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.

Do different pedagogical conceptions result in different quality of life levels?

OBJECTIVE: The present study aims to compare medical students' quality of life (QoL) at two Brazilian institutions with different pedagogical conceptions. METHODS: We studied students during the first four years of medical school at two institutions (one using active methodologies and small groups and the other using traditional lectures and large groups). We used a demographic questionnaire and the WHOQOL-BREF. RESULTS: 820 medical students were included. No significant differences in quality of life were found in general, nor while evaluating the course phase, except for the physical WHOQOL, which was lower for 2nd-year students at the institution with traditional lectures, even when adjusted for gender. CONCLUSION: Our findings revealed that, despite having very distinct pedagogical conceptions and characteristics, there were no significant differences in medical students' QoL scores between both institutions. These results are surprising and differ from our initial hypothesis, which expected better QoL for those using more active and student-centered methods.

Do different pedagogical conceptions result in different quality of life levels?

SUMMARY OBJECTIVE The present study aims to compare medical students' quality of life (QoL) at two Brazilian institutions with different pedagogical conceptions. METHODS We studied students during the first four years of medical school at two institutions (one using active methodologies and small groups and the other using traditional lectures and large groups). We used a demographic questionnaire and the WHOQOL-BREF. RESULTS 820 medical students were included. No significant differences in quality of life were found in general, nor while evaluating the course phase, except for the physical WHOQOL, which was lower for 2nd-year students at the institution with traditional lectures, even when adjusted for gender. CONCLUSION Our findings revealed that, despite having very distinct pedagogical conceptions and characteristics, there were no significant differences in medical students' QoL scores between both institutions. These results are surprising and differ from our initial hypothesis, which expected better QoL for those using more active and student-centered methods.

RESUMO OBJETIVO O presente estudo tem como objetivo comparar a qualidade de vida (QV) de estudantes de medicina de duas instituições brasileiras com diferentes concepções pedagógicas. MÉTODOS Estudo comparativo incluindo estudantes do 1o ao 4o ano do curso de medicina de duas instituições no Brasil (uma usando metodologias ativas e pequenos grupos e a outra aulas expositivas tradicionais e grandes grupos). Utilizou-se um questionário demográfico e o instrumento WHOQOL-Bref. RESULTADOS Foram incluídos 820 estudantes de medicina. Nenhuma diferença significativa na qualidade de vida foi encontrada no geral e na avaliação por fase do curso, com exceção do WHOQOL físico, que mostrou ser mais baixo para os estudantes da da instituição com aulas tradicionais, mesmo quando ajustado para o gênero. CONCLUSÃO Nossos achados revelaram que apesar de terem concepções e características pedagógicas bem distintas, não se observaram diferenças significativas nos escores de QV dos estudantes de medicina das duas instituições. Esses resultados são surpreendentes e diferem da nossa principal hipótese, uma vez que esperávamos uma melhora de QV para aqueles que usam métodos mais ativos e centrados no estudante.

Mental health and quality of life of Brazilian medical students: Incidence, prevalence, and associated factors within two years of follow-up.

Medical students' mental health and quality of life (QoL) cause growing concern worldwide, but, to date, few longitudinal studies have followed these students. Our objective was to evaluate the incidence, prevalence, and factors associated with quality of life and symptoms of depression, anxiety, and stress of Brazilian medical students who were followed for a period of two years. Students' mental health (DASS-21), QoL (WHOQOL-Bref), and religiousness (DUREL) were evaluated in four different waves(four semesters). A total of 312 (54.2%) medical students responded to all four waves. Medical students demonstrated a high prevalence and incidence of emotional disorders. Almost half of the students presented high levels of depression, anxiety, and stress during the two-year follow-up; approximately one out of five students without symptoms at the baseline were considered new cases and these problems have a cyclical nature. Baseline factors such as depression, anxiety, stress, having low income, being female, being in the early stages of medical training and non-white were associated with poorer mental health and quality of life in the follow-up. Our results show that medical students have a high prevalence and incidence of mental health disorders during their medical training. This data may help educators plan preventive strategies.

