Mental health and quality of life across 6 years of medical training: A year-by-year analysis.

BACKGROUND: Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training. OBJECTIVE: To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years. METHODS: This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses. RESULTS: The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels. CONCLUSION: Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

Machine-learning vs. logistic regression for preoperative prediction of medical morbidity after fast-track hip and knee arthroplasty-a comparative study.

BACKGROUND: Machine-learning models may improve prediction of length of stay (LOS) and morbidity after surgery. However, few studies include fast-track programs, and most rely on administrative coding with limited follow-up and information on perioperative care. This study investigates potential benefits of a machine-learning model for prediction of postoperative morbidity in fast-track total hip (THA) and knee arthroplasty (TKA). METHODS: Cohort study in consecutive unselected primary THA/TKA between 2014-2017 from seven Danish centers with established fast-track protocols. Preoperative comorbidity and prescribed medication were recorded prospectively and information on length of stay and readmissions was obtained through the Danish National Patient Registry and medical records. We used a machine-learning model (Boosted Decision Trees) based on boosted decision trees with 33 preoperative variables for predicting "medical" morbidity leading to LOS > 4 days or 90-days readmissions and compared to a logistical regression model based on the same variables. We also evaluated two parsimonious models, using the ten most important variables in the full machine-learning and logistic regression models. Data collected between 2014-2016 (n:18,013) was used for model training and data from 2017 (n:3913) was used for testing. Model performances were analyzed using precision, area under receiver operating (AUROC) and precision recall curves (AUPRC), as well as the Mathews Correlation Coefficient. Variable importance was analyzed using Shapley Additive Explanations values. RESULTS: Using a threshold of 20% "risk-patients" (n:782), precision, AUROC and AUPRC were 13.6%, 76.3% and 15.5% vs. 12.4%, 74.7% and 15.6% for the machine-learning and logistic regression model, respectively. The parsimonious machine-learning model performed better than the full logistic regression model. Of the top ten variables, eight were shared between the machine-learning and logistic regression models, but with a considerable age-related variation in importance of specific types of medication. CONCLUSION: A machine-learning model using preoperative characteristics and prescriptions slightly improved identification of patients in high-risk of "medical" complications after fast-track THA and TKA compared to a logistic regression model. Such algorithms could help find a manageable population of patients who may benefit most from intensified perioperative care.

MEASURING HEALTH STUDENTS' ATTITUDES, PERCEPTIONS AND READINESS FOR INTERPROFESSIONAL LEARNING: RELIABILITY, VALIDITY AND PSYCHOMETRIC PROPERTIES OF THREE SCALES ADAPTED INTO PORTUGUESE.

Background and Purpose: To adapt, validate and assess the psychometric properties of the Readiness for Interprofessional Learning Scale (RIPLS-19 items), Interdisciplinary Education Perception Scale (IEPS-18 items) and Team Skills Scale (TSS-17 items) in 484 undergraduate students. Methods: Transcultural adaptation of the scales was performed. Internal consistency, test-retest reliability, factor analysis, and convergent and discriminant validity were determined. Results: The instruments showed good internal consistency and test-retest reliability for total score. However, factor analyses revealed differences in the subscales compared to the original validations. The RIPLS detected more differences, discriminating gender, race, course semester and course enrolled. The TSS and IEPS detected differences in age and course enrolled. Conclusions: These scales appear to have satisfactory psychometric properties and could be used in both research and education. The subscales, however, should be interpreted with caution.

The Effects of High versus Low Levels of Altruism and Volunteering on the 4-Year Follow-Up Cognitive Performance of Community-Dwelling Older Adults.

OBJECTIVES: Currently, there is a growing interest on the benefits of volunteering. Nevertheless, there is scarce evidence for non-volunteering altruistic behaviors. This study aims to investigate the role of both altruism and volunteering on the cognitive performance of older individuals followed for four years. METHODS: This was cohort study carried out in 180 Brazilian older adults assessed in three different timepoints (baseline [2015-2016], 2 years of follow-up [2017-2018] and 4 years of follow-up [2019-2020]). Composite cognitive score was calculated based on the Mini-Mental State Examination, Verbal Fluency, Clock-Drawing test, and CERAD Word-List. Altruism was assessed through the Self-reported Altruism Scale and self-reported volunteering status. Mixed ANCOVAS were performed. RESULTS: For altruism, there were significant differences in all time points (Baseline, 2 years and 4 years) favoring higher cognitive scores for higher levels of altruism. However, no differences were observed for volunteering in all time points. CONCLUSIONS: Having higher levels of altruism was significantly associated with better cognitive scores. CLINICAL IMPLICATIONS: Altruism, even without volunteering, seem to have positive effects on the cognitive functioning of older adults. Health professionals who take care of older adults might take account of the presence or absence of altruistic behaviors of their patients in their formulations and recommendations.

