Seafarers' depression and suicide

This review assesses available evidence on the frequency of and trends in depression and suicide among seafarers. Investigations of depression and suicide are scarce and the findings are inconsistent, they do, nevertheless, show indications of improvement although some recent case series do indicate that suicide remains a problem. A review of additional indicators for mental distress and lack of wellbeing supports the decline in frequency of problems, but nuances this in terms of the relative risks in different groups of seafarers, showing internal variations in the frequency of mental health issues among seafarers, with markers such as rank, type of voyage, gender, age, nationality and crew multiculturalism being relevant variables. The methodological limitations that hinder the understanding of depression and suicide in the maritime sector are identified.

Lessons learned: medical and health care management for emergency workers at the TEPCO Fukushima Daiichi APP accident

During the emergency work at the Fukushima Daiichi Atomic Power Plant (APP), the Tokyo Electric Power Company (TEPCO) and the Japanese government experienced various problems in medical and health care management issues, including special medical examinations, on-site triage and initial treatment, patient transportation, lodging and food, and long-term health care for emergency workers. To resolve these problems, the Ministry of Health, Labor and Welfare (MHLW) issued a series of compulsory directives and provided administrative guidance to TEPCO. Based on the experiences and lessons learned, the MHLW recognized that the proper management and implementation of medical and health care management in response to a similar accident would require sufficient measures and systematic preparation, including the following: 1. In case of large-scale nuclear accidents, the government needs to assist in dispatching medical staff to the affected plants. 2. Nuclear facility operators, medical facilities and fire departments should make an agreement to clarify the division of the roles played prior to the accident and should conduct emergency drills periodically with the full attendance of related personnel to identify and resolve the problems. 3. Operators need to develop a support base at a safe distance from the plant and to prepare to develop makeshift lodgings in case of emergency. 4. Operators need to come to an agreement to share food stocks among closely located nuclear plants and prepare cooking equipment that can be used in case of blackout to provide warm foods and drinks to as many workers as possible. 5. It is necessary to conduct long-term follow-up for emergency workers, including health care system, medical examinations and mental health consultations.

Association of Non-alcoholic Fatty Liver Disease With Salt Intake and Dietary Diversity in Chinese Medical Examination Adults Aged 18-59 Years: A Cross-Sectional Study

Objectives

Given the significance of dietary factors in the development of non-alcoholic fatty liver disease (NAFLD). We conducted a cross-sectional study to investigate the association of NAFLD with salt intake and dietary diversity in a medical examination population aged 18–59 years.

Methods

Data from two Chinese health management centers were utilized between January 2017 and December 2019. The general information, laboratory tests, lifestyle habits, and diet of the participants were all evaluated. Based on alcohol consumption and abdominal ultrasound results, a total of 23,867 participants were divided into the NAFLD (n = 7,753) and control (n = 16,114) groups. Salt intake and dietary diversity were calculated separately for study participants using the spot urine method and dietary diversity scores (DDS). The multilevel logistic model and subgroup analysis were used to analyze the relationship between salt intake, dietary diversity, and NAFLD.

Results

We found that the prevalence of NAFLD was 32.48%. Salt intake was associated with increased NAFLD (Q2 vs. Q1: OR = 1.201, 95% CI 1.094-1.317, P < 0.001; Q3 vs. Q1: OR = 1.442, 95% CI 1.316-1.580, P < 0.001; Q4 vs. Q1: OR = 1.604, 95% CI 1.465-1.757, P < 0.001), whereas sufficient dietary diversity was a protective factor for NAFLD (Sufficient DDS vs. Insufficient DDS: OR: 0.706, 95% CI 0.517-0.965, P < 0.05). The effects of salt intake and dietary diversity on NAFLD were equally stable in the subgroup analysis.

Conclusions

We can conclude that NAFLD is highly prevalent in medical examination adults aged 18-59 years in China. Furthermore, the risk of salt intake for NAFLD and the protective effect of dietary diversity on NAFLD should be taken into account in the management of NAFLD.

Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo

BACKGROUND

Informed consent (IC) is linked to the ethical principle of respecting patient autonomy, respect for human rights and ethical practice, while in many countries it is a standard procedure. Anecdotally, it should be noted that in the Democratic Republic of Congo (DRC) in many instances ICs are not obtained systematically. To date, no research appears to have been conducted on this matter. This study aimed to assess the knowledge and practice of obtaining IC from patients among health care providers (HCP) in the DRC.

METHODS

This was a cross-sectional study, with a convenient sampling of 422 participants. Data from the questions were collected on an imported Microsoft Excel spreadsheet for review at INSTAT.TM The authors set IC's accurate knowledge and practice at 80% or higher. The Fisher Exact test was used to compare categorical association results, and a p-value < 0.05 was considered statistically significant.

RESULTS

Results showed that giving information in detail to patients on their medical condition was associated with formal training on medical ethics and IC (p: 0.0028; OR: 1.894; CI: 1.246 to 2.881), which was also associated with answering the patient's questions in detail (p: 0.0035; OR: 1.852; CI: 1.236 to 2.774). About 127(30.09 %) of participants scored 80% or higher. Extracurricular training was associated with withholding information from patients, up to 27 times more than other factors (p< 0.0001; OR: 27.042; CI: 13.628 to 53.657). when it comes to get IC, HCP with many years of practice scored better than others, in one of the question the odd ratio was closer to 7 (p< 0.0001; OR: 6.713; CI: 4.352 to 10.356). Only 47(11.14%) of the participants scored 80% or more of the questions about practice of IC.

CONCLUSION

For a variety of reasons, knowledge and practice of IC among HCPs was very low. A common programme for the country as part of formal training might lead to an improvement. In addition, patients' education on IC should be displayed in waiting areas at all medical centres.

Twelve tips for introducing simulation based assessment in the objective structured clinical examination

The use of simulation as a tool for assessment in medical examinations is expanding. We describe 12 practical tips for the implementation of simulation based critical evaluation for the Objective Structured Clinical Examination (OSCE). The material in this article is a combination of personal experience and the available literature. Three themes are discussed encompassing simulation theory for the OSCE, practical features of simulation for the clinical examination and contingency planning. As clinical assessment evolves, the utility for simulation-based practice will advance alongside. An improved understanding of the processes for incorporating simulation into the OSCE will be of benefit to both the medical educator and the student.

Relationship between haematological data and radiation doses of TEPCO workers before and after the FDNNP accident

We evaluated the correlation between radiation dose and the medical examination data of Tokyo Electric Power Company Holdings, Inc (TEPCO) employees working during the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident in 2011. This study included 2164 male TEPCO workers who received periodic medical examinations from March 2006 to January 2013. First, we conducted log-linear regression analyses using the haematological data of 585 emergency workers and confounding factors to examine the effect of internal radiation exposure in March 2011. Since external radiation exposure was a major influence, we then evaluated the correlation between both internal and external radiation dose and the haematological data of 1801 emergency workers and confounding factors before and after the accident. Among 585 workers, internal radiation exposure in March 2011 alone was mainly due to thyroid doses (0.1-10 Gy) but not to bone marrow (BM) doses (0.01-1 mGy). Compared to before and after the accident, we found that the levels of monocytes, eosinophils (Eos) and basophils increased slightly, whereas the frequency of smoking and alcohol consumption decreased substantially. External dose exposure was positively correlated with haemoglobin (Hb), red blood cell and Eos but negatively correlated with age, haematocrit and frequency of alcohol consumption. Among these variables, Hb exhibited the strongest correlation with external dose. Regarding the correlation with Hb, although there is a possibility that confounding factors other than exposure were not evaluated, our findings on emergency workers can serve as a reference for the evaluation of health conditions during the emergency period of future nuclear-related accidents.

