While there is ample documentation that medical training is stressful, less is known about predictive variables that might identify students who have the most difficulty in managing stress during medical training. Depression and anxiety in first year medical students were investigated in a longitudinal design. One-hundred and twenty-one medical students (81% of the class) were surveyed. The first survey took place immediately prior to the beginning of medical training (wave 1); the second survey was approximately 8 months after the beginning of classes (wave 2). Medical students who began their first year with relatively low 'A' level grades, high ratings of state anxiety and depression, high trait anxiety and low dispositional optimism, and reliance on avoidant coping strategies were found to be at higher risk for developing depression and anxiety symptoms at wave 2. Students reported increased concern about curriculum and environment, personal competence and endurance, and time to have a life outside medical school at wave 2, compared to their reports at wave 1. Increase in concerns correlated with an increase in depression and anxiety. At both surveys, use of avoidant coping strategies resulted in increased depression and anxiety; at wave 2, active coping and positive reinterpretation resulted in decreased depression and anxiety. These findings suggest characteristics of vulnerable students who might be identified early in their first year and provided with additional support. Educating students to expect an increase in concerns about environment and personal ability to manage the academic load might make these concerns less overwhelming. In addition, information about effective coping strategies (i.e. active coping efforts) and ineffective means of dealing with stress (avoidant coping efforts) might be helpful in preventing distress.

One hundred and forty Hong Kong Chinese students were surveyed early in the second year of their medical education (year 2), and compared with 138 students surveyed prior to beginning their first year of medical school and with 74 non-medical university students in their second year. In year 2 students, distress as reflected in their scores on anxiety and depression self-report scales was high, and these students reported greater utilization of health professional services as compared with the other two groups. In year 2 students, concerns related to the medical school environment and curriculum, and whether one has the endurance and ability to be successful were significant correlates with depression and anxiety. Loss of opportunity to maintain social and recreational sources of gratification correlated with anxiety. There was no difference between the sexes with regard to the development of anxiety and depression symptoms. Academically less successful students reported somewhat higher levels of depressive ideation and symptomatology. Trait anxiety correlated with the development of distress, while optimism protected against the development of distress. Active coping styles and positive reinterpretation as a coping strategy correlated negatively with distress, while wishful thinking correlated positively with distress. These findings emphasize the need for greater attention to the psychological well-being of doctors-in-training, in Hong Kong as in the Western world. These findings should be further explored in longitudinal studies, and may be helpful in designing intervention and support programmes for vulnerable students.

We describe the pattern of soy intake and its association with blood lipid concentrations in the Hong Kong Chinese population. Subjects were contacted by random telephone survey and invited to a hospital for a physical examination and blood tests. A total of 500 men and 510 women with an age range of 24-74 y completed the dietary intake study. The dietary assessment was based on a semiquantitative food frequency questionnaire that included 10 commonly consumed soy items. Many (88%) of the study population had consumed some soy products during the previous week. About 80% of the soy protein or isoflavones were obtained from different forms of tofu, and an additional 9% was obtained from soy milk. The mean weekly isoflavone intake was 102 +/- 107 mg in men and 77 +/- 90 mg in women. In men, soy intake and total plasma cholesterol were negatively correlated (r = -0.09, P: = 0.04), as were soy intake and LDL cholesterol (r = -0.11, P: = 0.02). The respective values in women <50 y old were r = -0.11, P: = 0.04 and r = -0.11, P: = 0.05. Soy protein remained significantly associated with these two lipid concentrations after adjustment for other social and dietary confounders. Higher soy intake seemed to be related to a better plasma lipid profile in men and in younger women, but more epidemiological studies and controlled clinical trials in this setting would help to confirm the optimal amount required for the prevention and treatment of hyperlipidemia.

Anxious depression is well received by primary care professionals, but BSS requires further modification. International field trials will be held to further test these new diagnoses in draft ICD-11-PHC.

Medical education is important to China's large population. The undergraduate medical education system is being streamlined and national standards are being established. Innovations in medical education have recently been encouraged and supported, including the adoption of problem-based learning. It is important that the momentum is kept up so that the health care of a fifth of the world's population is assured.

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ABSTRACT:The hypocholesterolemic and atheroscleroprotective potentials of dietary consumption of hawthorn (dried fruit of Crataegus pinnatifida, Shan Zha) were investigated by monitoring plasma lipid profiles and aortic relaxation in Sprague-Dawley rats fed with either normal diet, high-cholesterol diet (HCD) or HCD supplemented with hawthorn powder (2%, w/w) (4 weeks). In HCD-fed rats, an increased plasma total cholesterol and LDL-cholesterol with a decreased HDL-cholesterol was observed, and consumption of hawthorn markedly suppressed the elevated total cholesterol and LDL-lipoprotein levels plus an increased HDL-cholesterol level. The blunted acetylcholine-induced, endothelium-dependent relaxation of isolated aortas of HCD-fed rats was improved by hawthorn. The development of fatty liver, an increased nitric oxide synthase activity and an elevated oxidative stress (as estimated by the attenuated levels of anti-oxidant enzymes) associated with HCD were attenuated by hawthorn. Thus, the results demonstrated that hawthorn consumption provides overall beneficial effects on reversing HCD associated detrimental changes.

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