The current status of "spirituality and health" teaching in Brazilian medical schools: a nationwide survey.

BACKGROUND: Recent data on the teaching of "spirituality and health" (S/H) in medical schools are needed. In this study, we aimed to investigate the current status of S/H teaching in Brazilian medical schools, the opinions of medical directors/deans on this topic and the factors associated with its incorporation into the curriculum. METHODS: A nationwide cross-sectional survey was carried out in 2021. Information concerning the S/H content in the curricula of medical schools was obtained through medical school representatives and other sources. Medical school representatives were asked about their opinions of and barriers to S/H teaching. Regression models were used to evaluate the factors associated with the incorporation of such content into the curriculum. RESULTS: Information on the incorporation of S/H content in medical curricula was retrieved from different sources for all 342 (100%) Brazilian medical schools. Among the representatives, 150 (43.9%) completed the online form. An increase in the S/H content in Brazilian medical schools was observed (from 40% to 2011 to 65.5% in 2021). Most medical school representatives agreed that this issue is important in medical training and that more space in the curriculum is needed. However, they also observed several barriers, such as a lack of knowledge of medical teachers/faculty, a lack of time, and the topic not being included in teaching plans. The most important factors that influenced the incorporation of S/H teaching in medical schools and representatives' opinions were a lack of time and knowledge, professor preparedness and standardized national competency requirements. CONCLUSION: These results could help medical educators rethink the incorporation of S/H content into their curricula.

Mental health throughout the medical career: A comparison of depression, anxiety, and stress levels among medical students, residents, and physicians.

BACKGROUND: Different stages of a physician's career may be associated with different types of mental health impairment. AIMS: This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians. METHODS: A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale - DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models. RESULTS: The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students. CONCLUSION: Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.

One-minute preceptor and SNAPPS for clinical reasoning: a systematic review and meta-analysis.

Clinical reasoning teaching strategies could be important models to teach healthcare trainees. This study aims to assess the effectiveness of clinical reasoning teaching strategies (one-minute preceptor (OMP) and SNAPPS) for developing clinical reasoning skills, attitudes and satisfaction of medical/healthcare students and post-graduate trainees as compared to controls. A systematic review and meta-analysis of randomised controlled studies, with no restriction on language or publication date, were carried out by searching the PubMed, SCOPUS, ERIC, Web of Science, Embase and Cochrane Library databases. The risk of bias of the studies selected was determined using Cochrane's risk-of-bias tool (RoB 2) and the quality of evidence used the Grading of Recommendations Assessment, Development and Evaluation system. Of the 1066 articles retrieved, 12 were included in the systematic review and 10 in the meta-analysis. The results showed a growing body of literature on the use of strategies for teaching clinical reasoning that consisted predominantly of low-quality quasi-experimental studies. When only randomised controlled trials were included, analyses showed effectiveness among both healthcare students and post-graduate trainees for a series of outcomes, including total presentation length, duration of discussion, number of basic attributes, number of justified diagnoses in differential diagnoses and number of uncertainties expressed. Lastly, results for SNAPPS were better than for OMP relative to the control group. The strategies for teaching clinical reasoning improved the performance of healthcare students and professionals on this skill, promoting deeper discussion of clinical cases and a higher number of differential diagnoses. Further good-quality trials are needed to corroborate these findings. PROSPERO Registration: CRD42020175992.

Association of Smartphone Use and Digital Addiction with Mental Health, Quality of Life, Motivation and Learning of Medical Students: A Two-Year Follow-Up Study.