Prevalence, Incidence, and Factors Associated With Substance Use Among Medical Students: A 2-Year Longitudinal Study.

OBJECTIVES: Although there are a number of studies about substance use by medical students, the majority are still cross-sectional. We aimed to investigate prevalence, 2-year incidence, and factors associated with substance use during medical training. METHODS: This longitudinal study included medical students in 4 different waves (with each wave equaling 1 semester). Socio-demographic data, Duke Religion Index (DUREL), DASS-21, and the "Alcohol, Smoking and Substance Involvement Screening Test" (ASSIST) were used. RESULTS: A total of 327 (56.2%) medical students were followed for 2 years. Prevalence of lifetime substance use was 89.9% for alcohol, 34.5% for cannabis, and 17.1% for sedatives. Tobacco had the greatest incidence of use over the 2 years (16.4%), followed by alcohol (13.8%) and cannabis (13.8%). At least 24% of the students would need an intervention for alcohol use, 11.4% for tobacco, and 6.5% for cannabis. Alcohol use during wave 4 was associated with organizational religiosity, and alcohol and tobacco use at the baseline; tobacco use during wave 4 was associated with age, non-organizational religiosity, and cannabis and tobacco use at the baseline; and cannabis use during wave 4 was associated with cannabis and tobacco use at the baseline. CONCLUSIONS: Our results indicate an increase in the incidence of lifetime substance use during medical training. Prior use of substance was associated with a higher chance of use after 2 years, while age and religiousness seem to reduce the chance of use.

Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students.

OBJECTIVE: This study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a medical institution in the USA and another one in Brazil. METHODS: This cross-cultural study included students enrolled in the first and second years of their undergraduate medical training. We evaluated depression, anxiety, and stress (DASS 21), empathy, openness to spirituality, and wellness (ESWIM), burnout (Oldenburg), and quality of life (WHOQOL-Bref) and compared them between schools. RESULTS: A total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical students and all Brazilian medical students revealed that Brazilians reported more depression and stress and US students reported greater wellness, less exhaustion, and greater environmental quality of life. In order to address a possible response bias favoring respondents with better mental health, we also compared all US medical students with the 50% of Brazilian medical students who reported better mental health. In this comparison, we found Brazilian medical students had higher physical quality of life and US students again reported greater environmental quality of life. Cultural, social, infrastructural, and curricular differences were compared between institutions. Some noted differences were that students at the US institution were older and were exposed to smaller class sizes, earlier patient encounters, problem-based learning, and psychological support. CONCLUSION: We found important differences between Brazilian and US medical students, particularly in mental health and wellness. These findings could be explained by a complex interaction between several factors, highlighting the importance of considering cultural and school-level influences on well-being.

Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters.

OBJECTIVE: To compare the prevalence of anxiety, depression, and stress in medical students from all semesters of a Brazilian medical school and assess their respective associated factors. METHOD: A cross-sectional study of students from the twelve semesters of a Brazilian medical school was carried out. Students filled out a questionnaire including sociodemographics, religiosity (DUREL - Duke Religion Index), and mental health (DASS-21 - Depression, Anxiety, and Stress Scale). The students were compared for mental health variables (Chi-squared/ANOVA). Linear regression models were employed to assess factors associated with DASS-21 scores. RESULTS: 761 (75.4%) students answered the questionnaire; 34.6% reported depressive symptomatology, 37.2% showed anxiety symptoms, and 47.1% stress symptoms. Significant differences were found for: anxiety - ANOVA: [F = 2.536, p=0.004] between first and tenth (p=0.048) and first and eleventh (p=0.025) semesters; depression - ANOVA: [F = 2.410, p=0.006] between first and second semesters (p=0.045); and stress - ANOVA: [F = 2.968, p=0.001] between seventh and twelfth (p=0.044), tenth and twelfth (p=0.011), and eleventh and twelfth (p=0.001) semesters. The following factors were associated with (a) stress: female gender, anxiety, and depression; (b) depression: female gender, intrinsic religiosity, anxiety, and stress; and (c) anxiety: course semester, depression, and stress. CONCLUSION: Our findings revealed high levels of depression, anxiety, and stress symptoms in medical students, with marked differences among course semesters. Gender and religiosity appeared to influence the mental health of the medical students.

Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters

Summary Objective: To compare the prevalence of anxiety, depression, and stress in medical students from all semesters of a Brazilian medical school and assess their respective associated factors. Method: A cross-sectional study of students from the twelve semesters of a Brazilian medical school was carried out. Students filled out a questionnaire including sociodemographics, religiosity (DUREL - Duke Religion Index), and mental health (DASS-21 - Depression, Anxiety, and Stress Scale). The students were compared for mental health variables (Chi-squared/ANOVA). Linear regression models were employed to assess factors associated with DASS-21 scores. Results: 761 (75.4%) students answered the questionnaire; 34.6% reported depressive symptomatology, 37.2% showed anxiety symptoms, and 47.1% stress symptoms. Significant differences were found for: anxiety - ANOVA: [F = 2.536, p=0.004] between first and tenth (p=0.048) and first and eleventh (p=0.025) semesters; depression - ANOVA: [F = 2.410, p=0.006] between first and second semesters (p=0.045); and stress - ANOVA: [F = 2.968, p=0.001] between seventh and twelfth (p=0.044), tenth and twelfth (p=0.011), and eleventh and twelfth (p=0.001) semesters. The following factors were associated with (a) stress: female gender, anxiety, and depression; (b) depression: female gender, intrinsic religiosity, anxiety, and stress; and (c) anxiety: course semester, depression, and stress. Conclusion: Our findings revealed high levels of depression, anxiety, and stress symptoms in medical students, with marked differences among course semesters. Gender and religiosity appeared to influence the mental health of the medical students.

Resumo Objetivo: Comparar a prevalência de ansiedade, depressão e estresse em estudantes de todos os períodos de graduação de medicina e avaliar os fatores associados. Método: Estudo transversal e comparativo, realizado com alunos dos seis anos (doze semestres) de um curso de medicina brasileiro. Os alunos preencheram um questionário com dados sociodemográficos e relacionados à religiosidade (Duke Religion Index) e à saúde mental (DASS-21 - Depression, Anxiety and Stress Scale). Os estudantes dos 12 períodos do curso foram comparados quanto às variáveis demográficas, socioeconômicas e saúde mental por meio dos testes de Qui-quadrado ou ANOVA. Para avaliar os fatores associados a cada variável dependente (estresse, depressão e ansiedade), foram utilizados modelos de regressão linear. Resultados: Responderam ao questionário 743 (73,63%) dos 1.009 estudantes matriculados no curso de medicina, com 34,6% apresentando sintomatologia depressiva; 37,2%, sintomas de ansiedade; e 47,1%, estresse. Houve diferenças significantes entre os períodos em relação à ansiedade - ANOVA: (F = 2,536; p=0,004), sendo as diferenças entre o primeiro e o décimo período (p=0,048) e entre o primeiro e o décimo primeiro período (p=0,025); à depressão - ANOVA: (F = 2,410; p=0,006), sendo as diferenças entre o primeiro e o segundo período (p=0,045); e ao estresse - ANOVA: (F = 2,968; p=0,001), sendo as diferenças entre o sétimo e o décimo segundo período (p=0,044), entre o décimo e o décimo segundo (p=0,011) e entre o décimo primeiro e o décimo segundo (p=0,001). Estiveram associados (a) ao estresse: gênero feminino, ansiedade e depressão; (b) à depressão: gênero feminino, religiosidade intrínseca, ansiedade e estresse; (c) à ansiedade: semestre do curso, depressão e estresse. Conclusão: Os achados do presente estudo mostram altos níveis de sintomas de depressão, ansiedade e estresse em estudantes de medicina, com diferenças marcantes nos diferentes semestres do curso. Fatores como gênero e religiosidade parecem influenciar a saúde mental dos estudantes de medicina.

