Category: Academic

Paulina Szlendak, Year 3

According to astounding statistics by alzheimers.org.uk, women with dementia outnumber men 2 to 1 worldwide. What is the cause of such a drastic difference in prevalence? One common hypothesis is that, on average, women live longer than men, and therefore have more time to develop dementia, which is commonly associated with old age (Brinton et al., 2015). While risk does increase with age, the pathophysiology of dementia in relation to gender is much more complex than that. Current research suggests that looking at hormonal changes during menopause is the key to uncovering the mystery of this dementia gender gap (Mishra et al., 2022).

Menopause is a natural stage of life experienced by half of the population worldwide. As of now, there are approximately 850 million women aged 40-60 years old who are likely to be going through or are already past menopause (US Census Bureau, 2014). The neuroendocrine transition of this process often manifests with numerous neurological symptoms: insomnia, depression, hot flashes and loss of cognitive sharpness (Brinton et al., 2015). Unfortunately, all these common symptoms of menopause have been identified as risk factors for dementia, especially Alzheimer’s Disease (AD) (Brinton et al., 2015).

Before we look at why women are at a greater risk of developing dementia and AD, experts in the field of neurological ageing highlight an important change in perception of brain ageing. It was previously thought to be a linear process of steady decline in function, paired with a slow accumulation of toxic compounds. Only recently have scientists realised that ageing of the brain is in fact not linear at all, but a dynamic process. In the female brain there is an important catalyst of this process during midlife (Mishra et al., 2022). Recent studies looking at sex differences in AD development confirm that there are earlier neuro-degenerative changes occuring in female brains than male (Mielke et al., 2014). Moreover, these changes have been linked to the endocrine ageing process physiologically occurring in females during menopause (Mosconi et al., 2017).

Mid-life ageing in women is characterised by three stages: 1) early chronological (pre-menopause), 2) endocrinological (menopause) and 3) late chronological (post-menopause) (Scheyer et al., 2018; Mishra et al., 2022). Throughout these steps there is a shift in the energy metabolism of the brain. Unlike a young brain, it stops relying exclusively on glucose, and switches to utilising lipids and ketone bodies (Mishra et al., 2022). It is thought that this change in fuel dependence to be more lipid-based puts the greatest store of fatty acids in the CNS – white matter – at risk of breakdown in order to produce ketones. Data from numerous studies on Alzheimer’s Disease point to endocrinological ageing as the critical ‘tipping point’, which could initiate the start of late-onset AD (Scheyer et al., 2018).

You may ask: “How does it affect men, if the process is linked to endocrinological changes with menopause?”. Well, males with AD exhibit the same shifts in the brain’s energy metabolism, which lead to fuel deficits, immune system activation and progression of degenerative changes. The process shares pathological mechanisms in both sexes. However, in females the critical catalyst – decreased oestrogen control of glucose metabolism – in turn leads to increased risk of developing disease (Mishra et al., 2022). 

It may seem a bit unfair, that a physiological hormonal transition predisposes women to developing such debilitating conditions as dementia. Despite the multiple dementia risk factors that women face as they near the menopause, there is hope in the brilliant scientists and doctors at the frontiers of dementia research. Moreover, evidence-based lifestyle advice is available to people, who want to decrease their risk of developing a neurodegenerative condition. Some of these practices include: preventing head trauma, limiting alcohol and smoking, managing neuropsychiatric disorders, and in some cases – managing menopause with Hormone Replacement Therapy – which tackles the key hormonal risk factor of dementia (Dementia prevention, intervention, and care: 2020 report of the Lancet Commission).

References:

Brinton RD, Yao J, Yin F, Mack WJ, Cadenas E. Perimenopause as a neurological transition state. Nat Rev Endocrinol. 2015 Jul;11(7):393-405. doi: 10.1038/nrendo.2015.82. Epub 2015 May 26. PMID: 26007613.

Lisa Mosconi, Valentina Berti, Crystal Quinn, Pauline McHugh, Gabriella Petrongolo, Isabella Varsavsky, Ricardo S. Osorio, AlbertoPupi, Shankar Vallabhajosula, Richard S. Isaacson, Mony J. de Leon, Roberta Diaz Brinton

Neurology Sep 2017, 89 (13) 1382-1390; DOI:10.1212/WNL.0000000000004425

Scheyer, O., Rahman, A., Hristov, H. et al. Female Sex and Alzheimer’s Risk: The Menopause Connection. J Prev Alzheimers Dis 5, 225–230 (2018). https://doi.org/10.14283/jpad.2018.34

Mielke MM, Vemuri P, Rocca WA. Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences. Clin Epidemiol. 2014 Jan 8;6:37-48. doi: 10.2147/CLEP.S37929. PMID: 24470773; PMCID: PMC3891487.

Aarti Mishraa, Yiwei Wanga, Fei Yin, Francesca Vitali, Kathleen E.Rodgers, Maira Sotoa, LisaMosconi, Tian Wang, Roberta D. Brinton, Person Envelope et al. (2021) A tale of two systems: Lessons learned from female mid-life aging with implications for alzheimer’s prevention & treatment, Ageing Research Reviews. Elsevier. Available at: https://www.sciencedirect.com/science/article/pii/S1568163721002890?via%3Dihub (Accessed: January 8, 2023). 

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission: Gill Livingston, Jonathan Huntley, Andrew Sommerlad, David Ames, Clive Ballard, Sube Banerjee, Carol Brayne, Alistair Burns, Jiska Cohen-Mansfield, Claudia Cooper, Sergi G Costafreda, Amit Dias, Nick Fox, Laura N Gitlin, Robert Howard, Helen C Kales, Mika Kivimäki, Eric B Larson, Adesola Ogunniyi, Vasiliki Orgeta, Karen Ritchie, Kenneth Rockwood, Elizabeth L Sampson, Quincy Samus, Lon S Schneider, Geir Selbæk, Linda Teri, Naaheed Mukadam

Jonathan Boby John (MSc. Clinical Embryology & ART)  

The emergence of novel coronaviruses that have caused more lethal illnesses (namely SARS, MERS  and COVID-19) has led to an increase into research of coronaviruses and for identifying antiviral  strategies for COVID-19 in particular. Vero cell lines are one of a number of cell lines that are being  used in a large number of these studies. Examples of these studies include evaluation of existing  antiviral and other drugs for improved treatment within as short a time-frame as possible. 

