What do medical students think about their quality of life? A qualitative study.

BACKGROUND: Medical education can affect medical students' physical and mental health as well as their quality of life. The aim of this study was to assess medical students' perceptions of their quality of life and its relationship with medical education. METHODS: First- to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student's lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training. RESULTS: Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life. CONCLUSION: Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students' quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

Violence against women by their intimate partner and common mental disorders.

The World Health Organization considers gender violence a cause of anxiety, depression and suicidal thoughts among women. This study investigated the association between violence committed against women by their intimate partners, defined by psychologically, physically and sexually abusive acts, and common mental disorders, assessed by using the Self Reporting Questionnaire (SRQ-20). A population-based household survey was carried out among women aged 15-49 years in two sites: São Paulo, the largest Brazilian city, and Zona da Mata of Pernambuco, a region with both urban and rural areas in the Northeast of the country. A large proportion of women reported violence (50.7%). The most frequent forms were psychological violence alone (18.8%) or accompanied by physical violence (16.0%). The prevalence of mental disorders was 49.0% among women who reported any type of violence and 19.6% among those who did not report violence (p<0.0001). After adjustment for demographic and socioeconomic characteristics, the nature of the relationship, stressful life events and social support, all the forms of violence studied, with the exception of sexual violence alone or accompanied by either physical or psychological violence (p=0.09), were significantly associated with mental disorders: physical violence alone (OR1.91; CI 95%1.2-3.0), psychological violence alone (OR 2.00; CI 95% 1.5-2.6), sexual violence alone or accompanied by either physical or psychological violence (OR1.80; CI95% 0.9-3.6), both psychological and physical violence (OR 2.56; CI 95% 1.9-3.5) and all three forms of violence (OR 2.68; CI 95% 1.8-4.0). This is the first population-based study on the association between intimate partner violence and mental health in Brazil. It contributes to the existing body of research and confirms that violence, frequently experienced by women in the country, is associated with mental disorders. Policies and strategies aimed at reducing gender-based violence are necessary for preventing and reducing anxiety and depression among women.

Intimate partner violence among undergraduate students of two universities of the state of Sao Paulo, Brazil.

INTRODUCTION: The prevalence of violence in intimate relationships, suffered or perpetrated, was estimated among undergraduate students, be it physical, psychological and sexual, describing the overlap between them. This is an original study and there is scarce literature on this matter in Brazil. Men and women were investigated and some issues on gender violence were discussed. METHODS: The study is part of the multicenter survey "International Study of Violence in Dating - IDVS" conducted in 2002 - 2003, using its standardized instrument. A total of 362 students, from two universities in the state of São Paulo, one public and one private, answered the self-reported questionnaire, being 37% male and 63% female, mean age of 20 years old. Suffered and perpetrated intimate partner violence during life was examined. RESULTS: Among all interviewees, 75.9% suffered and 76.4% perpetrated some kind of violence throughout life. Psychological violence was the most prevalent type, followed by sexual violence, both suffered and perpetrated. The great superposition between suffered and perpetrated violence (83.9%) reflects the reciprocity of aggression, with no observed difference between men and women. The results of this study are consistent with previous literature on dating violence, which shows high prevalence of suffered and perpetrated violence, besides reciprocity for both men and women. CONCLUSIONS: Intervention actions at this stage of intimate relationships may potentially impact on subsequent marital partnership situations.

Intimate partner violence among undergraduate students of two universities of the state of Sao Paulo, Brazil / Violencia por parceiro intimo entre estudantes de duas universidades do Estado de Sao Paulo, Brasil

INTRODUCTION: The prevalence of violence in intimate relationships, suffered or perpetrated, was estimated among undergraduate students, be it physical, psychological and sexual, describing the overlap between them. This is an original study and there is scarce literature on this matter in Brazil. Men and women were investigated and some issues on gender violence were discussed. METHODS: The study is part of the multicenter survey "International Study of Violence in Dating - IDVS" conducted in 2002 - 2003, using its standardized instrument. A total of 362 students, from two universities in the state of São Paulo, one public and one private, answered the self-reported questionnaire, being 37% male and 63% female, mean age of 20 years old. Suffered and perpetrated intimate partner violence during life was examined. RESULTS: Among all interviewees, 75.9% suffered and 76.4% perpetrated some kind of violence throughout life. Psychological violence was the most prevalent type, followed by sexual violence, both suffered and perpetrated. The great superposition between suffered and perpetrated violence (83.9%) reflects the reciprocity of aggression, with no observed difference between men and women. The results of this study are consistent with previous literature on dating violence, which shows high prevalence of suffered and perpetrated violence, besides reciprocity for both men and women. CONCLUSIONS: Intervention actions at this stage of intimate relationships may potentially impact on subsequent marital partnership situations. .