Background: Despite studies evaluating the insertion of technology and the use of smartphones in the mental health and learning of medical students, few have investigated these outcomes longitudinally. This study aims to investigate the association between smartphone use and digital addiction with mental health, quality of life, learning, and academic motivation of medical students. Methods: This is a longitudinal study conducted between 2016 and 2018. Socio-demographics, smartphone use, digital dependence (Internet Addiction Test), surface and deep learning approach (Biggs), motivation (Academic Motivation Scale), evaluation of symptoms of depression, anxiety, and stress (DASS- 21) and Quality of Life (WHOQOL-BREF) were assessed. Adjusted regression models were used for data analysis. Results: A total of 269 students were included(51.4% of the total). In the two-year follow-up, despite an increase in the frequency of smartphone use in general and also in the classroom for non-educational activities, no increase in digital dependence was found. In the adjusted models, the frequency of smartphone use and digital dependence were predictors of lower academic motivation and greater surface learning after two years of follow up. However, only digital dependence was a predictor of worse mental health (anxiety, depression, and stress) and worse quality of life. Conclusion: Greater use of smartphones and high addiction scores were associated with worse educational outcomes. Digital dependence was another marker of outcomes in mental health and quality of life. It is important that educators are aware of these negative effects and can guide students on the proper and safe use of these devices.

The role of spirituality and religiosity on the cognitive decline of community-dwelling older adults: a 4-year longitudinal study.

OBJECTIVES: This study aims to assess whether having religious beliefs, attending religious services and using spiritual-religious coping (SRC) are longitudinally associated with cognitive decline in community-dwelling older adults. METHODS: A 4-year longitudinal study of 261 Brazilian older adults was conducted. Hierarchical adjusted linear regression models and logistic regression models were performed to evaluate the longitudinal effects of religious beliefs, church attendance and positive and negative SRC on cognitive decline. RESULTS: The findings revealed that spiritual and religious beliefs at baseline could affect cognitive function in two different ways. When older adults use religiosity and spirituality (RS) in a functional positive manner, it results in better cognitive outcomes and a slower rate of decline. However, when used in a negative manner, it results in worse cognitive outcomes. CONCLUSION: These results could help health care professionals address SRC among older adults, particularly those at a higher risk of cognitive decline. Considering that RS is very important for older adults, health care professionals should be aware of the beliefs of their patients and address RS in clinical practice.

Factors Associated with Motivation in Medical Students: A 30-Month Longitudinal Study.

This longitudinal study aimed to assess the factors associated with motivation in 303 Brazilian medical students after a 30-month follow-up. Their demographics, study habits, sleep quality, motivation (Brazilian version of the Academic Motivation Scale-BAMS), learning approaches (R-SPQ-2F scale), and stressors (MSSF-Medical Student Stress Factor scale) were examined. We found an increase in amotivation and extrinsic motivation through external regulation (e.g., "I come to school to earn a degree") and a decrease in intrinsic motivation and extrinsic motivation through integrated regulation (e.g., "because studying broadens our horizons") in medical students after the 30-month follow-up. Students in earlier stages of medical training showed greater increases in amotivation. Factors such as the learning approach, hours spent studying, sex, stressors, studying just before examinations, and sleep problems were predictors of the different dimensions of motivation. Medical students' motivation changed negatively as medical training progressed.

Enhanced DNA repair through droplet formation and p53 oscillations.

Living organisms are constantly exposed to DNA damage, and optimal repair is therefore crucial. A characteristic hallmark of the response is the formation of sub-compartments around the site of damage, known as foci. Following multiple DNA breaks, the transcription factor p53 exhibits oscillations in its nuclear concentration, but how this dynamics can affect the repair remains unknown. Here, we formulate a theory for foci formation through droplet condensation and discover how oscillations in p53, with its specific periodicity and amplitude, optimize the repair process by preventing Ostwald ripening and distributing protein material in space and time. Based on the theory predictions, we reveal experimentally that the oscillatory dynamics of p53 does enhance the repair efficiency. These results connect the dynamical signaling of p53 with the microscopic repair process and create a new paradigm for the interplay of complex dynamics and phase transitions in biology.

Comparison of the Role of Different Levels of Religiousness and Spirituality in Controversial Ethical Issues and Clinical Practice among Brazilian Resident Physicians: Results from the Multicenter SBRAMER Study.

This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.

Short and medium-term effects of different teaching strategies for interprofessional education in health professional students: A randomized controlled trial.