The Vero cell line is an immortalized cell line established from kidney epithelial cells of the African  green monkey. A variety of Vero sublines have been developed and can be classified into four major  cell lineages. Vero gets its name from a derivation of green kidney – Verda Reno. Verotoxin, a potent  E.coli toxin that is involved in severe food poisoning and can cause kidney failure, was originally so named (now known as shiga-like toxin) as it was first screened by its ability to kill vero cells. Vero cell  lines are used less frequently in biological studies than the more popular HeLa cell line, in part  because this is a non-human cell line. However, vero cell lineages are still widely used for screening  purposes for bacterial toxins, viruses and for parasite studies. Since they are derived from normal  kidney cells and not immortal cells like HeLa, Vero cells retain the attributes of normal cells, notably  cell contact inhibition. So, once they reach confluence in the cell mono layer, they need to be  passaged otherwise they will start to die off. In addition, Vero cells have been used in the  development and validation of techniques such as super resolution microscopy. Other applications  include detection of verotoxins, detection of virus in ground beef, efficacy testing, study of malaria,  media testing, vaccine development, protein expression, and mycoplasma testing.

Vero cell line was initiated from the kidney of a normal adult African green monkey on March 27,  1962, by Y. Yasumura and Y. Kawakita at the Chiba University in Chiba, Japan. Vero cells are one of  the most common mammalian continuous cell lines used in research. This anchorage-dependent cell  line has been used extensively in virology studies, but has also been used in many other applications,  including the propagation and study of intracellular bacteria (e.g., Rickettsia and parasites; Neospora), and assessment of the effects of chemicals, toxins and other substances on mammalian  cells at the molecular level. In addition, Vero cells have been licensed in the United States for  production of both live (rotavirus, smallpox) and inactivated (poliovirus) viral vaccines, and  throughout the world Vero cells have been used for the production of a number of other viruses,  including rabies virus, reovirus and Japanese encephalitis virus. The protocols outlined in this  appendix detail procedures for the routine growth and maintenance of Vero cells in a research  laboratory setting. There are several lines of Vero cells commercially available (i.e., Vero, Vero 76,  Vero E6), but they were all ultimately derived from the same source, and the protocols in this unit  can be used with any line of Vero cells. 

It is often difficult to obtain robust data from the clinical cases directly given the many variables  involved. For example, use of anti-viral treatments may have improved patient outcome if given at  an early stage but not once complications developed further, or that the patient may have recovered  regardless of being given a specific treatment. Therefore, effective research models are one 

important part of helping to determine what anti-viral treatments can be seen to have a statistically  relevant impact and warrant further study. 

Screening for the toxin of first named “Vero toxin” after this cell line, and later called “Shiga-like  toxin” due to its similarity to Shiga toxin isolated from Shigella dysenteriae. The cell bank is easy to  establish and preserved and at the same time it can be continuously processed with a fast growth rate.  Vero cells have stable genetic traits and a low probability of malignancy. Vero cells are sensitive to a  variety of viruses and have high virus titers.  

Vero cells stem from monkeys and are therefore a non-human cell line. This will in most cases affect  conclusions drawn from experiments in Vero cells, especially if they are being extrapolated to  humans. The production of biopharmaceuticals in Vero cells will always carry the risk of producing  undesired products. Post-translational modifications such as glycosylation can vary dramatically  between species and affect product properties and quality. The origin of a cell line from epithelial  kidney cells should always be kept in mind, as this will affect cellular properties and outcomes.  Possibility of continuously culturing a cell line also harbours potential risks, as cell lines change and  adapt during long-term culture, altering their characteristics. 

More current applications rely on the lack of interferon-production of Vero cells, which makes them  susceptible to infection by many viruses, making them prime candidates for the production of  viruses and testing the effect of antiviral drugs on viral replication. Analogously, Vero cells are  frequently used for producing vaccines which often rely on viral particles or proteins. In addition to  testing therapeutics, Vero cells can also be used to quantify virus concentrations as infectious doses  via plaque assay. Here, culture dishes confluent with Vero cells are treated with increasingly diluted  virus-containing solutions that will lyse cells and create plaques that can be counted.

Zak Muggleton, Year 3 

Maybe you’ve seen it on social media? Maybe you’ve seen it whilst switching through channels when the Olympic are on every four years? Or maybe you’ve even seen it performed by street performers, watching them twist and turn as they fly above cement? Undeniably, gymnastics is an enthralling sport to watch, and, as you may know if you’ve taken part in the sport, it’s for the adrenaline junkie, bound to put a smile on your face! 

But there is a bleaker side to gymnastics. It is dangerous. Very dangerous. If it were not for the extensive conditioning that the gymnasts face for hours a week, and meticulous coaching, their bodies would simply not be able to cope with the strain put upon them. As a former gymnast, I recall how it took up a large majority of my childhood, and has had huge implications on my life nowadays. Unfortunately, I live with chronic back pain. This is due to coaches inadequately warming us up before starting to practice backbends and high-flying backflips. Nowadays, whilst in university, not being able to take part in gymnastics has a huge psychological impact on me. Especially since it was my entire life, doing it 40+ hours a week as a child. It was my identity. Therefore, I was interested to research the injuries that take place in elite gymnastics. I want to look at this topic not only from a medical perspective, but appreciating the psychological effect on the gymnasts, who have to say goodbye to everything they know from their childhoods. 

It is part of college culture in America to have gymnastics teams that compete in competitions, a bit like supporting your university football team. This is of huge benefit to those gymnasts that have achieved level 10 (the highest level you can achieve before you qualify for elite) as they get a full scholarship to their chosen college, and get to continue the sport they love. Reiterating again that many gymnasts grow up with the sport, therefore making it such a major part of their lives, continuing it into college. Live injury updates, including their college team, name, timeline of injury and detail of injury, are put onto College Gym News to update fans and to keep the records current (College Gym News, 2022). This has been used in this article to try and establish the most common types of injuries, but this is by no means a big enough study to conclusively state which injury is the most common, as fact. At the time of research, there were 90 recorded injuries. Of theses, there were 10 ACL (anterior cruciate ligament) tears, 16 Achilles’ tendon tears (the ligament connecting the gastrocnemius and the calcaneus, known as the heel), 15 boots (defined as any foot or ankle injury requiring a boot to be worn), 7 knee injuries (not an ACL injury), 8 crutches, 5 retirements (injuries so severe that it requires a gymnast to leave the sport), 5 unknown and 1 arm in a cast, occurring due to a Colles’ fracture (a distal radius fracture). 

It could be concluded that the limbs are most likely to be affected by gymnastics injuries, with lower limb injuries coming out on top. This sample is a demonstration that it is unlikely for gymnastics to cause a fatality/injury to one’s trunk. However, the most dangerous injuries are to the head and neck, causing potentially death or disability, but all precautions are taken to prevent this. Safety equipment is always used and difficulty of skills is slowly progressed to prevent someone being unable to complete the skill safely. As there is no reference to head injuries within this list, these precautions could be the reason for that. 