INTRODUÇÃO: Foram estimados entre universitários a prevalência da violência em relacionamentos íntimos, sofrida ou perpetrada, para os tipos físico, psicológico e sexual, descrevendo-se as sobreposições entre eles. Estudo original com rara produção no Brasil. Foram pesquisados homens e mulheres, com discussão de algumas questões da violência de gênero. MÉTODO: O estudo faz parte de pesquisa multicêntrica "Estudo Internacional de Violência no Namoro - IDVS", realizada em 2002 - 2003, usando seu instrumento padronizado. O questionário foi auto-aplicado em 362 alunos de duas universidades, uma pública e outra privada, do Estado de São Paulo, sendo 37% do sexo masculino e 63% do feminino, com idade mediana de 20 anos. Foram descritas as violências sofridas por e perpetradas na vida contra parceiros íntimos. RESULTADOS: Entre todos os entrevistados, 75,9% sofreram e 76,4% perpetraram algum tipo de violência na vida. O tipo de violência mais prevalente, tanto sofrida como perpetrada, foi a psicológica, seguida da sexual. A grande sobreposição entre violências sofridas e perpetradas (83,9%) reflete a reciprocidade das agressões, sem diferença entre homens e mulheres. Os resultados do presente estudo estão em consonância com a literatura que analisa a violência no namoro, com alta prevalência de violências sofridas e perpetradas, além da reciprocidade tanto para homens como para mulheres. CONCLUSÕES: Ações de intervenção nesta fase dos relacionamentos íntimos podem potencialmente repercutir em situações posteriores de parceria conjugal. .

O trabalho médico: questoes acerca da autonomia profissional / Work in medicine: some issues concerning professional autonomy

Analisa algumas questoes da prática médica relacionadas com a autonomia técnica que caracteriza a açäo profissional. Aponta a existência simultânea do lado científico e do lado empírico-pragmático da medicina, mais conhecido como a arte médica; ou a complexidade de sua açäo, pelas incertezas que cercam o julgamento clínico, conjugado à racionalidade tecnológica que rege a aplicaçäo de suas ciências e historicamente busca ser soberana. Define o trabalho em medicina como uma estrutura sob tensäo, examinando a repercussäo desta condiçäo nas auto-representaçoes dos médicos acerca de si mesmos como agentes do trabalho e sujeitos da açäo.

A autonomia e o trabalho em medicina / Autonomy and work in medicine

Discute a autonomia no trabalho médico como decorrente de dois momentos essenciais: como trabalho social, que consome e produz bens e serviços, reproduzindo o modo de produçäo dominante e valores decorrentes; e como serviço, onde esta autonomia, relativizada pela sua realidade de trabalho social, manifesta-se em atributos adquiridos pelo trabalho médico (independência técnica e auto-regulaçäo) via monopólio da aplicaçäo da ciência às necessidades individuais percebidas como relativas à saúde. Estes produtos cristalizam-se na relaçäo médico-paciente, o que realça as incertezas que cercam tal relaçäo e as necessidades a ela transferidas. A partir desta compreensäo do trabalho médico e sua condiçäo de exercício autônomo discutem-se alguns quadros teóricos que, relacionados ao estudo do trabalho e/ou dos serviços contemporâneos na sociedade, permitem abordagens mais adequadas e epistemologicamente mais profícuas na pesquisa científica que o toma por objeto.

Violência contra mulheres: interfaces com a Saúde / Violence against women: interfaces with Health care

Este ensaio procurará tratar do tema violência sob o recorte da violência contra mulheres. Discute a precedência histórica da tomada da violência contra a mulher como questäo do Direito e objeto da justiça, traçando paralelos na emergência do problema como questäo de Saúde e alvo da Saúde Pública e das práticas médico-sanitárias.

A violência contra mulheres: demandas espontâneas e busca ativa em unidade básica de saúde / Violence against women: spontaneous demands v. screening in healthcare centers

Avalia a emergência de demandas refiridas à violência por parte das usuárias de uma unidade básica da rede pública, contrastando-se a demanda espontânea com a busca ativa de casos. Realiza um primeiro estudo por técnicas de observação participante, seguida de estudo de prontuário, com 142 mulheres sendo acompanhadas. Num segundo estudo, em uma amostra de 322 usuárias, aplicou-se entrevista. Em atividades grupais foram observados relatos espontâneos e nos prontuários médicos registros de demandas espontâneas; o mesmo não ocorreu em consultas individuais. A entrevista detectou uma prevalência de casos muito maior. A possibilidade de detecção de casos, seu acolhimento e algumas respostas do serviço, requer especificidade de abordagem e cuidados próprios para que a violência contra mulheres possa emergir como parte da demanda usual na saúde