Students' perceptions of and satisfaction with their Orthopaedic posting learning environment by using the Healthcare Education Micro-Learning Environment Measure (HEMLEM) questionnaire.

BACKGROUND: The learning environment in medical education is crucial for student development, encompassing social, psychological, and physical aspects that significantly affect learning. This study aimed to assess undergraduate medical students' perception of the orthopaedic ward's learning environment and examine the factors influencing their overall satisfaction during clinical rotation. METHODS: This cross sectional quantitative study was conducted in a private medical college in Pakistan. Data was collected through a pre-validated questionnaire, "The Healthcare Education Micro-Learning Environment Measure (HEMLEM)." Data analysis was done using SPSS version 23 software. RESULTS: A total of 205/300 students (response rate 68.33%) [103 (50.2%) males and 102(49.85) females] participated in this survey. Notably, 116 (56.6%) appreciated the ward's welcoming, friendly, and open atmosphere, and 114(55.6%) of the respondents appreciated the ward culture where they felt free to ask questions or comment. Additionally, 111(54.7%) appreciated the faculty's enthusiasm for teaching. A comparison between male and female students showed significantly higher satisfaction among males regarding staff attitudes and behaviours (p < .019). CONCLUSION: Undergraduate students held a predominantly positive view of the orthopaedic ward's learning environment, with differences observed based on gender and year of study. The study highlights the importance of both staff attitude and teaching quality in shaping the educational experience. It suggests that medical institutions should focus on enhancing teaching skills among clinicians to improve learning experiences and ultimately benefit patient care and the healthcare system.

Exploring perceptions of pre-clerkship students about workplace learning in the clinical learning environment at Gulf Medical University, UAE.

BACKGROUND: Medical students view clinical workplace placements as an inspiring and motivating learning environment where active student participation is pivotal to development of students' identity. The progress from pre-clerkship to clerkship education harbors many challenges which consist of experiential learning, adjusting to the clinical environment, and understanding roles & responsibilities. Workplace learning is underpinned by various adult learning theories including social theories,constructivism, supported participation and legitimate peripheral participation. Workplace learning course was recently initiated for pre-clerkship students at a medical university in UAE, which will enable their smooth entry into the clerkship phase of the curriculum. OBJECTIVES: The research aims to explore students' perceptions of various domains of their clinical learning environment (CLE), highlight the challenges they face, and extract valuable feedback to improve their environment. METHODS: This study was conducted qualitatively by using focus groups method in order to explore students' perceptions of the clinical learning environment. Two focus group discussions were conducted (n = 8 +/-10) to determine the common challenges of workplace learning and its potential solutions. Data were analyzed using thematic analysis. The approach used to carry out this study was phenomenology, as it helps to understand the learning and behavior of these students who are undergoing this pre-clerkship training in order to transition smoothly to the clerkship phase. RESULT: The focus groups helped to deeply explore the perceptions of students about their clinical learning environment. It helped to reveal the challenges encountered by the students including the significance of proper orientation of staff and students, language barrier, availability of learning opportunities, and supervision quality. The focus groups provided worthwhile suggestions to improve the learning opportunities in the clinical learning environment which include orientation of the staff and students what to expect, improved supervision, mentoring and providing learning opportunities to encourage participation. CONCLUSION: This study attempted to identify the pre-clerkship students' perception of their clinical learning environment and the challenges they face over there. Possible suggestions by the students included a formal orientation for the staff and students to be carried out at the beginning. Efforts should be made by clerkship directors to provide students with learning opportunities by increasing patient exposure, encouraging participation, and providing high-quality supervision.

Serum Leptin levels in newly diagnosed Epileptic Patients.

Objectives: To compare leptin levels in newly-diagnosed treatment-naive epileptic patients and healthy controls. METHODS: This case-control study was conducted from January 10 to September 15, 2022, at the Dow University of Health Sciences, Karachi, and comprised newly-diagnosed epileptic patients age 12-35years who had no comorbidity. The subjects were enrolled from the Neurology out-patient department of Civil Hospital, Karachi. Healthy individuals matched for age, gender and body mass index were also enrolled as controls. Blood samples were collected between 8am and 10am for the evaluation of serum leptin levels using enzyme-linked immunosorbent assay. Data was analysed using SPSS 26. RESULTS: Of the 100 subjects, 64(64%) were males and 36(36%) were females. There were 50(50%) cases with mean age 19.34±5.65 years, and 50(50%) controls with mean age 19.76±5.67 (p=0.614). 100% of 50 individuals in control group did not have any family history of epilepsy,while 18% of cases (9) reported a positive family history. Mean leptin level in cases was 31.03±19.37 compared to 5.25±4.03 in the controls (p<0.05). CONCLUSIONS: Serum leptin levels were elevated in newly-diagnosed epileptic patients compared to healthy controls.