Overlin et al conducted a study that has updated the world on artistic gymnastic injuries, and as you can see by figure 1, there is a list of common gymnastic injuries by location (Overlin et al, 2011). Here are descriptions of some of the conditions: 

• Lisfranc injury (injury of foot with one or more metatarsal bones displaced from tarsus, torn Lisfranc ligaments with widened space between metatarsal bone) [Wikipedia, 2022]
• Os trigonum fracture (Fracture of accessory bone at the posterolateral aspect of the talus) [Royal Orthopaedic hospital, 2022]
• Distal fibula physeal fracture (Fracture of the fibula near the talus bone) [Royal Children’s Hospital Melbourne, 2022]
• OCD (osteochondral defect) of the talar dome (injures cartilage and underlying bone of the talus in the joint) [Zanon et al, 2014]
• Posterior tibial tenosynovitis (inflammation of the covering around the tendon, the tibialis posterior tendon) [Whitney K, 2021]
• Osgood-Schlatter disease (pain and swelling below the knee, at the tibial tuberosity) [Johns Hopkins Medicine, 2022] 
• Gymnast’s Wrist (distal radial epiphysis – overgrowth injury of the growth plate of the radius – it can lead to premature closure of the radial growth plate causing the radius to be shorter than the ulna) [Children’s Hospital of Chicago, 2022]
• TFCC tear (connects the ulnar and radius distally) [Handcare, 2018]
• Grip lock fracture (fracture of distal radius and ulna, when finger and wrist come into contact, and occurs when the grip attaches to the bar upon rotation, it requires up to one year recovery) [Tabila E, 2007]
• Medial Epicondyle Apophysitis (pitcher’s elbow – medial epicondyle inflammation around a growth point, leading to an inability to perform certain actions without pain) [Columbia, 2022]
• Rotator cuff impingement (muscles between the bursa and the humerus that gets stuck between the acromion and the humerus) [Webmd, 2020]
• Labral tears (injury to tissue holing the ball and sockets together, sharp catching like pain in the shoulder) [OrthoNorCal, 2020]
• Spondylosis (term used to describe degenerative conditions of the spine) [DeWitt, 2016]
• Spondylolisthesis (vertebra slips out of position) [NHS, 2022]
• Facet syndrome (arthritis-like condition of the spine that can be a significant source of back and neck pain. It is caused by degenerative changes to the joints between the spine bones. The cartilage inside the facet joint can break down and become inflamed, triggering pain signals in nearby nerve endings) [Mayfield, 2022]
• Scheuermann disease ( some spine grow in a triangle rather than a cylinder causing varying speeds of growth during growth spurt) [McAfee, 2015]
• Discogenic back pain (a form of low back pain, caused by chemically or mechanically damaged intervertebral discs) [Physiopedia, 2022]
• Sacroiliitis ( an inflammation of one or both of your sacroiliac joints) [Mayo Clinic, 2021]
• Turf toe (sprain to main joint of the big toe by hyperextension) [webmd, 2022]

In your future practice, if you ever have a gymnast coming into your GP, you could, theoretically, look back over this list! As you can seen, a large number of ailments affect gymnasts. But it’s not only just damage to their bodies as adults in the sport; it is evident that a lot of gymnasts hurt themselves in the process of developing whilst learning gymnastics. I only feel lucky I didn’t experience more of these injuries!

References

College Gym News., Injury Updates., 2022., [Online]., Available at:  Injury Updates – College Gym News (Accessed: 20/07/22) 

Overlin, A. Chima, B. Erickson, S., Update on Artistic Gymnastics., 2011., [Online]., Available at:  Update on Artistic Gymnastics : Current Sports Medicine Reports (lww.com) (Accessed: 24/11/22) 

Wikipedia., 2022., Lisfranc Injury., [Online]. Available at : https://en.wikipedia.org/wiki/Lisfranc_injury#:~:text=A%20Lisfranc%20injury%2C%20also%20known,are%20displaced%20from%20the%20tarsus (Accessed: 24/11/22) 

WebMD., Turf Toe: Symptoms, Causes and Treatments., 2022., [Online]., Available at: https://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments (Accessed: 24/11/22)

Royal Orthopaedic hospital., Posterior Impingement Surgery (os trigonum)., 2022., [Online]., Available at:  file (roh.nhs.uk) (Accessed: 24/11/22)

Royal Children’s Hospital Mebourne., Distal tibia and-or fibula physeal fractures – Emergency Department., 2022., [Online]., Available at:  https://www.rch.org.au/clinicalguide/guideline_index/fractures/ankle_emergency/#:~:text=Distal%20tibial%20physeal%20fractures%20are,transitional%20fractures%20can%20also%20occur (Accessed: 24/11/22)

Zanon G, Di Vico G, Marullo M., Osteochrondritis Dissecans of the Talus., 2014., [Online]., Available at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295677/ (Accessed: 24/11/22)

Whitney K., Tibialis Posterior Tendinosis and Tibialis Posterior Tenosynovitis., 2021., [Online]., Available at:  https://www.msdmanuals.com/en-gb/home/bone,-joint,-and-muscle-disorders/foot-problems/tibialis-posterior-tendinosis-and-tibialis-posterior-tenosynovitis#:~:text=Tibialis%20posterior%20tenosynovitis%20is%20inflammation,are%20felt%20around%20the%20ankle (Accessed: 24/11/22)

Johns Hopkins., Osgood-Schlatters Disease., 2021., [Online]., Available at:  https://www.hopkinsmedicine.org/health/conditions-and-diseases/osgoodschlatter-disease#:~:text=Osgood%2DSchlatter%20disease%20is%20a%20condition%20that%20causes%20pain%20and,which%20stretches%20over%20the%20kneecap (Accessed: 24/11/22)

Children’s Hospital of Chicago., Gymnast’s Wrist (Distal Radial Epiphysitis)., 2022., [Online]., Available at:  https://www.luriechildrens.org/en/specialties-conditions/gymnast-wrist-distal-radial-epiphysitis/ (Accessed: 24/11/22)

The Hand Society., TFCC Tear: Causes and Symptoms., 2018., [Online]., Available at:  TFCC Tear: Causes and Symptoms | The Hand Society (assh.org) (Accessed: 24/11/22)

Tabila E. Grip Lock: A unique Mechanism of Injury in Gymnastics. 2007., [Online]., Available at:  [Online at Human Kinetics Journals] (Accessed: 24/11/22)

Columbia University., Medial Epicondyle Apophysitis / Little League Elbow (Pediatric)., [Online]., Available at:  Medial Epicondyle Apophysitis / Little League Elbow (Pediatric) | ColumbiaDoctors – New York (Accessed: 24/11/22)