BACKGROUND: Interprofessional education (IPE) is recognized as important for teaching in healthcare. However, few studies comparing active versus traditional strategies for this teaching approach have been conducted. OBJECTIVES: This study aims to compare the use of different educational strategies (i.e. active learning versus formal lectures) for teaching interprofessional geriatric competencies in health professional students from different healthcare courses. DESIGN: Randomized controlled trial. SETTINGS: Public university. PARTICIPANTS: Health professional students (nursing, physiotherapy, medicine, nutrition and psychology courses). METHODS: Different theoretical educational strategies (active learning in intervention group versus formal lectures in control group) were associated with case-based group discussions. The RIPLS (Readiness for Interprofessional Learning Scale), IEPS (Interdisciplinary Education Perception Scale) and TSS (Team Skills Scale) instruments were applied at 3 timepoints: on first day of class, on last day of class and at 6 months post-intervention. RESULTS: Of 151 eligible students, 99 concluded all stages of the study and were subsequently included in the analysis. A significant increase in scores on the RIPLS, IEPS and TSS was measured on the last day of class and this performance gain persisted after 6 months for both strategies. However, no significant performance difference between the two strategies was found. Similarly, although student satisfaction was very good, no difference in ratings between the strategies was evident. CONCLUSIONS: The results of this project, besides developing and fostering important discussion on IPE, can add to the literature and aid researchers in IPE by furthering knowledge on how different teaching strategies can impact future health professionals.

Smartphone Use, Digital Addiction and Physical and Mental Health in Community-dwelling Older Adults: a Population-based Survey.

This study aims to assess mobile technology use (cell phones and smartphones), level of digital addiction, and the association of these factors with physical, mental and social health and quality of life (QOL) in community-dwelling older adults. A population-based study of a city with a low-income population in Brazil was carried out. Sociodemographics, cognition(MMSE), mental health(DASS-21), QOL(WHOQOL-bref), sleep quality(Pittsburgh Index), instrumental activities of daily living(Lawton), loneliness(UCLA), digital addiction(Internet Addiction Test) and cell phone/smartphone use were investigated. A total of 668 older adults (93.6% of total) were included; 175(26.2%) owned cell phones, 172(25.7%) smartphones and 321(48.1%) no mobile device. Smartphones owners were predominantly younger, white, had higher income, MMSE scores and social support, and were less dependent. However, no group differences were observed for depression, anxiety or stress symptoms, QOL, sleep disturbances or loneliness. Among 172 smartphone users, Structural Equation Models revealed that the degree of digital addiction was correlated with better physical and environmental conditions, in detriment of a poorer sleep quality. Hours of use were not correlated with health outcomes, whereas greater importance of the smartphone in life correlated with less depressive symptoms and lower loneliness. Different from previous studies in adults or adolescents, older adults who were smartphones users had similar health outcomes than those without Internet access. These findings serve to further our understanding on technology use in this age group.

Resilience and Mental Health Among Regularly and Intermittently Active Older Adults: Results From a Four-Year Longitudinal Study.

BACKGROUND: This study aims to investigate whether regularly active individuals have different levels of mental health and resilience compared to intermittently active individuals. METHODS: In this 4-year longitudinal study, 180 older people were included. General linear models were used to assess the level of physical activity, psychological resilience, and mental health among regularly and intermittently active older adults. RESULTS: Those who maintained regular physical activity were more resilient than those who did not. However, no differences were observed for mental health outcomes. Although those with higher levels of resilience had fewer mental health problems, there were no significant differences between the groups based on their level of physical activity. CONCLUSION: Differences in resilience levels favoring regularly active individuals were found. In both groups, resilience was inversely associated with mental health problems. These findings may help elucidate the underlying mechanisms in the relationship between physical activity and health outcomes.

Biophysical Modeling of Dopaminergic Denervation Landscapes in the Striatum Reveals New Therapeutic Strategy.