Oxidative stress in polycystic ovary syndrome: a case-control study.

OBJECTIVE: To compare the serum levels of biochemical and oxidative stress markers i.e., malondialdehyde (MDA) and paraoxonase-1(PON1) in polycystic ovary syndrome (PCOS) patients and healthy female individuals of reproductive age group (18-40 years). METHODS: This case-control study was conducted in Dow University of Health Sciences (DUHS), Karachi from June 2019 to October 2020. Seventy Subjects including 35 PCOS patients that have primary subfertility problem (cases) and 35 healthy and fertile females (controls) were recruited. Serum samples were collected for analysis of insulin, sex hormone-binding globulin, testosterone, fasting blood glucose and lipid profile. PON 1 and MDA levels were estimated by ELISA. Comparison between the two groups was done using independent t-test. RESULTS: The patients had significantly increased mean body mass index (28.5+4.6 kg/m2 vs 25.7+4.5 kg/m2, p=0.014), systolic (129.6±13.9 mm of Hg vs 113±7.7 mm of Hg, p<0.001) and diastolic (78.7±8.8 mm of Hg vs 74.6±6.7 mm of Hg, p=0.032) blood pressures compared to controls. The high-density lipoprotein cholesterol levels were significantly lower in PCOS (42.2±8.6mg/dl) than controls (48.8±11.8mg/dl, p=0.009, p=0.009). Serum insulin (14.3±5.8 uIU/mL) vs (10.0±5.2 uIU/mL), p=0.002 and testosterone levels (1.3±0.9 nmol/L) vs (0.82±0.3 nmol/L), p<0.001 were significantly higher whereas sex hormone binding globulin (SHBG) levels (35.2±19.7nmol/L vs 58.8±31.0 nmol/L) were significantly lower in patients than healthy controls (p<0.001). Both oxidative stress markers, paraoxonase 1 (7.7±2.4 vs 6.4±2.6 µg/mL, p=0.04) and malondialdehyde (2.5±1.0 vs 1.9+0.51µg/mL, p=0.034) levels were significantly elevated in PCOS patients than controls. No significant correlation was found between dietary habits and life style between cases and controls. CONCLUSIONS: The study reported significantly elevated levels of oxidative stress markers in PCOS patients.

Workplace Learning: Learning Experiences Of Pre-Clerkship Students In Their Clinical Learning Environment At A Medical University In UAE.

Objectives: To explore how studentsin the pre-clerkship phase perceive the workplace clinical learning environment based on their experiential learning and social participation. METHODS: The cross-sectional study was conducted at the Gulf Medical University, United Arab Emirates in June 2019 and comprised 2nd and 3rd year medical students. Data was collected using the undergraduate clinical education environment measure tool which is a valid and reliable instrument to measure clinical learning environment for undergraduate medical students. RESULTS: There were 858 students, and 70.3% of the students expressed satisfaction with clinical learning environment categories. CONCLUSIONS: The average satisfaction level of the students regarding the quality of supervision was better than that of workplace environment and learning opportunities provided.

Disparities in Compliance with Colorectal Cancer Screening: Evidence from Two US National Surveys.