WebMd., Rotator Cuff Impingement., 2020., [Online]., Available at:  https://www.webmd.com/pain-management/rotator-cuff-impingement#:~:text=A%20rotator%20cuff%20impingement%20is,move%20and%20lift%20your%20arms (Accessed: 24/11/22)

OrthoNorCal., Labral Tears of the Shoulder., 2020., [Online]., Available at:  https://www.orthonorcal.com/labral-tears-of-the-shoulder-orthopedic-specialists-los-gatos-morgan-hill.html (Accessed: 24/11/22) 

DeWitt., Spondylosis: What It Actually Means., 2016., [Online]., Available at:  Spondylosis: What It Actually Means (spine-health.com) (Accessed: 24/11/22)

NHS., Spondylolisthesis., 2022., [Online]., Available at:  Spondylolisthesis – NHS (www.nhs.uk) (Accessed: 24/11/22)

Orlando M., Facet Joint Syndrome/ Arthritis., 2018., [Online]., Available at:  Facet Joint Syndrome, Facet arthropathy Mayfield Brain & Spine Cincinnati, Ohio (mayfieldclinic.com) (Accessed: 24/11/22)

McAfee P., Scheuermann’s Disease of the Thoracic and Lumbar Spine., 2015., [Online]., Available at:  Scheuermann’s Disease of the Thoracic and Lumbar Spine (spine-health.com) (Accessed: 24/11/22)

Physiopedia., Lumbar Discogenic Pain., 2022., [Online]., Available at:  https://www.physio-pedia.com/Lumbar_Discogenic_Pain#:~:text=Discogenic%20pain%20is%20a%20form,in%20deterioration%20due%20to%20ageing (Accessed: 24/11/22)

Mayoclinic., Sacroilitis., 2021., [Online]., Available at:  https://www.mayoclinic.org/diseases-conditions/sacroiliitis/symptoms-causes/syc-20350747 (Accessed: 24/11/22)

Zak Muggleton, Year 3

Following a recent diagnosis of type two diabetes, your doctor will advise you to exercise more and to change your diet—it may be time to make a lifestyle change. When diagnosed with alcohol fatty liver disease, your doctor will advise you to stop drinking alcohol—a necessary lifestyle change. Or you’ve been diagnosed with COPD, and your doctor will advise you to stop smoking—A lifestyle change. So what if you were diagnosed with an risk of mortality, starting right at this moment? There is new evidence to suggest that searching for ‘purpose in life’ is the lifestyle change you may need. 

Shiba K et al have recently conducted a study that thinks a lower risk of mortality to those with a ‘purpose’ in life (Shiba K et al, 2022). So how can one define themselves as having ‘purpose?’ Perhaps this study begins to answer the age-old question—what is the meaning of life? To suggest that I can objectively answer this question would be absurd—especially as there is no such thing as objective truth, in my opinion—but a sense of ‘purpose’ could be a foundational reason that humans live.  

If one is devoid of any ‘purpose,’ due to having nothing meaningful to live for at all, then they are ‘disengaged.’ They may wake up alone, stay in their house all day, go for a short walk around the neighbourhood and then go to bed, alone. Bridget Jones in the lonely years, if you will. The rest of the population are split into three categories. They include the dabblers (those who never commit to specific purposeful activities and struggle to articulate why they are partaking in them), the dreamers (being able to dream about something purposeful and being able to articulate why, but never taking action)—yes, if you live your life dreaming of being a professional footballer and never become one, you still have purpose, however much others may oppose—and finally the group most are envious of, the purposeful (those who partake in a genuinely meaningful activity, and can articulate why they devote their time to it).  

It is also proven that, especially with the addition of this new eight year-long cohort study, there are numerous benefits to having a ‘purpose.’ These include increased optimism, hope, resilience, joy, physical health, effectiveness as a colleague in the workplace, belonging, satisfaction and finally income. (Scottsdale Community College, 2019) These features have been championed by society for many years as the ideal position to be in, especially for an adult. In my opinion, being able to obtain a few of these qualities will mean that someone is successful, but to have an even better quality of life I would argue that ‘purpose’ is an integral factor. 

Shiba K et al’s study followed over 13,000 adults, around age 50, for 8 years. Each participant had to self-reflect on whether they thought they had purpose (which is entirely subjective, and a possible flaw in the study) and they were then observed for 8 years afterward, to calculate how many people died and why. Data was also analysed to determine whether race/ethnicity and gender have an effect. Ultimately It was determined to not have an effect. Interestingly, however, there was a minimally stronger correlation in women, and this is theorized to be because ‘due to social norms, men have more of an unwillingness to seek medical help than women.’ But it is possible this could be due to confirmation bias. Overall, however, those with ‘purpose’ seemed to use preventative health services more than those who did not, which makes sense as to why they would live longer with earlier intervention. Early trials seem to suggest that group cognitive behavioural therapy (CBT) and volunteering can increase people’s ‘purpose,’ but this has not been confirmed by any comprehensive research. 

To conclude, this is an intriguing, developing area of psychology that is not thoroughly researched yet but definitely has the potential to drastically improve the lives of those who most need it. Because after all, if all you need to do is dream, then anyone in the world is capable of finding their ‘purpose,’ they just need to be given the opportunity to. 

References

Shiba, K et al. (2022). “Purpose in life and 8-year mortality by gender and race/ethnicity among older adults in the U.S.” Preventative Medicine,.  Volume 164.

Scottsdale Community College. (2019). “Why Having a Sense of Purpose is Important.” Accessible by [https://www.scottsdalecc.edu/news/2019/why-having-sense-purpose-important#:~:text=Think%20about%20this%3A%20When%20you,Better%20physical%20health]. [Accessed on 23/11/22].

Imogen Jones, Year 3

Medical physicist Dr Hadiyah-Nicole Green has developed a revolutionary new cancer treatment that targets a variety of solid tumours with minimal effect on healthy tissues. With 1 in 2 people developing cancer in their lifetime, this ground-breaking research could be life-changing for millions of people worldwide.

Dr Green earned her doctoral degree in physics from the University of Alabama at Birmingham. During her early career, Green was a caregiver to her aunt and uncle, both diagnosed with cancer. The loss of her aunt and witnessing her uncle’s suffering during his treatment inspired Green’s future research into a better, less painful approach to cancer treatment.

Green’s idea for applying lasers to cancer research began during an internship at NASA. From there, Green joined a laboratory to investigate these ideas further. The Research resulted in the production of a method to insert gold nanoparticles directly into cancerous cells, without affecting healthy cells around them. These nanoparticles can then be targeted by laser radiation, heating the nanoparticles and subsequently killing the cell. This treatment, named Laser-Activated Nano Therapy (LANT), should have little to no effect on the healthy cells around the cancer, leading to minimal side effects.

