Cultural variations in wellbeing, burnout and substance use amongst medical students in twelve countries.

High levels of stress, burnout, and symptoms of poor mental health have been well known among practicing doctors for a number of years. Indeed, many health systems have formal and informal mechanisms to offer support and treatment where needed, though this varies tremendously across cultures. There is increasing evidence that current medical students, our doctors of the future, also report very high levels of distress, burnout, and substance misuse. We sampled large groups of medical students in 12 countries at the same time and with exactly the same method in order to aid direct comparison. 3766 students responded to our survey across five continents in what we believe is a global first. Our results show that students in all 12 countries report very high levels of 'caseness' on validated measures of psychiatric symptoms and burnout. Rates of substance misuse, often a cause of or coping mechanism for this distress, and identified sources of stress also varied across cultures. Variations are strongly influenced by cultural factors. Further quantitative and qualitative research is required to confirm our results and further delineate the causes for high rates of psychiatric symptoms and burnout. Studies should also focus on the implementation of strategies to safeguard and identify those most at risk.

Wellbeing and mental health amongst medical students in Jordan: a descriptive study.

Across the globe medical students are experiencing high levels of depression, anxiety, and psychological distress. This can ultimately lead to poor academic performance, substance misuse and/or concerns over clinical practice and fitness to practice. We surveyed Jordanian medical students to assess burnout (using the Oldenburg Burnout Inventory, OLBI), minor psychiatric illness (General Health Questionnaire 12, GHQ12) and alcohol/substance abuse (CAGE questionnaire). Results indicate a high level of exhaustion (91%), disengagement (87%) and 'minor' psychiatric illness (92%). OLBI and GHQ12 scores were found to correlate positively (p < 0.001). The CAGE questionnaire was positive in 8% of students. Further research is required to confirm these results and compare them to the global burden of mental illness in medical students. Medical students in Jordan should be considered a high-risk group for burnout and mental health problems and strategies should be employed to recognise and appropriately manage those most at risk.

Gall bladder wall thickening as non-invasive screening parameter for esophageal varices - a comparative endoscopic - sonographic study.

BACKGROUND: The mortality due to hemorrhage of esophageal varices (EV) is still high. The predominant cause for EV is liver cirrhosis, which has a high prevalence in Western Europe. Therefore, non-invasive screening markers for the presence of EV are of interest. Here, we aim to investigate whether non-inflammatory gall bladder wall thickening (GBWT) may serve as predictor for the presence of EV in comparison and combination with other non-invasive clinical and laboratory parameters. METHODS: One hundred ninety four patients were retrospectively enrolled in the study. Abdominal ultrasound, upper endoscopy and blood tests were evaluated. GBWT, spleen size and the presence of ascites were evaluated by ultrasound. Platelet count and Child-Pugh-score were also recorded. The study population was categorized in two groups: 122 patients without esophageal varices (non EV) compared to 72 patients with EV were analyzed by uni-and multivariate analysis. RESULTS: In the EV group 46% showed a non-inflammatory GBWT of ≥4 mm, compared to 12% in the non-EV group (p < 0.01). GBWT was significantly higher in EV patients compared to the non-EV group (mean: 4.4 mm vs. 2.8 mm, p < 0.0001), and multivariate analysis confirmed GBWT as independent predictor for EV (p < 0.04). The platelets/GBWT ratio (cut-off > 46.2) had a sensitivity and specificity of 78 and 86%, PPV 76% and NPV of 87%, and ROC analysis calculated the AUC of 0.864 (CI 0.809-0.919). CONCLUSIONS: GBWT occurs significantly more often in patients with EV. However, because of the low sensitivity, combination with other non-invasive parameters such as platelet count is recommended.