The value of peer mentoring for the psychosocial wellbeing of junior doctors: a randomised controlled study.

OBJECTIVE: To explore the value of a peer mentoring program for first year medical interns and to assess the demand for and benefits of such a program in an Australian hospital. DESIGN, SETTING AND PARTICIPANTS: Randomised controlled study of the impact on first year interns of peer-led mentoring by second and third year interns, undertaken during 2015 at the Royal Perth Hospital, a tertiary teaching hospital. Methods and main outcome measure: Interns were recruited and randomised 1:1 to being assigned or not assigned a mentor. Qualitative outcome data were collected in semi-structured interviews and focus groups at 12 months to assess psychosocial wellbeing and job satisfaction. RESULTS: Fifty-three of 79 interns (67%) applied to participate in the program. Twenty-six mentor-mentee pairs matched by sex and career preferences were established; 27 interns were allocated to the control group. Iterative data analysis identified two major themes related to the value of the mentorship program: aiding navigation through the complex health care system, and enhancing a sense of community. Participants with mentors reported high satisfaction with the program and a positive impact on stress levels, morale, sense of support, job satisfaction, and psychosocial wellbeing compared with participants without mentors. CONCLUSION: An optional peer mentoring program enhances junior doctor support structures, builds a sense of community, and helps participating interns navigate their new professional environment. Our trial provides a feasibility model that could be adapted to local conditions, regionally or nationally. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618000455268; 29 March 2018 (retrospective).

Diabetic medications in pregnancy.

All forms of diabetes are increasing in prevalence, but with the advent of the obesity epidemic, we now face the prospect of an increasing number of women conceiving whilst taking traditional oral antidiabetic agents (OADs). This is also further complicated by the availability of new incretin-based therapies, the dipeptidylpeptidase-4 (DPP-IV) inhibitors and glucagon-like-1 receptor (GLP-1R) analogues. Original concerns regarding the use of such OADs have meant that diet control and insulin has been the mainstay of treatment for hyperglycaemia during pregnancy. However, recent NICE guidelines have suggested a role for oral antidiabetic agents. Safety is of paramount concern, especially in pregnancy, and this review will discuss the evidence to date.

Strong diabetes.

The case of a 36-year-old male professional bodybuilder is reported. He presented to the accident and emergency department with right upper quadrant pain. This was on the background of a 15-year history of anabolic steroid and growth hormone misuse. Examination revealed mild hepatomegaly and a random blood sugar of 30.2 mmol/l. There was no evidence of ketonuria or acidosis. Biochemical evidence of hepatitis was found, and the patient was in acute renal failure. He was given a sliding scale of insulin and an intravenous infusion of crystalloid. The hepatitis and hyperglycaemia settled with conservative treatment. It is believed that this is the first reported case of frank diabetes precipitated by supraphysiological recreational growth hormone misuse.

Strong diabetes.

The case of a 36-year-old male professional bodybuilder is reported. He presented to the accident and emergency department with right upper quadrant pain. This was on the background of a 15-year history of anabolic steroid and growth hormone misuse. Examination revealed mild hepatomegaly and a random blood sugar of 30.2 mmol/l. There was no evidence of ketonuria or acidosis. Biochemical evidence of hepatitis was found, and the patient was in acute renal failure. He was given a sliding scale of insulin and an intravenous infusion of crystalloid. The hepatitis and hyperglycaemia settled with conservative treatment. It is believed that this is the first reported case of frank diabetes precipitated by supraphysiological recreational growth hormone misuse.

Glucocorticoid regulation of p450 aromatase activity in human adipose tissue: gender and site differences.

The distinct gender-specific patterns of fat distribution in men and women (android and gynoid) suggest a role for sex steroids. In keeping with these observations, it has been suggested that estrogens can promote preadipocyte cell proliferation and/or differentiation. The enzyme aromatase P450 is responsible for the conversion of androgen precursor steroids to estrogens and may, therefore, have a role in regulating adipose tissue mass and its distribution. We have investigated the glucocorticoid regulation of aromatase expression in human adipose tissue, specifically to define any site- and gender-specific differences. Abdominal subcutaneous (Sc) and omental (Om) adipose tissue was obtained from male and female patients undergoing elective surgery. After collagenase digestion, preadipocytes were cultured in serum-free medium, for 6-10 d, until confluent with either cortisol (10(-6) M, 10(-7) M) or insulin (500 nM) or a combination of both treatments. Adipocytes were studied in suspension cultures. Aromatase activity was assessed using tritiated [1 beta-(3)H]-androstenedione as substrate. In Sc preadipocytes, basal aromatase activity increased in females from 11.5 +/- 1.4 (mean plus minus SEM) to 28.0 +/- 1.8 pmol/mg x h (n = 17, P < 0.05) with 10(-6) M cortisol. By contrast, in males, aromatase activity was inhibited by 10(-6) M cortisol (19.4 +/- 2.4 pmol/mg x h vs. 7.5 +/- 1.3, n = 9, P < 0.01; men vs. women, P < 0.005). These data were endorsed through Western blot analysis using an in-house antihuman aromatase antibody, which recognized a specific 55-kDa species. Aromatase activity was less at Om sites in preadipocytes, increasing in females from 1.1 +/- 0.2 to 3.2 +/- 0.7 pmol/mg x h with 10(-6) M cortisol (P < 0.05) and in males from 2.6 +/- 0.1 pmol/mg x h to 7.8 +/- 0.3 pmol/mg x h after cortisol (men vs. women, P < 0.001). Cortisol-induced aromatase activity in Om adipocytes from postmenopausal females was higher than that in premenopausal females (P < 0.001). Insulin had no independent effect on aromatase expression, but coincubation of preadipocytes with cortisol and insulin eliminated both gender- and site-specific differences. In conclusion, in women, but not men, cortisol increased aromatase activity at Sc sites, and this may facilitate predilection for Sc adiposity in females. The observed site-, gender-, and menopausal-specific differences in the glucocorticoid regulation of this enzyme may contribute to the gender- and menopausal-specific patterns of fat distribution.