Since this development Green was able to begin early trials on mice, which have so far been highly successful. During mice trials, Dr Green’s technique was able to entirely eliminate the cancerous tumour in just 15 days after only one 10-minute treatment. Pictured below are the results of her experiment.

The LANT treatment is now ready to enter human trials. However, Dr Green is determined to keep this treatment affordable and accessible to all. As a result, the funding for human trials is being raised through her non-profit organisation, The Ora Lee Smith foundation, without large pharmaceutical company funding. 

The goal of Dr Green’s research and foundation is to provide an affordable and accessible treatment for cancer. The LANT treatment she developed can be administered as an outpatient procedure with minimal side effects that could revolutionise cancer treatment for many solid tumours, including chemo-resistant or inoperable ones.

Holly Dobbing, Year 2

Schizophrenia is a chronic and debilitating mental illness that affects 1% of the population worldwide (Nemade & Dombeck, 2015). It is believed to be a brain malfunction that affects the interaction between the part of the brain that controls judgement–in the prefrontal cortex–and the parts of the brain that control emotion and memory–in the temporal lobes and limbic system (“The negative symptoms of schizophrenia – Harvard Health”, 2006). The illness is an enigma to many in the medical and psychiatric communities as the exact cause is unknown, however many theorise that schizophrenia is caused by an amalgamation of genetic and environmental factors (“Schizophrenia | NHS”, 2016). Schizophrenia has been shown to cause impaired judgement and psychotic symptoms, such as vivid hallucinations (“The negative symptoms of schizophrenia – Harvard Health”, 2006). Because of this, schizophrenia is notorious for its perception as a violent illness; more than 40% of sufferers to attempt suicide at least once (“Schizophrenia.com – Introductory Resources on Schizophrenia”, n.d.). Furthermore, it is estimated that one thousand homicides every year are committed by untreated mentally ill individuals (Watnik, 2001) and that schizophrenia, in particular, is a prominent feature of infamous serial killers; Ed Gein, David Berkowitz, Richard Chase  and Peter Sutcliffe, to name a few (“Dangerous Minds: Mental Illnesses of Infamous Criminals”, n.d.; Brannen, 2018). 

Peter Sutcliffe, the Yorkshire Ripper, was a serial killer who terrorised the Leeds and Bradford area in the 1970s, after, as he believed, being told by ‘the voice of God’ to do so (Dennigan, 1981). He killed thirteen women and attempted to murder a further seven over the course of 15 years before being arrested and sentenced to 20 concurrent sentences of life imprisonment (Brannen, 2018). During his preliminary hearing in April 1981, Sir Michael Havers, the Attorney General, told the judge that the Crown accepted Sutcliffe’s pleas of manslaughter because “the general consensus of the doctors is that this is a case of diminished responsibility, the illness being paranoiac schizophrenia.” (Clark and Tate, 2015) Whilst this does not definitively prove that Sutcliffe’s horrifically violent murders can be attributed to his schizophrenia, people with schizophrenia are estimated to be 4 to 6 times more likely to commit a violent crime than people without the disorder (Fazel, 2009), therefore it could be reasoned that Sutcliffe’s paranoid schizophrenia is a significant factor in his motivation to kill. 

The destructive and disturbing nature of schizophrenia is also evident in the case of Ed Gein, an American serial killer whose gruesome crimes and jarring behaviour earned worldwide notoriety. Gein inspired multiple books and movies such as The Silence of the Lambs (1991) and Psycho (1960) (Jenkins, 2018). In 1957, Gein confessed to the murders of Bernice Worden in 1957 and Mary Hogan three years prior, as well as admitting to practicing necrophilia and digging up corpses to fashion their body parts into different clothing garments and articles of furniture (Biography.com Editors, 2014). After being deemed unfit to stand trial by reason of insanity, Gein was admitted to various psychiatric institutions until it was decided he could participate in his own defence in 1968 (Biography.com Editors, 2014). He was found guilty of the murder of Worden but was found to be insane at the time of the murder (Jenkins, 2018). Gein was sentenced to life imprisonment in psychiatric institutions and was subsequently admitted to the Central State Hospital in Wisconsin, USA, where he remained until his death in 1984 (Jenkins, 2018; Biography.com Editors, 2014). Whilst in hospital, Gein was described as ‘mild-mannered’ (Biography.com Editors, 2014). 

This brings me on to the key point of my article: should people with schizophrenia be treated as though they are inherently dangerous, or are we assuming the worst for no reason? The stark juxtaposition of the ‘deranged’ and ‘gruesome’ killer Gein was described as being before going to hospital, in comparison to the ‘mild-mannered’ man he was when he was in hospital may suggest that schizophrenia, as an illness, is only a risk if the patient is untreated and/or unsupported. Perhaps given support early on, Gein and Sutcliffee wouldn’t have felt the urge to commit the heinous crimes they committed. Perhaps people with schizophrenia would benefit more from empathy, instead of stigma, fear and the threat of ostracism from society. In an article about her experience with schizophrenia, Tanara, a 27-year-old college student discussed a violent outburst that landed her in jail (Derrow, 2017). After she was released and seen by a psychiatrist, with support from doctors, family and friends, she is now living a ‘happy, beautiful life’ (Derrow, 2017) and acts as absolute proof that schizophrenia can be safely managed, like any other illness. So, in answer to my question, no, I don’t think that schizophrenia is intrinsically linked with violence. I think a better correlation, that could be derived from this, is that between violence and lack of support and care in society. 

References

Biography.com Editors. (2014). Ed Gein Biography. Retrieved from https://www.biography.com/people/ed-gein-11291338 

Brannen, K. (2018). The Yorkshire Ripper Website. Retrieved from http://www.execulink.com/~kbrannen/ 

Clark, C. and Tate, T. (2015). Yorkshire Ripper. John Blake Publishing Ltd, p.15. Cognitive Behavioural Therapy. (2016). Retrieved from https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/

Dangerous Minds: Mental Illnesses of Infamous Criminals. Retrieved from https://www.forensicscolleges.com/blog/resources/dangerous-minds-criminal-mental-illness

Dennigan, M. (1981). Accused ‘Ripper’ says God told him to kill. Retrieved from https://www.upi.com/Archives/1981/05/11/Accused-Ripper-says-God-told-him-to-kill/7868358401600/

Derrow, P. 2017. ‘I Have Schizophrenia’: What It’s Really Like to Live With the Mental Illness [Online]. Johnson & Johnson. Available: https://www.jnj.com/personal-stories/i-have-schizophrenia-what-its-really-like-living-with-the-mental-illness [Accessed 26 April 2022].

