Joseph L. Mailman School of Public Health

Stigma is prevalent among patients with schizophrenia, and its impact can be profound. Improving insight is a critical aspect of treating schizophrenia, but it is often accompanied by increased stigma. This study aims to explore how trait mindfulness and perceived social support moderate the relationship between insight and stigma in patients with stable schizophrenia. A cross-sectional study was conducted in Shanghai's Changning and Huangpu Districts from August to December 2023, recruiting patients through convenience sampling from local mental health centers. A total of 350 patients were included in the study, with their demographic information, insight, trait mindfulness, perceived social support, and stigma being measured. The study found that patients with higher BMI, unemployment or retirement status, and lower income levels experienced significantly higher stigma. The correlation analysis revealed that insight was positively correlated with stigma, while trait mindfulness and perceived social support were negatively correlated with stigma. Regression analysis showed that insight increased stigma, whereas trait mindfulness and perceived social support reduced it. Moderation analysis indicated that higher levels of both trait mindfulness and perceived social support significantly reduced the negative impact of increased insight on stigma in patients with schizophrenia. These findings highlight the importance of enhancing patients' trait mindfulness and perceived social support while improving insight in the treatment of schizophrenia.

One of the justifiable criticisms of human genetic studies is the underrepresentation of participants from diverse populations. Lack of inclusion must be addressed at-scale to identify causal disease factors and understand the genetic causes of health disparities. We present genome-wide associations for 2068 traits from 635,969 participants in the Department of Veterans Affairs Million Veteran Program, a longitudinal study of diverse United States Veterans. Systematic analysis revealed 13,672 genomic risk loci; 1608 were only significant after including non-European populations. Fine-mapping identified causal variants at 6318 signals across 613 traits. One-third ( n = 2069) were identified in participants from non-European populations. This reveals a broadly similar genetic architecture across populations, highlights genetic insights gained from underrepresented groups, and presents an extensive atlas of genetic associations.

Fragmentation occurs when a patient receives care at more than one hospital, and the long-term effects in ovarian cancer are unknown. We examined the association between fragmentation of primary debulking surgery (PDS) and adjuvant chemotherapy (AC) and overall survival (OS).

The National Cancer Database was used to identify women with stage II-IV epithelial ovarian cancer between 2004 and 2016 who underwent PDS followed by AC. Fragmentation was defined as receipt of AC at a different institution than where PDS was performed. After propensity score weighting, proportional hazard models were developed to estimate the association between fragmented care and OS.

Of the 36,300 patients identified, 13,347 (36.8%) had fragmented care. Patient factors associated with fragmentation included older age, higher income, and longer travel distance for PDS; hospital factors included PDS performed at a community center or a facility with lower annual surgical volume (P < 0.05, all). Fragmentation was associated with a 15% risk of 30-day delay to AC (aRR 1.15, 95% CI 1.09-1.22). In a propensity scoring weighted analysis, mortality was reduced when AC was fragmented (HR 0.95, 95% CI 0.92-0.97). Sensitivity analyses indicated fragmentation was associated with improved survival in metropolitan residents. Stratified analyses indicated patients who traveled 50 miles or more with PDS and AC at the same institution had the worst OS.

Fragmentation of PDS and AC has no adverse effects on long-term survival. Survival outcomes were worst for those who received care at the same institution 50 miles or more away.