OBJECTIVE: Colorectal cancer (CRC) is the most preventable cancer if adherence to its screening guidelines through compliance with physician recommendations are met. Lack of access to care is the most significant barrier which was decreased by the Affordable Care Act (ACA), that may influence healthcare behaviors/practices. The aim of this study was to determine the factors affecting compliance with recommendations for CRC screening between two US National Health Interview Surveys (NHIS) in 2010 and 2015. METHODS: We used individual data of adults aged ≥50 years from the Cancer Module of NHIS that repeats every-5-years. Multiple logistic regression analyses were employed to identify the compliance associated factors and their changes after five years. RESULTS: We included final data of 1,553 and 2259 and individual from 2010 and 2015, respectively. Overall, compliance to physician recommendations for colorectal cancer was 85.70% in 2010 and 81.54%. Men compiled more in 2010 than women which was reversed in 2015. The multivariable-adjusted odds of compliance were increased with age; lower for female [Odds ratio (OR)= 0.45 Confidence Interval (CI 95% 0.27, 0.75), having a family history of CRC [OR=3.05 CI:1.02, 9.05], having insurance [OR 3.58 CI:1.4, 9.12], and Odds increased with the number of doctor visit in 2010. However, in 2015 the odds were substantially increased with the increasing age, reversed odds for female [OR= 3.49 CI: 1.67, 7.29)], increased for non-Hispanic Blacks [OR= 4.87 CI: 2.05, 11.55] and lower for Asian [OR=0.33 CI:0.15, 0.74], higher for family history of colorectal cancer [OR=3.31 CI:1.92, 5.69]. Although insurance coverage and the number of doctor visits were significant predictors of compliance in 2010, those became non-significant in 2015. CONCLUSIONS: Compliance disparities by gender and access to healthcare either reduced in strength or reversed between 2010 and 2015. The non-Hispanic Black significantly higher in compliance than other race-ethnicities in 2015.

Factors Impacting Parental Quality of Life in Preschool Children on the Autism Spectrum.

This study examined connections between parental quality of life (QoL) and features of children (autism severity, cognitive ability, behavioral profile, and sociodemographic factors). Parents of 97 children attending an autism-specific preschool completed the Quality of Life in Autism, Vineland Adaptive Behavior Scales and Child Behavior Checklist. The Autism Diagnostic Observation Schedule and Mullen Scales of Early Learning were also administered. Reduced restrictive/repetitive behavior and higher socialization and play/leisure scores were associated with better parental QoL. Better behavioral regulation and attention also predicted better QoL, as did stronger communication and reduced internalising behaviours. Findings indicate that a child's level of autism specific traits, adaptive functioning and behavioral profile has greater impact on parental QoL than cognitive level.

Clinical and behavioral attributes leading to sleep disorders in children on the autism spectrum.

Sleep disorders are a common comorbid condition in children diagnosed with autism spectrum disorder ("autism"). However, the relationship between the clinical features of autism and sleep disorders remains unclear. A better understanding of the inherent autism-related characteristics linked to comorbid sleep disorders would improve comprehensive assessment and management. This study examined the relationship between sociodemographics, autism symptoms, sleep problems, cognitive status, behavioral attributes, and sensory profiles. Using data from 1268 participants who took part in the Australian Autism Biobank, sleep-related measurements using the Child Sleep Habits Questionnaire (CSHQ) were compared between autistic children aged 2 to 17 (N = 969), their siblings (N = 188), and unrelated children without an autism diagnosis (N = 111). The known relationship between sleep problems and autism was further explored by including scores from the Autism Diagnostic Observation Schedule-2, Mullen Scales of Early Learning, Vineland Adaptive Behavioral Scale-II and the Short Sensory Profile-2; which were included in analyses for autistic participants who had a completed CSHQ. Multiple regression models were used to identify clinical/behavioral variables associated with CSHQ subscales. The autism group had a significantly higher total CSHQ score than the sibling and comparison groups (p < 0.001), indicating worse sleep quality. Within the autism group, lower adaptive behaviors (i.e., VABS-II) and sensory issues (i.e., SSP-2 subclass scores) were positively associated with the severity of sleep problems (i.e., the CSHQ subclass scores) (p < 0.001). The significant functional impact of poor sleep on autistic children warrants an assessment of sleep as a critical part of a holistic approach to supporting autistic children and their families. LAY SUMMARY: Autistic children generally have co-occurring conditions. Sleep disorders impact approximately 50%-80% of autistic children. The impact on the quality of life for both the children and their families can be significant. This study compares sleep problems in autistic children and adolescents with their siblings and children without a diagnosis of autism, and investigates the relationship between specific autistic traits, daily life behaviors and sleep problems. The findings highlight the importance of a holistic assessment for autistic children and matching appropriate sleep intervention and supports where indicated.

Dissemination of Early Intervention Program for Preschool Children on the Autism Spectrum into Community Settings: An Evaluation.

