Medical Students' and Trainees' Country-By-Gender Profiles: Hofstede's Cultural Dimensions Across Sixteen Diverse Countries.

PURPOSE: The global mobility of medical student and trainee populations has drawn researchers' attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede's cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede's six-dimensional perspective. In doing so we examine medical students' and trainees' country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede's general population data. METHODS: We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede's 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months' clinical training using school-specific methods including emails, announcements, and snowballing. RESULTS: We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede's general population data. CONCLUSIONS: Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.

[Correlation between levels of serum growth differentiation factor-15 and acute coronary syndrome].

OBJECTIVE: To explore the association between the levels of serum growth differentiation factor-15(GDF-15) and acute coronary syndrome(ACS) in patients undergoing coronary angiography(CAG). METHODS: In this prospective study, 120 candidates (30 healthy controls and 90 patients with ACS) admitted to our hospital from March 2006 to April 2008 were included. The patients with ACS were divided into 3 groups: (1)Group AMI-emergency (AMI-E), including 30 patients with acute myocardial infarction (AMI) who underwent CAG within 12 hours of the onset of symptoms. (2) Group AMI 7-14 d, including 30 patients with AMI who underwent CAG within 7-14 days of the onset of symptoms. (3)Group UAP including 30 patients with unstable angina pectoris. The serum level of GDF-15 was determined by ELISA. RESULTS: The level of GDF-15 for group ACS was (649.0 ± 224.21) ng/L, which was significantly higher than that of control group [(537.2 ± 262.9)ng/L,P<0.01]. The level of serum GDF-15 significantly increased in group AMI-E [(801.6 ± 218.4)ng/L] compared with group AMI 7-14 d [(656.2 ± 252.4)ng/L,P=0.042, 95% CI 1.001-1.061], group UAP [(586.9 ± 225.6)ng/L, P=0.001, 95% CI 0.809-0.950] and control group(P<0.05, 95% CI 1.000-1.012) after being adjusted for relevant covariates. The elevated level of GDF-15 was related to biomarkers, such as white blood cells count (WBC, r(2)=0.276, P=0.002), lactate dehyerogenase(LDH, r(2)=0.288, P=0.004), creatine kinase 2(CK-MB, r(2)=0.350, P<0.001) and troponin T(TnT, r(2) =0.344, P=0.001). CONCLUSION: GDF-15 protein expression increases in ACS, and the level of GDF-15 rapidly increases and remains elevated in the early period of acute myocardial infarction. The elevated level of GDF-15 is related to biomarkers, such as WBC, LDH, CK-MB, and TnT. GDF-15 could be a new and independent biomarker in evaluating the patients with cardiovascular disease.

Growth differentiation factor 15 in different stages of heart failure: potential screening implications.

Identification of individuals in the early stage of heart failure (HF) may allow earlier initiation of disease-modifying treatment. We evaluated concentrations of the growth differentiation factor (GDF)-15 at different stages and its potential screening value in 208 subjects. Plasma GDF-15 was measured by using an enzyme-linked immunosorbent assay. GDF-15 was positively correlated with the stages of HF (r=0.804, p<0.001). In distinguishing patients with stage B HF, the area under the curve was 0.873 (p<0.001). These findings indicate that GDF-15 concentration was elevated with the progressing stages of HF and might have potential screening implications for stage B HF.