Luiz Antonio Nogueira Martins

The characteristics of depressive symptoms in medical students during medical education and training: a cross-sectional study

BackgroundMedical education and training can contribute to the development of depressive symptoms that might lead to possible academic and professional consequences. We aimed to investigate the characteristics of depressive symptoms among 481 medical students (79.8% of the total who matriculated).MethodsThe Beck Depression Inventory (BDI) and cluster analyses were used in order to better describe the characteristics of depressive symptoms. Medical education and training in Brazil is divided into basic (1st and 2nd years), intermediate (3rd and 4th years), and internship (5th and 6th years) periods. The study organized each item from the BDI into the following three clusters: affective, cognitive, and somatic. Statistical analyses were performed using analysis of variance (ANOVA) with post-hoc Tukey corrected for multiple comparisons.ResultsThere were 184 (38.2%) students with depressive symptoms (BDI > 9). The internship period resulted in the highest BDI scores in comparison to both the basic (p < .001) and intermediate (p < .001) periods. Affective, cognitive, and somatic clusters were significantly higher in the internship period. An exploratory analysis of possible risk factors showed that females (p = .020) not having a parent who practiced medicine (p = .016), and the internship period (p = .001) were factors for the development of depressive symptoms.ConclusionThere is a high prevalence towards depressive symptoms among medical students, particularly females, in the internship level, mainly involving the somatic and affective clusters, and not having a parent who practiced medicine. The active assessment of these students in evaluating their depressive symptoms is important in order to prevent the development of co-morbidities and suicide risk.

Sintomas depressivos entre internos de medicina em uma universidade pública brasileira

OBJECTIVE: To estimate, among Medical School intern students, the prevalence of depressive symptoms and their severity, as well as associated factors. METHODS: Cross-sectional study in May 2008, with a representative sample of medical intern students (n = 84) from Universidade Federal de Sergipe (UFS). Beck Depression Inventory (BDI) and a structured questionnaire containing informationon sociodemographic variables, teaching-learning process, and personal aspects were used. The exploratory data analysis was performed by descriptive and inferential statistics. Finally, the analysis of multiple variables by logistic regression and the calculation of simple and adjusted OR swith their respective 95% confidence intervals were performed. RESULTS: The general prevalence was 40.5%, with 1.2% (95% CI: 0.0-6.5) of severe depressive symptoms; 4.8% (95% CI: 1.3-11.7) of moderate depressive symptoms; and 34.5% (95% CI: 24.5-45.7) of mild depressive symptoms. The logistic regression revealed the variables with a major impact associated with the emergence of depressive symptoms: thoughts of dropping out (OR 6.24; p = 0.002); emotional stress (OR 7.43;p = 0.0004); and average academic performance (OR 4.74; p = 0.0001). CONCLUSION: The high prevalence of depressive symptoms in the study population was associated with variables related to the teaching-learning process and personal aspects, suggesting immediate preemptive measures regarding Medical School graduation and student care are required.

Well-being and help-seeking: an exploratory study among final-year medical students

OBJECTIVE Doubts, competitiveness and preparation for the residency examination increase stress and insecurity at the end of medical course. Well-being is very important at this point, but it is known that medical students are reluctant to seek help, particularly for emotional problems. This study investigated the relationship among well-being, perceived needs and help-seeking in final-year students. METHODS Well-being was assessed using Becks Inventories of Anxiety (BAI) and Depression (BDI) and the WHOQOL-brief (quality of life). A questionnaire was used to assess perceived needs and medical school support resources. RESULTS The students reported good quality of life (68%) but presented anxiety (27%), depression (20%) and impaired social functioning. Fifty-one percent of the students acknowledged academic needs and 25% psychological needs. Only a portion of the students with anxiety and depression or bad quality of life used the institutional support. Female gender, perceived psychological needs and anxiety symptoms were associated to the use of the Mental Health Service. Satisfaction with mentoring relationships and positive changes were associated to Mentoring attendance. CONCLUSION There are different factors involved in help-seeking and identifying specificities in the use of institutional support resources can help to develop strategies to sensitize students about help-seeking during the medical course.

