Evolving Mental Health Dynamics among Medical Students amid COVID-19: A Comparative Analysis of Stress, Depression, and Alcohol Use among Medical Students.

Background and Objectives: The ongoing COVID-19 pandemic has posed an array of new challenges for medical students worldwide. Amidst academic rigors, students are confronted with unique stressors, potentially affecting their mental health and substance use. This study aimed to investigate the multifaceted effects of depression, alcohol use, and stress on medical students and discern how these factors have been amplified by the pandemic's circumstances, and to identify predictors of mental distress during the COVID-19 pandemic period. Materials and Methods: Two online anonymous and cross-sectional surveys were conducted at the University of Medicine and Pharmacy "Iuliu Hatieganu" in Romania among medical students in 2018 and in 2022. Data were gathered via online questionnaires distributed through closed student groups on social media platforms, with a total of 1061 participants, to investigate stress, depression, alcohol and drug use, and the impact of the pandemic and online education on mental health, maintaining anonymity and ethical approval. The Medical Student Stress Questionnaire (MSSQ) was employed to measure different aspects of stress, the Beck Depression Inventory (BDI) provided insights into the participants' depressive symptoms, and for the assessment of alcohol consumption habits, the Alcohol Use Disorders Identification Test (AUDIT) was utilized. Results: Our findings showed a significant decrease in mean depression scores (13.81 vs. 11.56, with p < 0.001) from 2018 to 2022. In 2018, students scored significantly higher in the overall stress-related domains. Additionally, being female, facing financial constraints, and being in pre-clinical years emerged as predictors of heightened academic-related stress and depressive symptoms. Students who had experienced the loss of a family member due to COVID-19 exhibited a statistically significant rise in their average BDI score and current anxiety levels. Conclusions: The pandemic, despite introducing new stressors, may have indirectly fostered an increased focus on students' mental health, leading to more refined support mechanisms. Specialized interventions, taking into account gender and financial problems, are needed to address the multifaceted challenges faced by medical students. Our study highlights the ongoing need to nurture both the academic and emotional strength of future medical practitioners.

Recent Advances on the Roles of PCSK-9 Inhibitors in the Management of Acute Ischemic Stroke Patients.

Acute ischemic stroke (AIS) represents an important cause of disability and death. Since only a minor percentage of patients with AIS are eligible for acute therapy, the management of risk factors is mandatory. An important risk factor of AIS is hyperlipemia. The current guidelines recommend a strict correction of it. Statins are recommended as the first-line treatment, while proprotein convertase subtilin/kexin type 9 (PCSK-9) inhibitors are administered as a second or even third option when the goal for a low-density lipoprotein cholesterol (LDL-C) level is not achieved. PCSK-9 inhibitors effectively decrease the LDL-C levels through the inhibition of PCSK-9-LDL-receptor complex formation. The in-depth understanding of the PCSK-9 protein mechanism in the metabolism of LDL-C led to the development of effective targeted approaches. Furthermore, a better understanding of the LDL-C metabolic pathway led to the development of newer approaches, which increased the therapeutic options. This article aims to offer an overview of the PCSK-9 inhibitors and their mechanism in reducing the LDL-C levels. Moreover, we will present the main indications of the current guidelines for patients with hyperlipemia and for those who have suffered an acute ischemic stroke, as well as the importance of LDL-C reduction in decreasing the rate of a recurrence.

Predictors of Pregnant Women's Decision to Opt for Cesarean Section in Romania.

INTRODUCTION: In Romania, the latest official report indicates that more than half of the births (80,890 cases, representing 52.88% of the total) are performed by cesarean, a rate significantly higher than the World Health Organization (WHO) recommendation of 15-20%. This study aims to identify the predictors associated with women's decisions to opt for cesarean in Romania. MATERIALS AND METHODS:  An analytical cross-sectional observational study was conducted in the general population of Romania. The study was carried out over the course of 2023, with a total duration of four months. During this period, researchers targeted pregnant women from various regions of the country, regardless of their place of residence, age, or education level. The primary data collection tool was a self-administered online questionnaire, distributed via Google Forms, an accessible and efficient platform that allows for automatic response collection. The questionnaire was distributed online, particularly on social media platforms frequented by pregnant women, such as Facebook, Instagram, and TikTok. RESULTS: A total of 1,301 participants were validated. Socio-demographic and clinical factors significantly influence women's decisions to give birth by cesarean. Among these participants, 435 expressed a preference for cesarean delivery. Key predictors include fear of pain and concern for the child's health. Fear of pain at birth is the first predictor in Romanian women to choose cesarean (OR=2.09; 95% CI: 1.62-2.68). Concerns about the child's health do not increase the likelihood of opting for a cesarean. CONCLUSION:  By utilizing valuable resources such as midwives and implementing strategies like birth plans, significant contributions can be made toward reducing the cesarean rate and improving the childbirth experience for women worldwide.