Anemia in inflammatory bowel disease outpatients: prevalence, risk factors, and etiology.

UNLABELLED: Anemia is common in inflammatory bowel disease (IBD). However, epidemiological studies of nonwestern IBD populations are limited and may be confounded by demographic, socioeconomic, and disease-related influences. This study evaluated the prevalence, risk factors, and etiology of anemia in Brazilian outpatients with IBD. METHODS: In this cross-sectional study, 100 Crohn's disease (CD) patients and 100 ulcerative colitis (UC) subjects were assessed. Anemia workup included complete blood count, ferritin, transferrin saturation, serum levels of folic acid and vitamin B12, and C-reactive protein (CRP) concentration. RESULTS: The overall prevalence of anemia in IBD was 21%. There was no significant difference in the prevalence of anemia between CD subjects (24%) and UC (18%). Moderate disease activity (OR: 3.48, 95% CI, 1.95-9.64, P = 0.002) and elevated CRP levels (OR: 1.8, 95% CI, 1.04-3.11, P = 0.02) were independently associated with anemia. The most common etiologies of anemia found in both groups were iron deficiency anemia (IDA; 10% on CD and 6% on UC) followed by the anemia of chronic disease (ACD; 6% for both groups). CONCLUSIONS: In Brazilian IBD outpatients, anemia is highly concurrent condition. Disease moderate activity as well as increased CRP was strongly associated with comorbid anemia. IDA and/or ACD were the most common etiologies.

Tuberculose: aspectos imunológicos na infecção e na doença / Tuberculosis: immunological aspects in the infection and in the disease

A tuberculose (TB) é problema de saúde pública mundial, com quase dois milhões de mortes anualmente, o que torna imperiosa a busca por mais conhecimentos sobre seus aspectos imunológicos para que possa ser tratada e prevenida adequadamente. Apenas 5 a 10% dos seres humanos imunocompetentes são susceptíveis à TB e mais de 85% desses desenvolvem lesão exclusivamente nos pulmões. Ao contrário, indivíduos imunocomprometidos podem desenvolver TB sistêmica, que pode se tornar rapidamente letal. A resposta inflamatória Th1 é a principal responsável pela proteção contra o Mycobacterium tuberculosis (Mtb), sendo o interferon-gama a citocina importante no mecanismo de proteção, o que pode originar métodos diagnósticos mais precisos para a TB. O entendimento do equilíbrio entre a resposta Th1 e Th2 e do papel de células TCD8 e T regulatórias é essencial para o conhecimento da resposta imune contra o Mtb e a reflexão sobre a aquisição de novas formas de tratamento e prevenção da TB que, apesar de ser curável, causa milhões de mortes anualmente em todo o mundo.

Tuberculosis (TB) is a public health problem in all over the world, which presents two million deaths annually. This fact show the incessant search for more knowledge about its immunological aspects in order to be prevented and treated appropriately. Only 5-10% of immunocompetent humans are at risk to TB and more than 85% of these humans develop lesions, mainly in the lungs. In contrast, immunocompromised individuals may develop systemic TB that can fastly become lethal. Th1 inflammatory response is the main responsible for protection against Mycobacterium tuberculosis (Mtb), and interferon-gamma cytokine is important for the mechanism of protection, which can lead to more accurate diagnostic methods for TB. The understanding of the balance between Th1 and Th2, and also the role of the TCD8 and regulatory T cells is essential for identifying the immune response against Mtb, besides the observation on the acquisition of new forms of TB treatment and prevention, despite being curable, this disease cause millions of deaths annually worldwide.