Fazel, S. (2009). Schizophrenia, Substance Abuse, and Violent Crime. JAMA, 301(19), 2016. doi: 10.1001/jama.2009.675 https://www.ncbi.nlm.nih.gov/pubmed/19454640 

Jenkins, J. (2018). Ed Gein. Retrieved from https://www.britannica.com/biography/Ed-Gein

Nemade, R., & Dombeck, M. (2015). Schizophrenia Symptoms, Patterns and Statistics and Patterns. Retrieved from https://www.mentalhelp.net/articles/schizophrenia-symptoms-patterns-and-statistics-and-patterns/ 

Schizophrenia – NHS. (2016). Retrieved from https://www.nhs.uk/conditions/schizophrenia/

Schizophrenia.com – Introductory Resources on Schizophrenia. Retrieved from http://schizophrenia.com/suicide.html

The Negative Symptoms of Schizophrenia – Harvard Health. (2006). Retrieved from https://www.health.harvard.edu/mental-health/the-negative-symptoms-of-schizophreniaWatnik, I. (2001). A Constitutional Analysis of Kendra’s Law: New York’s Solution for Treatment of the Chronically Mentally Ill. University Of Pennsylvania Law Review, 149(4), 1181. doi: 10.2307/3312992

Holly Dobbing, Year 2

I’m sure you know someone who makes solving maths equations look as easy as reciting the alphabet. Or there’s always that one addition to your quiz team who seems to have an eidetic memory. And even people with gifts for sports, who can turn their hand at any physical activity and appear like they were born to do so. We can all think of people who seem so naturally talented in a given area, that it seems impossible that they weren’t born with some sort of genetic advantage. But is this the case? Are some of us born with different abilities or are there other factors at play? 

Of course, practice is pivotal to excelling in a certain field. Violinists in the world’s top orchestras don’t achieve that level of excellence without complete dedication and gruelling practice throughout their lives. Likewise Olympic athletes and world-class sportspeople, elite academics and even those people who can solve a Rubik’s cube in under a minute aren’t able to do these things overnight. In his book ‘Talent is Overrated’, award-winning journalist Geoff Colvin discusses the importance and necessity of ‘deliberate practice’ in being successful (Colvin, 2019). He explains how we often assume we have either have an aptitude for something, or we don’t, when actually no one fits into these strict categories—talent isn’t something you have or not, it is something you gain (Colvin, 2019). He also says ‘great performance isn’t reserved for a preordained few’ because in reality, there is nothing genetic or insurmountable difference separating us from world-class performers except practice. 

Another key and often over-looked factor is opportunity. This can be as simple as where you live. In his book ‘Bounce’, international table-tennis champion Matthew Syed discusses the true nature of talent and how success isn’t confined to those with a genetic predisposition to greatness (Syed, 2010). He talks about his success in table tennis, and how the street he grew up on produced ‘more outstanding table-tennis players than the rest of the nation combined’ (Syed, 2010). Was someone putting something in the water? No. They just all happened to attend the same school, with the same hard-working coach, and a high performing table-tennis club nearby (Syed, 2010). He also talks about a similar scenario in Canada, where almost all top ice-hockey players are born in January, February or March (Syed, 2010). Of course, this isn’t due to some crazy genetic mutation—it’s actually because the boys born earlier in the year were more likely to be picked by scouts because they looked bigger, stronger and more mature, and so would have additional opportunities to train and practice and therefore improve quicker and ultimately be more successful (Syed, 2010). Strange to think, but if you imagine one of your role models—maybe if they were born somewhere else or at a different point in time, they wouldn’t be where they are today. Maybe if Tiger Woods was born six months earlier, he wouldn’t even know how to hold a golf club. Similarly, maybe if you were born in the catchment area of a different school, you would be at the next Olympics representing team GB in the diving final alongside Tom Daley. Maybe not. But just maybe.  

Still, even after reading all of this, I wasn’t one hundred percent convinced. What about people who excel at something the very first time they try it? You may argue that typically these people have prior experience in similar activities, where the very basic principles are the same. For example, being good at tennis because you have previously played badminton, or even less tangible links like being good at art and becoming an excellent surgeon (some studies indicate artistic hobbies improve dexterity and subsequently improve surgical practice (ADEA, 2022)). I’m still not convinced, but I think partly this is because it feels almost like a betrayal to be told that natural talent is a myth. We’re so used to looking up to our role models and thinking there is something special about them that sets them apart from us. But actually, maybe there isn’t. Perhaps it really does come down to opportunity and practice.

It’s interesting because we’re so quick to believe that our circumstances in life reflect the disadvantages and failures we experience—not getting into your chosen university or not making it onto the top sports team—but we seem to be so reluctant to believe that these things could also give us advantages. Yes, it’s obvious that you will have advantages if you’re born into a family with lots of money and influence, but you can also be privileged just by being born at the beginning of the school year, or by being the youngest child in the family. Ultimately, what I’m trying to say is this: talent may or may not be a concept made by humans to explain people who are more successful than ourselves, but it is not confined to a select few. Hard-work and determination will result in success.  

References

ADEA. 2022. The Importance of Manual Dexterity [Online]. Available: https://www.adea.org/GoDental/Application_Prep/Preparing_for_Dental_School/The_Importance_of_Manual_Dexterity.aspx [Accessed 16th March 2022].

COLVIN, G. 2019. Talent is Overrate: What Really Separates World-Class Performers from Everybody Else, Nicholas Brealey Publishing.

SYED, M. 2010. Bounce: The Myth of Talent and the Power of Practice, UK, Fourth Estate GB.

Matty Griffiths, Year 2 Sports and Exercise Science, Durham University.   

The importance of people’s psychological well-being in western societies has been translated into many areas, one of these being sport. Sports psychology has proved itself to be key in maximising performance within the athletic population. One of the most important and intriguing aspects of sports psychology looks at motivation (Marheni et al, 2018) and more recently its elevated significance in mental health. This article will walk you through how motivation is categorised and later explore how it may be linked to mental health, as I think the findings have a broader application than the sporting context in which they were conceived. 

How motivation is categorised 

Research around Motivation by Deci and Ryan (1985) saw the emergence of the Self-determination theory (SDT), the basis for much of the academic understanding of motivation. Within SDT, Organismic Integration Theory (OIT) describes the states of motivation an individual can experience: Amotivation, Extrinsic Motivation and Intrinsic motivation. 

Starting with Amotivation, this is a state where an individual simply feels unmotivated. They are no desire to engage which will mean an individual perceives themselves as incompetent and/or has the perception that any outcome from participation will yield no positive impact. 