Psychological profile and mood disturbance of women who gave birth during the COVID-19 pandemic in Romania.

OBJECTIVE: This study aimed to outline the emotional profile and the mood disturbance of women who gave birth during Emergency and Alert states in Covid-19 pandemic. METHODS: A cross-sectional study was carried out to investigate how the emergency and alert states due to Covid-19 affected the emotional profile and the mood disturbance of pregnant women who gave birth during these times. We included 244 postpartum women, divided into two groups: 124 women during the State of Emergency and another 120 women during the State of Alert. After expressing their informed consent, they completed an anonymous questionnaire that collected demographic data and the Profile of Mood States Questionnaire, as well as a follow-up survey. Data analysis was performed using the statistical program SPSS 24.0. RESULTS: Out of the 300 questionnaires distributed, we collected 244 valid questionnaires. 45.2% of State of Emergency group and 53.3% of State of Alert group experienced Anxiety, 16.9% of State of Emergency group, respectively 18.3% of State of Alert group, Depression, and 25% of State of Emergency group respectively 34.2% of State of Alert group, Distress. Compared to the ideal Iceberg profile, the emotional profile of both groups presented an inverted graph for Anxiety and Depression and much lower values for Vigor. Only 35.5% of State of Emergency group and 16.7% of State of Alert group received information concerning the virus, symptoms, and evolution of the disease from the specialists who monitored their pregnancy and 25.8% of State of Emergency group respectively 11.7% of State of Alert group received information about measures to prevent contamination and infection. Psycho-emotional and mood disturbance was more pronounced among State of Alert group. CONCLUSIONS: There was a significant psycho-emotional alteration of surveyed women during the pandemic, worsened by the radical measures of the State of Emergency and associated with the major deficiency of care services in supplying valid information and counseling for pregnant women's safety in the State of Alert. There is a highlighted need to pay more attention to the psychological profile of pregnant women and to modernize the health services in this field and adapt them to pandemic situations with the use of modern virtual techniques. In addition, the Romanian health care system should round off the team responsible for the care of mother and child with midwives, internationally recognized very skilled in informing, monitoring, counseling, and support in this field.

Utilization of psychotropic medicines in Romania during 1998-2018.

Background: Mental disorders can have a significant impact on patients' life, including economic, social and individual consequences, and psychotropic medication is essential to treat these conditions. Psychotropic drug utilization studies contribute to a clearer picture of the management of these conditions. Data published from Romania on this topic is limited. The present study aims to characterize the utilization patterns of anxiolytics, antidepressants (ADs), and antipsychotics (APs) in Romania during 1998-2018. Methods: Drug utilization data were provided by Management Center for Documentation, Information and Marketing (CEGEDIM) Romania and quantitative data for each psychotropic medicine were converted to total defined daily doses (DDDs) and to DDD/1000inhabitants/day (DDD/TID). The total use of medicines in DDD/TID was computed in order to obtain the drug utilization 90% (DU90%) segment. Results: An increasing trend in total utilization of psychotropic medicines in Romania started in 2004. Anxiolytics use was predominant until 2013 and the yearly anxiolytic use over the entire study period remained between 10 and 15 DDD/TID. Diazepam lost popularity over time in detriment of the utilization of other anxiolytic benzodiazepines, such as alprazolam and lorazepam. ADs utilization markedly increased during the study period (the average annual growth rate was 13.66% starting 1999). Selective serotonin reuptake inhibitors (SSRIs) became present on the 2008 DU90% and was the dominant class of ADs, with sertraline being the most prescribed, followed by escitalopram and paroxetine. APs utilization showed an increasing trend from 2003 until 2018. Atypical APs became present on the 2008 DU90%, while typical APs were no longer included in the 2018 DU90%. Among atypical APs, olanzapine was the main agent prescribed, and starting 2010 was followed by quetiapine and risperidone. The uptake of APs long-acting formulations became more evident during the last analyzed years (2015-2018). Conclusion: We observed an increasing utilization of APs and a more prominent increase in ADs utilization in Romania during 1998-2018. The anxiolytic prescribing remained nearly stable during this time. Further research can bring more information on the various factors influencing psychotropic utilization in Romania.