We aimed to address a policy-relevant research area with high priority, namely disseminating early intervention for children on the autism spectrum into mainstream community settings. The study cohort comprised 47 children with a diagnosis of Autism Spectrum Disorder (ASD) receiving the Early Start Denver Model (ESDM) intervention: 23 children attending an Autism Specific Early Learning and Care Centre (ASELCC) and 24 children attending a mainstream preschool setting. Group comparisons revealed that the overall response to intervention was in the majority of cases not significantly different between settings. One difference was found in that children in the mainstream preschool setting showed a significant reduction in externalising behaviours compared to the children attending the autism-specific preschool. Intervention duration was found to influence outcomes with a one-month increase in duration found to improve expressive language skills. While the results need to be interpreted with caution due to the small sample size, these findings suggest that early intervention can be successfully delivered in both autism-specific and mainstream settings. However, those families needing additional parent support may be better served by a specialised service.

Experiences of virtual teaching during COVID-19 in medical institutes of Karachi, Pakistan: teachers' perspective.

Objective: To determine the experiences of faculty members related to virtual teaching. METHODS: The cross-sectional study was conducted from January 15 to March 15, 2021, at undergraduate medical institutions located in Karachi, and comprised all the faculty members. Data was collected using a Google Survey questionnaire, and it was analysed using SPSS 20. RESULTS: Of the 385 subjects, 157(40.78%) were from basic sciences faculty, and 228(59.2%) were from the clinical sciences faculty. The majority had 3-5 years of teaching experience 142(37%). The most common online tool was Zoom 250(65%). The faculty who had prior experience or had received formal training for online teaching was more successful in controlling and engaging students than the rest (p<0.001). Those who had enough computer literacy had a better experience in conducting online teaching sessions (p=0.01). The experienced faculty found the opportunity to focus more on the topic that was to be taught online (p<0.001). CONCLUSIONS: Most of the faculty members used online tool Zoom. Faculty members with computer literacy and proper training for online teaching were more successful in controlling and engaging students and conducting online teaching sessions.

Frequency of mental distress among medical students from selected medical colleges of Pakistan: A systematic review.

OBJECTIVE: To find out the frequency of mental distress among medical students in Pakistani medical colleges. METHODS: The systematic review comprised a search on PubMed and Google Scholar databases for articles published in English language between 2004 and 2019 having the key words 'mental distress', 'medical undergraduate', 'depression' and 'anxiety'. After a four-phase scrutiny process, articles were shortlisted for detailed review. Conventional content analysis was utilised for data analysis. RESULTS: Of the 30 articles, 18(60%) were reviewed in detail. Distress among Pakistani medical students was reported up to 90% which is alarmingly high. Study year, financial issues and academic burden were the noteworthy causal factors. Academics and examinations were substantial stress factors and religion was the commonly adopted coping strategy. CONCLUSIONS: Multiple studies showed evidence of an increasing rate of mental distress among medical undergraduates having various causative factors, mainly the academic burden.

Co-Design of a Neurodevelopment Assessment Scale: A Study Protocol.

Neurodevelopmental disorders are a heterogeneous group of conditions with overlapping symptomatology and fluctuating developmental trajectories that transcend current diagnostic categorisation. There is a need for validated screening instruments which dimensionally assess symptomatology from a holistic, transdiagnostic perspective. The primary aim is to co-design a Neurodevelopment Assessment Scale (NAS), a user-friendly transdiagnostic assessment inventory that systematically screens for all signs and symptoms commonly encountered in neurodevelopmental disorders. Our first objective is to undertake development of this tool, utilising co-design principles in partnership with stakeholders, including both those with lived experience of neurodevelopmental disorders and service providers. Our second objective is to evaluate the face validity, as well as the perceived utility, user-friendliness, suitability, and acceptability (i.e., 'social validity'), of the NAS from the perspective of parents/caregivers and adults with neurodevelopmental disorders, clinicians, and service providers. Our third objective is to ascertain the psychometric properties of the NAS, including content validity and convergent validity. The NAS will provide an efficient transdiagnostic tool for evaluating all relevant signs, symptoms, and the dimensional constructs that underpin neurodevelopmental presentations. It is anticipated that this will maximise outcomes by enabling the delivery of personalised care tailored to an individual's unique profile in a holistic and efficient manner.

Interaction Between Chronic Bronchitis and Blood Cadmium Levels on the Prevalence of Myocardial Infarction in US Adults: The National Health and Nutritional Examination Survey, 2005-2016.