Parkinson's disease (PD) results from a loss of dopaminergic neurons. What triggers the break-down of neuronal signaling, and how this might be compensated, is not understood. The age of onset, progression and symptoms vary between patients, and our understanding of the clinical variability remains incomplete. In this study, we investigate this, by characterizing the dopaminergic landscape in healthy and denervated striatum, using biophysical modeling. Based on currently proposed mechanisms, we model three distinct denervation patterns, and show how this affect the dopaminergic network. Depending on the denervation pattern, we show how local and global differences arise in the activity of striatal neurons. Finally, we use the mathematical formalism to suggest a cellular strategy for maintaining normal dopamine (DA) signaling following neuronal denervation. This strategy is characterized by dual enhancement of both the release and uptake capacity of DA in the remaining neurons. Overall, our results derive a new conceptual framework for the impaired dopaminergic signaling related to PD and offers testable predictions for future research directions.

The role of positive behaviors, attitudes and virtues in the mental health of community-dwelling older adults: A 1-year follow-up study.

OBJECTIVES: Few studies have investigated the influence of positive behaviors, attitudes and virtues on mental health outcomes of older adults, particularly in developing countries. The aim of this longitudinal study was to investigate the influence of positive behaviors, attitudes and values on the mental health (depression, anxiety and stress) of Brazilian older adults treated in primary care. METHODS: A longitudinal study, with a 1-year follow-up, of older adults seen by Family Medicine teams was conducted. Instruments were applied assessing traditional factors (cognition, physical activity, sleep, quality of life, social support), behavioral factors (religiousness, spirituality, satisfaction with life, resilience, altruism, volunteerism, loneliness, meaning in life) and mental health (depression, anxiety and stress). Analyses using linear and logistic regression models were performed. RESULTS: A total of 490 older adults (91.8% of individuals assessed at baseline) were included. Traditional factors such as gender, sleep problems, ethnicity and alcohol use, as well as positive behavioral factors including loneliness, resilience and well-being at baseline, were found to be associated with mental health at 1-year follow-up. Similarly, changes in scores for quality of life, loneliness, religiousness, feeling at peace, sleep problems and altruism were associated with changes in mental health scores. CONCLUSIONS: The results revealed that positive behavioral factors influenced the mental health of older adults as much as traditional factors and should therefore be addressed by health professionals and medical managers.

Relationship Between Mental Health, Resilience, and Physical Activity in Older Adults: A 2-Year Longitudinal Study.

The aim of this study was to longitudinally investigate the association between resilience and mental health in older adults and to determine the influence of physical activity on this relationship. A total of 291 older adults were included in a 2-year follow-up study. Adjusted linear regression models evaluated the association between resilience at baseline and mental health after 2 years in sufficiently and insufficiently physically active older adults. A negative correlation was found between resilience at baseline and depression, anxiety, and stress after 2 years for the overall sample. This association changed after stratifying the group. Sufficiently physically active individuals made greater use of the resilience components "Self-Sufficiency" and "Perseverance," whereas insufficiently physically active individuals made greater use of "Meaning of Life" and "Existential Singularity." Physical activity can influence the relationship between resilience and mental health. These results can help guide the devising of more effective interventions for this age group.

The association of mental health with positive behaviours, attitudes and virtues in community-dwelling older adults: Results of a population-based study.

BACKGROUND: Despite major advancements in understanding of the factors associated with mental health in older adults, studies assessing positive behaviours, attitudes and virtues are still scarce in the literature. AIMS: This study aims to investigate whether factors related to positive behaviours, attitudes and virtues are associated with mental health (i.e. depression, anxiety and stress) and satisfaction with life in Brazilian community-dwelling older adults. METHODS: A population-based, cross-sectional study of Brazilian older adults who were users of the public health system and seen by Family Health teams was conducted in 2017. Instruments were applied to assess cognition, physical activity, sleep, quality of life, social support, religiousness, spirituality, satisfaction with life, resilience, altruism, volunteerism, loneliness, meaning in life and mental health (i.e. depression, anxiety and stress). Analyses were carried out using linear and logistic regression models. RESULTS: A total of 534 (93.5%) older adults were included. Positive behavioural factors and values including volunteerism, meaning in life, resilience, peace, loneliness, faith and religiousness were associated with mental health outcomes (i.e. depression, anxiety and stress), as were traditional factors, such as sleep, gender, social support and cognitive state. CONCLUSIONS: Aspects related to positive behaviour, attitudes and virtues can impact the mental health of the older population. These results can serve to alert health professionals on the importance of addressing these factors and help guide the implementation of preventive measures and interventions for this age group.