Meanwhile, extrinsic motivation has multiple layers which investigate how external entities affect an individual’s drive. Different regulatory styles explain how someone is externally motivated. An externally regulated individual would have rewards and punishments dictate their engagement in a specific exercise. Introjected regulation results in an individual’s compliance being a result of them feeling shame if they did not. Identified regulation would mean someone sees the benefit in partaking in an activity but not the activity itself. Finally, integrated regulation is when someone feels participation is part of their ethos and in line with their values. For example, someone who attends all of their academic commitments because being a ‘good student’ is something they believe in. 

Intrinsic motivation, however, simply refers to the drive to do something coming from the pure form of enjoyment and inherent satisfaction that is felt by someone partaking in an activity. While this is a better predictor of long-term engagement with activities over extrinsic motivation, it has also been shown to correlate with higher burnout rates due to the intensity of application that it can lead to.

What can impact motivation? 

Appreciating the complexity of motivation is vital when looking at its link with mental health (Lake and Turner, 2017), such as the quality of an individual’s motivation over its extent or. seeing that their motivation may be situational (Gillet et al, 2017). An example of this can be seen in Vygotsky’s Zone of Proximal Development (1978). Vygotsky (1978) suggests there is an optimum level of difficulty to maximise learning: a task needs to be stimulating enough to require effort from the leaner, yet not so challenging that they do not see themselves as competent enough for it. This can occur naturally, as Vygotsky observed that parents naturally speak to their children slightly above their child’s current linguistic ability, yet not too far beyond it so that the parents can still be understood.   

This links to an aspect of SDT (Deci and Ryan, 1985) called Basic Needs Theory. This theory states that there are three criteria that an individual needs to support a healthy psyche: Competence, Autonomy and Relatedness.  As stated in Vygotsky’s Zone of Proximal Development (1978), an individual must feel they can be competent at a task for them to participate effectively, which is echoed within Basic Needs Theory. Autonomy is the need for an individual to feel as they are in control of what they are doing, which can be a criticism of extrinsic motivation. Relatedness links how the individual feels a certain activity will affect them within a social context. Basic Needs Theory helps support the blend between social and physiological requirements and contextualises them when looking at motivation. 

How does motivation affect mental health? 

A study conducted by Sheehan et al (2018) aimed to look at the correlation between types of motivation and mental health within a sporting population. Some intriguing findings were made, for example, introjected regulation within an individual who is externally motivated resulted in a poor mood along with feelings of anxiety in those who experience extrinsic regulation. Looking at intrinsic motivation, while there was a correlation between factors such as autonomy and an increase in positive mood states, depressive states were also common. 

Context when assessing mental health is vital, so taking these findings with caution is advised. However, there is a clear correlation between poor moods and feelings of anxiety for the extrinsically motivated and positive mood states for those who are intrinsically motivated. One exception is the link between depressive states and burnout in intrinsically motivated populations (Leymre et al, 2007)  

Although these findings are taken from a sporting context, I feel the awareness of where our motivation comes from and how that makes us feel is key in caring for our mental health. So, as we move into exam season, I think the biggest takeaway is just to be aware of what drives you to get up for that early lecture or pull that all-nighter at the library and how that might be making you and your peers feel. 

References

Deci, E.L. and Ryan, R.M., (2012). Self-determination theory.

Gillet, N., Morin, A.J. and Reeve, J., (2017). ‘Stability, change, and implications of students’ motivation profiles: A latent transition analysis.’ Contemporary Educational Psychology, 51, pp.222-239.

Lake, J. and Turner, M.S., (2017). ‘Urgent need for improved mental health care and a more collaborative model of care.’ The Permanente Journal, 21.

Lemyre, P.N., Roberts, G.C. and Stray-Gundersen, J., (2007). ‘Motivation, overtraining, and burnout: Can self-determined motivation predict overtraining and burnout in elite athletes?’ European Journal of Sport Science, 7(2), pp.115-126.

Marheni, E., Purnomo, E. and Cahyani, F.I., (2019). ‘The Role of Motivation in Increasing Achievement: Perspective Sports Psychology.’ In 2nd International Conference on Sports Sciences and Health 2018, pp. 59-62.

Sheehan, R.B., Herring, M.P. and Campbell, M.J., (2018). ‘Associations between motivation and mental health in sport: A test of the hierarchical model of intrinsic and extrinsic motivation.’ Frontiers in psychology, 9, pp. 707.

Vygotsky, L. S. (1978). ‘Mind in society: The development of higher psychological processes.’ Cambridge, MA: Harvard University Press.

Holly Dobbing, Year 2

I’m going to start with a short but so incredibly huge question: what is consciousness? There are a thousand answers to that question. In fact, when you google it, you get almost four MILLION results (go on, try it). But it’s a concept that means something different to each of us. Am I conscious when I’m walking to the shop? Yes. Am I still conscious when I am daydreaming about being on a beach instead of walking to Aldi? Still yes, but probably significantly less so. How about when I’m sleeping? Or in that weird phase of half-asleep-half-awake? Where does consciousness start? Where does it end? What exactly is it that makes us conscious? Are other animals conscious? Are worms? Who determines who is conscious and who is not? I would argue it’s entirely subjective. Perhaps it isn’t. Who knows?

So now that I’ve successfully tied your brain into knots, let’s take it back to basics. The Oxford English Dictionary defines consciousness as, “the state of being aware of and responsive to one’s surroundings,” and “a person’s awareness or perception of something.” 

Let’s start by looking at that first definition. Essentially, this means two things: 1. to be conscious you need to be awake; and 2. to be conscious you need to find some sort of meaning in your surroundings. Which links nicely to the second definition which implies that consciousness comprises our every thought and feeling. It’s the warm feeling you get in your heart when you have a bite of chocolate. It’s the joy you feel when you’re laughing with your friends. It’s the love you have for your partner. The pain you feel when you hit your elbow. And the bitter knowledge that eventually we’re all going to die. (Sorry!) To summarise, consciousness is not only being awake, but being alert and responsive to the things around you. 

But what about when you’re awake but not responsive? Or responsive, but not awake? These anomalies are simply referred to as ‘altered-states of consciousness’ and can be induced by brain injury, drugs, alcohol and even extreme tiredness (Srinivasan, 2015). Seems like a bit of a cop-out really, but it does illustrate how consciousness isn’t a black and white concept – it exists on a spectrum that we all move along in our daily lives. 