The Impact of COVID-19 on Medical Examinations

Background and aim The coronavirus-19 (COVID-19) pandemic has had a profound impact on many aspects of our lives, including medical education. The suspension of clinical placements and cancellation of objective structured clinical examinations (OSCE) is likely to have an influence on students' performance.   Methods Using a questionnaire, a retrospective observational study was conducted. Our primary focus was 3rd year medical students following their examinations in May 2020.    Results Out of 46 responses obtained, the results demonstrated over 2/3 felt they perform better in clinical OSCE compared to written examinations and the majority performed worse this year during the pandemic. On a Likert scale, a mean result of 3/5 was obtained for confidence upon returning to placement and to address this, most stated they would benefit from extra optional teaching. Additionally, a further average of 3.82 was derived to represent how greatly students believed the absence of third year clinical OSCE would negatively impact their performance in the OSCE for the following academic year.  Conclusion The results of our study highlight that the cancellation of clinical placements and OSCE due to coronavirus has negatively impacted on medical education and if we are to be faced with future pandemics, we must be better prepared to train future doctors.

An Evaluation within the Context of the Istanbul Protocol of the Medico-Legal Examinations of Turkish Detainees during the Recent State of Emergency in Turkey

The present study evaluates the reported medical examination procedures in Turkish detention facilities of Turkish detainees who sought asylum in Germany after their detention in Turkey and the present process of medico-legal reporting, to evaluate compliance with the principles of the Istanbul Protocol and to discuss the issue in the context of the literature. Fifty-one participants were asked questions related to the examination steps specified in the Istanbul Protocol. 61% of participants were examined in an inappropriate place according to Istanbul Protocol. 42 participants (82.3%) claimed they had been mistreated through beatings, improper application of handcuffs, being forced to stand up for a long time, lying on bare concrete floors, staying in confined spaces without fresh air, and psychological torture. The answers given by the participants revealed that not all medical examinations conducted by the Turkish authorities during the detention were carried out in accordance with the Istanbul Protocol.

Comparison of the Performance of GPT-3.5 and GPT-4 With That of Medical Students on the Written German Medical Licensing Examination: Observational Study

BACKGROUND

The potential of artificial intelligence (AI)-based large language models, such as ChatGPT, has gained significant attention in the medical field. This enthusiasm is driven not only by recent breakthroughs and improved accessibility, but also by the prospect of democratizing medical knowledge and promoting equitable health care. However, the performance of ChatGPT is substantially influenced by the input language, and given the growing public trust in this AI tool compared to that in traditional sources of information, investigating its medical accuracy across different languages is of particular importance.

OBJECTIVE

This study aimed to compare the performance of GPT-3.5 and GPT-4 with that of medical students on the written German medical licensing examination.

METHODS

To assess GPT-3.5's and GPT-4's medical proficiency, we used 937 original multiple-choice questions from 3 written German medical licensing examinations in October 2021, April 2022, and October 2022.

RESULTS

GPT-4 achieved an average score of 85% and ranked in the 92.8th, 99.5th, and 92.6th percentiles among medical students who took the same examinations in October 2021, April 2022, and October 2022, respectively. This represents a substantial improvement of 27% compared to GPT-3.5, which only passed 1 out of the 3 examinations. While GPT-3.5 performed well in psychiatry questions, GPT-4 exhibited strengths in internal medicine and surgery but showed weakness in academic research.

CONCLUSIONS

The study results highlight ChatGPT's remarkable improvement from moderate (GPT-3.5) to high competency (GPT-4) in answering medical licensing examination questions in German. While GPT-4's predecessor (GPT-3.5) was imprecise and inconsistent, it demonstrates considerable potential to improve medical education and patient care, provided that medically trained users critically evaluate its results. As the replacement of search engines by AI tools seems possible in the future, further studies with nonprofessional questions are needed to assess the safety and accuracy of ChatGPT for the general population.

Sexism in a UK-wide medical examination

Gender bias and sexism in the health profession in the UK has been highlighted as a major problem. Efforts to reduce this must include medical training and examinations. The Situational Judgment Test (SJT) is an examination that must be passed to work as a foundation doctor in the UK; and is taken by all UK medical students. We analysed gender balance in all 215 scenarios included in the official practice papers for the SJT. We found that senior doctors were more than twice as likely to be men than women, while there was no significant gender difference in representation of foundation year-1 doctors, other health professionals or patients/relatives. This inequality has the potential to reinforce gender biases in healthcare. Medical examinations can, instead, represent an opportunity for prejudices to be challenged.