Mental health among currently enrolled medical students in Germany.

OBJECTIVES: The study identifies the prevalence of common mental disorders according to the patient health questionnaire (PHQ) and the use of psychotropic substances in a sample of currently enrolled medical students. STUDY DESIGN: A cross-sectional survey with a self-administrated questionnaire. METHODS: All newly enrolled medical students at the University of Dusseldorf, with study beginning either in 2012 or 2013, respectively, were invited to participate. The evaluation was based on 590 completed questionnaires. Mental health outcomes were measured by the PHQ, including major depression, other depressive symptoms (subthreshold depression), anxiety, panic disorders and psychosomatic complaints. Moreover, information about psychotropic substances use (including medication) was obtained. Multiple logistic regression analysis was used to estimate associations between sociodemographic and socio-economic factors and mental health outcomes. RESULTS: The prevalence rates, measured by the PHQ, were 4.7% for major depression, 5.8% for other depressive symptoms, 4.4% for anxiety, 1.9% for panic disorders, and 15.7% for psychosomatic complaints. These prevalence rates were higher than those reported in the general population, but lower than in medical students in the course of medical training. In all, 10.7% of the students reported regular psychotropic substance use: 5.1% of students used medication 'to calm down,' 4.6% 'to improve their sleep,' 4.4% 'to elevate mood,' and 3.1% 'to improve cognitive performance.' In the fully adjusted model, expected financial difficulties were significantly associated with poor mental health (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.31-3.48), psychosomatic symptoms (OR:1.85; 95% CI: 1.11-3.09) and psychotropic substances use (OR: 2.68; 95% CI: 1.51-4.75). CONCLUSION: The high rates of mental disorders among currently enrolled medical students call for the promotion of mental health, with a special emphasis on vulnerable groups.

Comparison of two aprotinin dosage regimens in pediatric patients having cardiac operations. Influence on platelet function and blood loss.

Only a few studies have reported on the effects of aprotinin in pediatric cardiac surgery, and the correct dose is controversial. In a prospective, randomized study, three groups of children weighing less than 20 kg were investigated. In group 1 (n = 14): aprotinin 20,000 U/kg was given after induction of anesthesia, 20,000 U/kg was added to the prime, and another 20,000 U/kg was given every hour of cardiopulmonary bypass (low-dose regimen). In group 2 (n = 14) aprotinin 35,000 U/kg was given after induction followed by an infusion of 10,000 U/kg.min until the end of the operation and 35,000 U/kg was added to the prime (high-dose regimen). In group 3 (n = 14) no aprotinin was used (control). Platelet function was evaluated by aggregometry (maximum platelet aggregation, maximum gradient of platelet aggregation) by means of turbidometric technique (inductors: adenosine diphosphate, collagen, and epinephrine) before and after cardiopulmonary bypass until the first postoperative day. Platelet aggregation was significantly reduced during and after bypass, values ranging from -29% to -54% (maximum aggregation) and -25% to -75% (maximum gradient of aggregation) with regard to baseline values. In the further postoperative course, platelet function recovered and mostly exceeded baseline values on the first postoperative day. Platelet aggregation variables were without any differences among aprotinin-treated and control patients. Blood loss was similar for all three groups and added up to approximately 28 ml/kg until the first postoperative day. The use of packed red cells was also comparable for the three groups, whereas the use of fresh frozen plasma was highest in group 1 (1680 ml until the first postoperative day). We conclude from this study that aprotinin did not improve platelet function and did nor reduce blood loss or the need for homologous blood transfusion in pediatric cardiac surgery, regardless of whether a low-dose or a high-dose regimen was used.

Aprotinin in pediatric cardiac operations: platelet function, blood loss, and use of homologous blood.

Excessive hemorrhage secondary to cardiopulmonary bypass may be encountered after pediatric cardiac operations. Platelet dysfunction appears to be especially responsible for this problem. The proteinase inhibitor aprotinin is suggested to possess platelet preservation properties and reduce blood loss in this situation. The effects of aprotinin (25,000 U/kg after induction of anesthesia, 25,000 U/kg added to the prime, 25,000 U/kg every hour of cardiopulmonary bypass) on platelet function were randomly studied in 12 children with a weight of less than 10 kg (group 2) and 12 children weighing more than 10 kg (group 4), who were compared with two groups of children without aprotinin (group 1, < 10 kg; group 3, > 10 kg). Twelve children undergoing major vessel operations without cardiopulmonary bypass and aprotinin served as a control. Platelet function was assessed using aggregometry (turbidometric technique with adenosine diphosphate, 2.0 mumol/L; collagen, 4 micrograms/mL; epinephrine, 25 mumol/L; NaCl [control]). Platelet function was not altered in the control patients within the entire investigation period. Maximum aggregation in the small children was already lower at baseline in comparison with that of the children > 10 kg. Cardiopulmonary bypass was followed by a significant reduction in platelet aggregation in all groups. Treatment with aprotinin did not improve platelet function (maximum aggregation and maximum gradient of aggregation) in any group. On the first postoperative day, maximum aggregation in the small children exceeded baseline values, whereas in both groups of children > 10 kg baseline values had almost been established. Postoperative blood loss was not reduced by treatment with aprotinin.(ABSTRACT TRUNCATED AT 250 WORDS)

When does work stress hurt? Testing the interaction with socioeconomic position in the Heinz Nixdorf Recall Study.

STUDY OBJECTIVE: To study systematically the separate and combined effects of work stress and socioeconomic position on three measures of health in an unselected working population. DESIGN: Two exposures (high demand/low control ("job strain"); effort-reward imbalance at work) are related to angina pectoris, depression, and poor self-rated health in a cross-sectional study design in which socioeconomic position was measured by occupational position and educational level. SETTING: Baseline data of a prospective population-based cohort study in Germany, collected between 2000 and 2003. PARTICIPANTS: 1749 employed or self-employed men and women (36.3% of total sample) aged 45-65 years. MAIN RESULTS: Effort-reward imbalance and job strain were associated with elevated odds ratios of all three health measures, using logistic regression analysis. The prevalence of poorer health was always highest in subgroups defined by high work stress and low socioeconomic position, with respective odds ratios ranging from 2.30 to 2.98 (95% CI 1.38 to 4.52) for self-rated health, 1.70 to 2.24 (95% CI 1.04 to 3.88) for angina and 2.61 to 8.20 (95% CI 1.53 to 14.15) for depression. CONCLUSION: Although stress at work was related to poorer health in the total study group, the strongest associations were consistently observed in men and women with low educational level or low occupational position. Worksite health promotion should be directed primarily towards these target groups.