OBJECTIVE: To explore the interaction between chronic bronchitis and blood cadmium on the prevalence of myocardial infarction. METHODS: We used weighted US-NHANES data. Multivariate survey logistic regression was used to examine the associations between myocardial infarction, cadmium concentration and chronic bronchitis. Adjusted odds ratios, 95% confidence intervals were computed. RESULTS: There was a significant interaction (OR=1.33, CI = [1.01, 1.74]) between chronic bronchitis and blood cadmium level on the presence of myocardial infarction. For 1 µg/L increase in cadmium level, people with chronic bronchitis had 1.65 (1.24 × 1.33) times the odds of having myocardial infarction, while those without chronic bronchitis would be only 1.24 times as likely having the outcome (OR = 1.24, CI = [1.05, 1.46]). CONCLUSION: Findings highlights the role of chronic bronchitis on the relationship between blood cadmium concentration and myocardial infarction. Prospective cohort designs are needed to confirm these findings.

Economic Evaluation of Interventions for Treatment of Neonatal Opioid Withdrawal Syndrome: A Review.

This study assessed the economic evidence on the pharmacological and non-pharmacological management of infants with neonatal opioid withdrawal syndrome (NOWS). Six databases were searched up to October 2020 for peer-reviewed studies. After titles and abstracts were screened, 79 studies remained for full-text review, and finally, 8 studies were eligible for inclusion in the review. The methodological quality of included studies was assessed using the Drummond checklist. The review showed significant limitations in these studies, with one study being rated as good and the remaining seven studies as of poor quality. There are methodological issues that require addressing, including a lack of detail on cost categories, a robust investigation of uncertainty, and extending the time horizon to consider longer-term outcomes beyond the initial birth hospitalization. Despite these limitations, existing evidence suggests non-pharmacological strategies such as rooming-in were associated with a shorter hospital stay and a decreased need for pharmacological treatment, thereby lowering hospitalization costs. The review highlights the paucity of high-quality studies assessing the cost-effectiveness of intervention strategies for NOWS. There is also a lack of evidence on long-term outcomes associated with NOWS and the treatment of NOWS. The inclusion of economic analyses in future studies will provide evidence to inform policymakers on resource allocation decisions for this patient population.

Impact of the COVID-19 pandemic on the well-being of children with neurodevelopmental disabilities and their parents.

AIMS: To examine the impact of COVID-19 pandemic on child mental health and socio-emotional and physical well-being (including sleep, diet, exercise, use of electronic media; care giver perceptions of symptoms of child neurodevelopmental disability [NDD] and comorbidities), and care giver mental health and well-being, social support and service use. METHODS: An online cross-sectional self-report survey was distributed via disability service providers and support groups. Care givers of children aged 2-17 years with a NDD were invited to respond to questions on child symptom severity and well-being, parent well-being and service access and satisfaction. RESULTS: Overall, 302 care givers (94.7% female) completed the survey. Average child age was 9.7 years and 66.9% were male. Worsening of any child NDD or comorbid mental health symptom was reported by 64.5% of respondents and 76.9% reported child health and well-being was impacted by COVID-19. Children were viewing more television and digital media (81.6%), exercising less (68.0%), experiencing reduced sleep quality (43.6%) and had a poorer diet (32.4%). Almost one fifth (18.8%) of families reported an increase in the dosage of medication administered to their child. Parents reported COVID-19 had impacted their own well-being (76.1%). Over half of respondents were not satisfied with services received during COVID-19 (54.8%) and just 30% reported that telehealth works well for their child. CONCLUSION: Targeted interventions are required to address worsening child neurodevelopmental disability, mental health symptoms and poor diet, sleep and exercise patterns. Improved access to telehealth services is indicated, as is further research on barriers and enablers of effective telehealth services.

Educational theories that inform the educational strategies for teaching ethics in undergraduate medical education.

OBJECTIVE: To find out the most appropriate learning theory for the ethics education of medical undergraduates. METHODS: Two electronic databases were searched PubMed and Web of Science. We searched for published articles written in English without a time limit using the keywords: ethics education, medical undergraduates and learning theory. In the four-phased retrieval process, six full texts out of 133 citations were included in this review. Data were analyzed done by conventional content analysis. RESULTS: This systemic review revealed that reflection is the most effective pathway to develop ethical attributes and values of the physician. Social constructivist and experiential theory seem appropriate to form the basis for developing effective ethics curriculum. CONCLUSIONS: This review heightens the importance of learning theories for ethics education. It gives prompt evidence that reflection is the most suitable model for ethical education. Therefore, the educational theories and teaching activities that endorse reflective learning should be used for ethics education.

Frequency of and Various Factors Associated with Stress, Anxiety, and Depression among Low Back Pain Patients.