Alcohol Consumption and Behavioral Consequences in Romanian Medical University Students.

Alcohol consumption is a major public health problem facing universities. The objectives of the present study were to investigate alcohol consumption and the behaviors associated with it among Romanian university medical students, with particular reference to sex differences, behavioral consequences, and lifestyle patterns. We performed a cross-sectional study on 722 medical students (60.4% females; 39.6% males); the participants filled out a validated questionnaire containing the following items co-occurring with alcohol consumption: smoking, illicit drug use, energy drink consumption, and other behavioral drinking consequences. Physical activity was estimated using the IPAQ questionnaire. We statistically analyzed the interrelation between alcohol consumption and target factors. The present study showed a high percentage of at-risk drinkers among male (15.0%) and female medical students (14.9%) in the studied group. Male students reported higher illicit drug use and physical activity than female students, but the at-risk female drinkers' group consumed more drugs than the low-risk female drinkers. Both male and female drinkers engaged in other risky behaviors correlated with drinking (e.g., smoking, low academic performance, and driving a car after drinking). Public health policies, strategies, and interventions should be initiated to reduce alcohol consumption and associated behaviors in medical students.

Effects of ethanol, nicotine and caffeine gestational exposure of female rats on lung and brain tissues in fetuses: morphological and biological study.

AIM: The purpose of this study was to evaluate the implications of toxic exposure on pregnancy, by exploring the oxidant-antioxidant balance and the histopathological (HP) changes of fetal organs. MATERIALS AND METHODS: Our study was performed on fetuses of gestating rats exposed to ethanol, nicotine and caffeine. HP tissue analysis of fetuses' brain and lung samples were performed. Brain and lung homogenates were quantitatively analyzed to determine the oxidant-antioxidant balance [malondialdehyde (MDA), protein carbonylation (PC), glutathione (GSH) and thiol groups (-SH)]. RESULTS: An increase in cerebral pro-oxidant capacity was observed for alcohol exposure groups through increased MDA levels (p<0.001), as compared to controls. An increase in pulmonary and cerebral pro-oxidant capacity was observed for nicotine and caffeine study groups, through increased PC levels (p<0.001). Lower GSH levels indicate a decrease in brain antioxidant defenses in alcohol, nicotine and caffeine groups. Alcohol and nicotine exposure in pregestational and gestational periods caused neuronal hypoplasia in hippocampus and brainstem congestion. Caffeine registered negligible differences as compared to controls. CONCLUSIONS: In our experimental model for gestational exposure to chemical agents, alcohol was the strongest teratogenic agent in rat brain samples. No significant changes were observed in lung samples. Results indicate an increase in oxidative stress as a result of alcohol and nicotine consumption during gestation in rats.

Attitudes toward mentally ill patients: a comparison between Romanian and international medical students.

BACKGROUND: Stigmatizing attitudes to mental illness, and especially schizophrenia, are not limited to the general population but are also common among health professionals. Health professionals are in a position to model health related attitudes both in the general public and patients. Medical students are an interesting group to focus upon, since they are future health professionals and correcting stigmatizing attitudes is still possible during their educational curriculum. METHODS: This study investigated the attitude toward mental illness in medical students at the Iuliu Hatieganu University of Medicine and Pharmacy. We surveyed first year students, since they have not yet received specific classes or internships in psychiatry; 322 students from the Romanian and English sections participated, representing a response rate of 94.7%. The questionnaire consisted of the Romanian and English versions of Link's Social Distance Scale towards people with mental illness scale. RESULTS: Overall, medical students had a relatively negative attitude towards people with mental illness, with moderate social distance and stereotypical attitudes. The level of personal contact with people with mental illness was correlated with positive attitudes. International students had scored lower then Romanian students on social distance toward mentally ill patients. CONCLUSIONS: Medical education can play an important role in the attitudes of students toward mental illness. Medical students have stigmatizing attitudes about mentally ill patients. Personal contact with people suffering from mental illness might contribute to a positive attitude from the medical students toward mentally ill patients.