Another thing to consider is whether or not consciousness is limited just to humans. In other words, do worms really know that they are worms? According to National Geographic, animals are conscious beings that can feel and perceive events around them, and make judgements and decisions based on what they have witnessed (Worrall, 2015). The article (which you can read for yourself via the URL in the references below the article) also states that animals are capable of empathy and if watched closely, often have personalities (Worrall, 2015). Think of your own pets if you have them, they play and have fun, they act scared when there is a present danger and they can learn behaviours if you train them. Surely that equates to consciousness. To some people, yes. To others, no. Some scientists argue that just because animals can react to stimulation doesn’t mean that they are conscious (Worrall, 2015) – much like receptors in our skin react to heat without being conscious themselves. Furthermore, it’s completely unethical to experiment on animals to test their level of consciousness, therefore there is no proof either way. Part of me thinks it is easier for people to assume that animals aren’t conscious so that it’s easier for them to justify awful acts – testing drugs, slaughtering animals for meat, battery-farming. 

This calls into question yet another key idea: if humans and animals can be conscious, can artificial intelligence somehow be conscious too? Is consciousness something that can be taught? Maybe it could be – there aren’t many human traits that aren’t teachable. But maybe it’s really an innate property. You either are conscious or you aren’t. It’s thought that consciousness arises in the cerebral cortex (Sohn, 2019) so perhaps you need a cerebral cortex to be conscious. What if we built a cerebral cortex? Imagine we can replicate the intricate neural pathways that bring about consciousness. Does that in itself induce consciousness? 

Consciousness is a bit of an enigma to the scientific community. It’s a word that means something different to different people and most people don’t totally know how to explain it. I’m aware that I’ve asked a lot of questions in this article, and given you significantly less answers, but I’ll ask just one more: what does consciousness mean to you? 

References

SOHN, E. 2019. Decoding the neuroscience of consciousness. Nature [Online]. Available from: https://www.nature.com/articles/d41586-019-02207-1 [Accessed 24th February 2022].

SRINIVASAN, T. M. 2015. Healing altered states of consciousness. International journal of yoga, 8, 87-88.

WORRALL, S. 2015. Yes, Animals Think And Feel. Here’s How We Know. . National Geographic [Online]. Available from: https://www.nationalgeographic.com/animals/article/150714-animal-dog-thinking-feelings-brain-science [Accessed 24th February 2022].

Shruti Chawla, Year 3

As Medical Students, our understanding of Women’s Health is rather sparse. We have a few lectures on menstruation, ovulation, and anatomy in first year and then this is titrated down until our GOSH placement in fourth year. It is clear, this is not enough to cover to the scope of menopause. 

Let’s start with the basics: What is the Menopause?

Is it: 

“The beginning of the end”

“PMS on steroids”

“The loss of youth” 

 Or can we start to see this change for what it really is: a biological endpoint of menstruation, usually between the ages of 45-55, which comes with a myriad of changes that cannot be categorised in a simple list and not something medication can be thrown at. 

I was able to learn the true extent of these changes, their effects on people and the general perception of menopause when I attended a talk hosted by Isabel Morgan (3^rd year at Leeds) in December. We were joined by three wonderful women who were kind enough to share their experience of the menopause, from the initial diagnosis to its continuing effects. 

The NHS website lists the common symptoms of menopause to be: “hot flushes, night sweats, vaginal dryness, difficulty sleeping, low mood and libido”. It states that symptoms can begin years before your periods stop “peri-menopause” and can last up to 4 years post this date. The menopause itself is only a day in theory (one year after your last period). 

The symptoms listed above sound rather unpleasant on paper, but the true story is only revealed when hearing women putting them into the context of busy lives. Lives which are usually spent working, spending time with family and socialising, but now burdened with uncontrollable changes that unfortunately are still considered a social taboo. 

Anxiety was a pivotal symptom which was described by one of the women. Stress at work seemed to spiral. It went from something that could be handled with a slight reduction in workload, to a process that became confusing, overwhelming, and tedious. After this became unbearable, upon discussion with the GP, menopause wasn’t even considered as an option, anti-depressants were the prescription of “choice”, but the anxiety didn’t stop.  It felt like being passed from pillar to post until a clinician finally suggested the menopause. 

A similar story (Advocacy Focus) comes describes facing “tremendous joint pain” alongside a low mood. Again, the story follows the same pattern. The low mood was treated with anti-depressants and the patient told to join a “return to hockey” team to improve her social life despite the joint pain. 

Whilst we can understand these presentations are not classic cases, do we really know so little as to not even consider the menopause in our differentials? Should we really discount physical symptoms when we have a presentation of low mood?

The truth is Menopause presents itself in many manifestations: 

1. Perimenopause: the transitional period before the menopause. Whilst this may seem milder condition, it still presents with menopause like symptoms which can last for years and be debilitating. 
2. Menopause after hysterectomy: with a radical ovarian removal, women can experience menopause immediately post op, with the symptoms lasting for years post this. (This is also known as surgical menopause)
3. Medical Menopause: permanent damage to both ovaries – e.g through chemo or radiotherapy. 
4. Temporary (whilst this may not fit within the natural definition, it can still exhibit similar symptoms): GnRH treatment in conditions like endometriosis. 

As future healthcare professionals, it is imperative for us to understand the various ways in which this change can present. Currently, research via a Channel 4 documentary (“The Menopause Doctor”) shows that 15% of women questioned (5187 British women in their 40s and 50s) waited approximately 6 years to receive a diagnosis. Only 33% of women received HRT (hormone replacement therapy) and a further 27% antidepressants – which are not the recommended treatment within NICE guidelines. It now falls on us as the next generation to turn these statistics around. 

So, what can we do as students to further our understanding of menopause? (Here is a short excerpt from Bee Macpherson who plays a huge role in Menopause support at the University)

“Firstly, it’s important to recognise the menopause as an occupational health issue. The menopause is not (just) a women’s issue and at the University of Leeds we have been working to raise awareness of the menopause as a health and wellbeing issue, the potential impact on personal and professional life and to change culture so conversations about the menopause are normalised and not taboo. Initiatives include monthly ‘menopause for thought’ cafes, a facilitated safe space where everyone is welcome, irrespective of age or gender to have a cup of tea and chat about the menopause, no issue is off limits!

The cafes moved to Teams in March 2020, we hope to host a mix of online and in campus cafes going forward. We also have information for students accessed via this link:

https://students.leeds.ac.uk/info/100002/togetherall_resources_and_self_help/1258/recommended_resources_and_self_help”

I hope this article provides the encouragement for us all to talk menopause more freely and confidently. 

References

Davina McCall: Sex, Myths and the Menopause. Channel 4. 12/15/2021

Macpherson, B. 2021. Menopause. [online] [Accessed 25 January 2022] Available from: https://wsh.leeds.ac.uk/health-wellbeing/doc/menopause

Unknown. 2019. Advocacy Focus. World Menopause Day – Our Stories. [online] [Accessed 28 January 2022] Available from: https://www.advocacyfocus.org.uk/news/world-menopause-day-our-stories