Objective To measure the frequency of depression, anxiety, and stress and its association with other variables i.e., age, gender, and off work hours among low back pain (LBP) patients attending an orthopedic outpatient department (OPD) at a private hospital in Jeddah, Saudi Arabia (SA). Methodology This is the cross-sectional study, which was done in a secondary care hospital of Jeddah, SA. Data was collected between the periods of 2017-2018. All patients who attended orthopaedic OPD with LBP were included in this study and were requested to fill the Depression, Anxiety, Stress Scale-21 (DASS-21) questionnaire. The gathered data were analyzed through the Statistical Package for Social Sciences (SPSS) version 23 (SPSS Inc., Chicago, IL). One-way analysis of variance (ANOVA) was used to compare the mean difference in depression, anxiety, and stress scores between genders, age, and number of leaves from their work. Results Three hundred sixty patients came to the orthopedic OPD with the primary complaint of LBP, 318 (88.3%) were male while 42 (11.7%) were female. The study showed that among these patients 24 (6.7%) subjects were suffering from the depression while 136 (37.8%) from anxiety and 167 (46.4%) from stress. Linear regression analysis showed that depression was negatively associated with age and stress was negatively associated with the off work because of the severity.  Conclusion In conclusion, the findings of this study revealed that LBP and mental distress are related to each other. This finding urges physicians to check and treat the mental distress in patients with LBP for a better outcome.

Frequency of orthopedic problems among patients attending an orthopedic outpatient department: a retrospective analysis of 23 495 cases.

BACKGROUND: Baseline statistical data on the current orthopedic outpatient load was needed to highlight the more frequent orthopedic problems. OBJECTIVE: Describe the frequency of orthopedic problems among patients attending the orthopedic outpatient department (OPD). DESIGN: Descriptive, retrospective medical record review. SETTINGS: Four-year data (2013-2017) was extracted from the computer records of patients attending the orthopedics OPD. PATIENTS AND METHODS: Computer entries of OPD visits were found, and after excluding incomplete and follow up data, age, gender, and diagnoses were described. MAIN OUTCOME MEASURES: Frequency of orthopedic diagnoses. SAMPLE SIZE AND CHARACTERISTICS: 23 495 patients, 19 377 (82.5%) males and 4118 (17.5%) females, majority (18 155, 77.3%) 19-50 years of age. RESULTS: Lower back pain (26%), tendinopathies and enthesopathies (18.3%), and bone fractures (11%) were the three common problems followed by arthritis (10.6%), nonspecific body ache (7.4%), and soft tissue injuries (9.9%). Others prominent diagnoses were ligamentous sprains (6.4%), neck-related problems (4.8%), joint stiffness (1.8%) and sports injuries (1%). CONCLUSION: This overview of the orthopedic problems in a secondary care hospital may aid in the formulation of better protocols and strategies to manage orthopedic disorders in a healthcare setting. LIMITATIONS: Retrospective and only included the primary diagnosis. CONFLICT OF INTEREST: None.

Frequency and perceived causes of depression, anxiety and stress among medical students of a private medical institute in Karachi: a mixed method study.

OBJECTIVE: To determine medical students' level of mental distress, assess their perceptions of its causes, and to gather their suggestions for possible solutions.. METHODS: The mixed-method qualitative-quantitative study was conducted at Liaquat National Medical College, Karachi, from August 2016 to March 2017, and comprised medical students across years 1 to 5. In phase one, the depression, anxiety and stress scale-21 questionnaire was administered to explore prevalence rates among the subjects. In phase two, focus group discussions were carried out to explore the possible reasons for the students' mental distress. Data was analysed using SPSS 20. RESULTS: Of the 270 students approached, 188(70%) returned the completed questionnaire. The overall mean age of subjects was 21.4}2.2 years (range: 18-25 years). There were 100(53%) females, and 88(47%) males. The prevalence of depression was 134(71%), anxiety 136(72%) and stress 66(35%). Major concerns mentioned by the students in phase two related to academic issues. Students in the focus group also complained of poor lifestyles, financial constraints, lack of support services for stress management, and lack of physical and recreational facilities. Students suggested that their mental distress might be alleviated by curricular innovations such as reducing the number and duration of lectures, increasing small group activities, and pre-scheduling exams. Students also strongly requested proper support services at the institutional level. CONCLUSIONS: There was high mental distress among medical students and it was mainly related to academic pressure.