Aggressiveness and Hostility in the Family Environment and Chronic Constipation in Children

Objective To compare the emotional aspects of children with and without constipation. Methodology Some emotional aspects were studied in children with and without constipation. A nonstructured interview was performed with the mothers regarding the emotional aspects of their children. The children were asked to tell a story based on the observation of a board from the thematic children apperception test. This is a qualitative study using the technique of constant comparison. Results In the interview with the mothers of constipated children. Conclusion In the children with constipation a higher prevalence of some emotional aspects was observed.

Estresse ocupacional e suas repercussões na qualidade de vida de médicos e enfermeiros intensivistas pediátricos e neonatais

OBJETIVO: Investigar as relacoes entre trabalho e qualidade de vida de medicos e enfermeiros em unidades de terapia intensiva pediatrica e neonatal. METODOS: Estudo transversal com 37 medicos e 20 enfermeiros. O Job Content Questionnarie (JCQ), Effort-Reward Imbalance (ERI) e World Health Organization Quality of Life (WHOQOL-100) foram utilizados. A correlacao foi estimada atraves do coeficiente de correlacao de Spearman. RESULTADOS: O esforco e inversamente correlacionado com os dominios: fisico, psicologico, nivel de independencia, meio ambiente (p<0,01) e relacao social (p<0,05). A recompensa e inversamente correlacionada com os dominios psicologico (p<0,05) e nivel de independencia (p<0,01). Controle sobre o trabalho e diretamente correlacionado com o dominio fisico (p<0,05). A demanda psicologica e inversamente correlacionada com os dominios fisico (p<0,05), psicologico (p<0,01) e nivel de independencia (p<0,05). A demanda fisica e inversamente correlacionada com os dominios fisico, nivel de independencia, meio ambiente (p<0,01) e psicologico (p<0,05) . Inseguranca no trabalho e inversamente correlacionada com os dominios psicologico, nivel de independencia (p<0,05) e meio ambiente (p<0,01). Suporte do supervisor e diretamente correlacionado com nivel de independencia (p<0,05). CONCLUSAO: Medicos e enfermeiros apresentaram altos esforcos, demandas psicologicas, fisicas e inseguranca no trabalho que repercutem na qualidade de vida.

Well-being and help-seeking: an exploratory study among final-year medical studentsBem-estar e busca de ajuda: um estudo exploratório entre alunos de Medicina ao final curso*

OBJECTIVE Doubts, competitiveness and preparation for the residency examination increase stress and insecurity at the end of medical course. Well-being is very important at this point, but it is known that medical students are reluctant to seek help, particularly for emotional problems. This study investigated the relationship among well-being, perceived needs and help-seeking in final-year students. METHODS Well-being was assessed using Becks Inventories of Anxiety (BAI) and Depression (BDI) and the WHOQOL-brief (quality of life). A questionnaire was used to assess perceived needs and medical school support resources. RESULTS The students reported good quality of life (68%) but presented anxiety (27%), depression (20%) and impaired social functioning. Fifty-one percent of the students acknowledged academic needs and 25% psychological needs. Only a portion of the students with anxiety and depression or bad quality of life used the institutional support. Female gender, perceived psychological needs and anxiety symptoms were associated to the use of the Mental Health Service. Satisfaction with mentoring relationships and positive changes were associated to Mentoring attendance. CONCLUSION There are different factors involved in help-seeking and identifying specificities in the use of institutional support resources can help to develop strategies to sensitize students about help-seeking during the medical course.

Common mental disorders and associated factors among final-year healthcare students

OBJECTIVE to assess the prevalence of common mental disorder (CMD) and to identify potential associated factors among medical, dental and nursing students. METHODS a cross-sectional study conducted in a public university in Northeast Brazil with 172 undergraduate students of the last three semesters of the medicine, dentistry and nursing courses, in February 2010, using the Self Reporting Questionnaire (SRQ-20) and a structured questionnaire developed by the authors. Logistic regression was performed for data analysis. RESULTS the prevalence of CMD was 33.7%. The courses presented no differences in CMD prevalence. The logistic regression analysis showed a strong association of the following variables with CMD: female (OR=4.34), lack of good expectations regarding the future (OR=5.83), course as not a source of pleasure (OR=7.52) and feeling emotionally tense (OR=11.23). CONCLUSION the high prevalence suggests that immediate preventive measures should be implemented, such as the setting up of psycho-pedagogic support services for students, and teacher development programs.

