticsAndTrends Accessed 7/23/2024

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Published on 2 Comments on Ultraviolet radiation and you
Hand holding a tube of sunscreen

In summer, the sun is a near-constant companion in many parts of the world. But we know that the sun can be our adversary – particularly the ultraviolet radiation emanating from it. Ultraviolet light is used as phototherapy, in the treatment of conditions including jaundice, psoriasis, and cutaneous T-cell lymphoma. But in honor of UV Safety Awareness Month, we focus here on UV exposure that is environmental and not therapeutic in nature, and how best to achieve protection from harmful UV rays. Use of tanning beds is one dangerous source of ultraviolet radiation, but exposure to them is avoidable via behavioral and lifestyle changes. For other types of exposure, there are fortunately a multitude of products available for protection.

That ultraviolet radiation awareness has increased dramatically in recent years is generally a positive change, but where do consumers go to get informed about UV protection? One prominent result in Google searches is a resource from the Environmental Working Group. EWG is an activist nonprofit focused on chemicals used in agriculture and cosmetics, as well as pollutants in drinking water. The EWG has been compiling an annual review of sunscreens since 2008. Its methodology includes assigning numerical ratings to sunscreens based on their “safety.” The EcoWell, a website dedicated to combating misinformation in the cosmetics industry, has expressed some doubts about the EWG’s methodology, which is disclosed at length on their website, but is not easily evaluated by non-experts. EWG includes the following statement in their page on methodology: “Most people [believe] the government oversees the safety of their cosmetics and other personal care items. Not so.” (EWG, n.d.) Even a non-expert can understand that this position stakes a specific claim, and thus the information is not coming from an unbiased source. Additionally, EWG offers companies an opportunity to become “verified” on their website, which in part involves a financial transaction, and means that verified products appear before others in the database. This information is inconclusive, but doesn’t inspire confidence in a nonprofit that claims to be organized in the public interest. 

While consumers might be grateful for a source that is easily accessible, it is very important to understand that the EWG’s findings are not evidence-based. According to Dr. Adewole Adamson, MD, MPP, speaking to Dermatology Times this month, “None of [the EWG’s] data is actually based on any information that involves actual clinical or actual patient use in the real world. I do not think that patients should change their behavior related to putting on whatever sunscreen it is that they use based on this data.” (Andrus, 2024)

Another important thing to understand about sunscreens on the market in the United States, as opposed to those sold in Europe or Asia, is that in the U.S. sunscreen is regulated as though it were a drug. In Europe and Asia, sunscreen is regulated as a cosmetic. Because drug regulation is a more rigorous process, the U.S. has seen fewer sunscreen filters approved for use than in other countries. As a result, Americans have fewer and more limited product choices for protection.

One recent evidence-based guide to sunscreens is this 2023 review on photoprotection, published in the Archives of Dermatological Research. Photoprotection is the practice of minimizing damage to skin and eyes from damage that ranges in severity from sunburn to photoaging to the development of malignant neoplasms. There are two types of ultraviolet radiation, UVA and UVB. UVB exposure is at its highest level in summer, while UVA exposure is more constant throughout the year and leads to carcinogenesis. Sunscreens which are labeled “broad spectrum” primarily protect from UVB, but also protect from UVA. In addition to UV, 50% of ultraviolet radiation comes from visible light, which causes other types of skin conditions, or else can trigger flares of chronic conditions. While UV radiation is absorbed or scattered, visible light is reflected.

The authors of the review state that people “should be encouraged to avoid outdoor activities during peak sun hours, seek shade, apply sunscreen, wear sun protective clothing, and sunglasses.” (McDonald et al, 2023) Avoiding exposure, then, is our first line of protection. But that isn’t practical for most people, especially those who want to participate in summer activities outdoors. It is important to learn more about the different types of sunscreen products and their pros and cons. Sun Protection Factor, or SPF, is a common measure of the effectiveness of sunscreens.

On an FDA website explaining SPF, we learn that the number associated with a sunscreen product’s SPF is commonly misconstrued as a measure of protection based on the amount of time one is exposed to the sun. This is incorrect because solar intensity differs by time of day. In fact, SPF denotes the amount of UV radiation required to produce sunburn on protected versus unprotected skin. (FDA, 2017) One study cited in the review from Archives of Dermatological Research found that SPF 85 provided significantly more protection against sunburn than did SPF 50. A product with a higher SPF may help compensate for an insufficient amount of sunscreen being applied. Frequency of reapplication of sunscreen is important, particularly when there is water exposure or perspiration.

The two main types of sunscreen are chemical, or organic sunscreens, which represent 75% of products currently on the market, and include chemical filters which absorb UVR. Physical, or inorganic sunscreens approved by the FDA include zinc oxide and titanium dioxide, which form a physical barrier to UV absorption. While chemical sunscreens are absorbed more readily on the skin, physical sunscreens are not. Tinted sunscreens contain iron oxides and synthetic mica for cosmetic purposes, in addition to other sunscreen ingredients. The authors of the review found limited evidence of the use of systemic agents protecting against UVR.

One photoprotective measure whose availability has dramatically increased in recent years is sun protective clothing. When selecting UPF (ultraviolet protection factor) clothing for sun safety, the number associated has to do with how much UVR is able to penetrate through different fabrics. However, the authors note that “UPF does not account for body surface area covered.” (McDonald et al, 2023) In general, most natural fibers provide less protection from UVR than synthetic fabrics or wool, darker colors absorb more UVR, and looser clothing provides more protection from UVR. Clothing marked UPF50+ is considered an excellent source of protection.

Now that we’ve discussed protecting the body, what about our heads and eyes? Wearing sunglasses helps decrease UVR damage to the skin around the eyes, the lens, and the cornea. Wearing a hat protects our vulnerable scalps, with wider brimmed hats providing optimal protection for both head and neck.

The review goes on to discuss evidence on adverse effects from photoprotection, including a comparison of evidence on superficial cutaneous absorption versus systemic absorption, concluding that despite the presence of sunscreen compounds in plasma, there simply is no evidence to date that sunscreen ingredients cause any harm to humans – a conclusion in stark contrast to those drawn by the EWG.

We only have the one skin we’re born with, so learning how best to protect it from UVR is time well spent!

References

Andrus, E. (2024/07/05). Addressing Sunscreen Safety. Dermatology Times, 45(7), 6. https://www.dermatologytimes.com/view/addressing-sunscreen-safety-a-review-of-ewg-s-2024-guide-to-sunscreens

Center for Drug Evaluation and Research. (n.d.). Sun Protection Factor (SPF). U.S. Food and Drug Administration. https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/sun-protection-factor-spf#:~:text=SPF%20is%20a%20measure%20of,produce%20sunburn%20on%20unprotected%20skin Accesssed on July 11, 2024

Environmental Working Group. About | Skin Deep | Cosmetics Database. Environmental Working Group. https://www.ewg.org/skindeep/learn_more/about/ Accessed on July 12, 2024 

McDonald, K. A., Lytvyn, Y., Mufti, A., Chan, A. W., & Rosen, C. F. (2023). Review on photoprotection: a clinician's guide to the ingredients, characteristics, adverse effects, and disease-specific benefits of chemical and physical sunscreen compounds. Archives of dermatological research, 315(4), 735–749. https://doi.org/10.1007/s00403-022-02483-4

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