Clinical and Demographic Profile of Anesthesiologists Using Alcohol and Other Drugs under Treatment in a Pioneering Program in Brazil

BACKGROUND AND OBJECTIVES Anesthesiologists are the majority in impaired-physician programs that assist physicians who abuse psychoactive substances. The aim of this paper is to show a descriptive study about the clinical and sociodemographic profile of a sample of chemically dependent anesthesiologists treated in a reference program. In addition, the objective is to cite the psychiatric comorbities, the most frequently used drugs and the psychosocial and professional repercussions of substance abuse. METHOD A cross-sectional and prospective study was conducted, and a socio-occupational questionnaire and a structured interview were carried out to diagnose mental and psychoactive substance use disorders, according to the International Classification of Diseases (the ICD-10). The questionnaire and the structured interview were carried out by two skilled researchers. RESULTS Fifty-seven anesthesiologists were interviewed. Most of them were male (77.2%), and the mean age was 36.1 years (SD=8.5%). A high prevalence of abuse of opioid (59.6%), benzodiazepine (3.1%) and alcohol (35.1%) was observed. Opioid users sought treatment earlier than other substance users and usually they were under pressure from their colleagues and the Regional Council of Medicine. The incidence of drug abuse for self-medication was high in this subgroup. CONCLUSIONS Anesthesiologists may present a different profile concerning the risks of opioid use. Opioid abuse usually begins during medical residency or during the first years of clinical practice, which supports the hypothesis that addiction to opioids is an occupational issue among anesthesiologists.

Semiologia integrada: uma experiência curricular de aproximação antecipada e integrada à prática médica

An early clinical exposure program was developed with the aim of avoiding fragmentation and stereotyped behaviors during medical training. Second-year medical students received an introductory course on Integrated Basic Clinical Skills (BCS), which included hospital rounds followed by case discussions led jointly by faculty members from medical psychology and various clinical areas (internal medicine, pediatrics, obstetrics, gynecology, and geriatrics). Special care was taken to provide a model in which medical students could learn about biological, psychological, and social aspects of illness within the same format. The article discusses the objectives, logistics, and staff of the course, based on the experience at the Federal University in Sao Paulo. The model offers an integrated model for both students and faculty. Further studies are necessary to evaluate these preliminary findings.

Validation of the Brazilian version of Chronic Liver Disease Questionnaire.

PurposeThe aim of this study was to validate the Chronic Liver Disease Questionnaire (CLDQ) for use in Brazilian population.MethodA total of 200 patients with chronic liver disease and varying disease severity answered a socio-demographic questionnaire, t CLDQ, and the Medical Outcome Study Short Form 36 (SF-36). Patients returned in 1–15 days to answer CLDQ again. The Cronbach’s alpha of the total CLDQ score was 0.95 and fluctuated between 0.69 and 0.83 in its six domains.ResultsThe intra-class correlation between total CLDQ scores in two evaluations was 0.97 and in all domains was >0.93. CLDQ was moderately correlated with the SF-36, 0.63 (total CLDQ vs. vitality, SF-36), 0.62 (CLDQ and mental health, SF-36), 0.62 (preoccupation, CLDQ, vs. General Health, SF-36), 0.59 (fatigue, CLDQ, vs. vitality, SF-36), 0.59 (activity, CLDQ, vs. vitality, SF-36), and 0.59 (fatigue, CLDQ, vs. mental health, SF-36). The highest scores were found in non-cirrhotic group. Child A patients had higher average scores than Child B and C groups in all domains, while patients with MELD <15 scored higher than patients with MELD ≥15.ConclusionCLDQ-BR was validated in Brazilian population and was appropriate for use in patients with liver disease of different etiologies and degrees of severity.