Prevalência e fatores de risco para transtornos mentais comuns entre estudantes de medicinaPrevalence and risk factors of common mental disorders among medical students RESUMO OBJETIVO: Estimar a prevalência de transtornos mentais comuns entre estudantes de medicina e respectivos fatores de risco. MÉTODOS:Estudo transversal realizado com 551 universitários de um curso de medicina de Botucatu, SP. Utilizou-se questionário auto-aplicável investigando aspectos sócio demográficos, relacionados ao curso e o Self Reporting Questionnaire. Para análise dos dados empregaram-se os testes de qui-quadrado e regressão logística. RESULTADOS:Participaram 82,6% dos alunos matriculados no curso, predominando mulheres (61%), jovens (60% 20-23 anos), procedentes de outros municípios (99%). A prevalência de transtornos mentais comuns foi de 44,7% associando-se independentemente a: dificuldade para fazer amigos (RC=2,0), avaliação ruim sobre desempenho escolar (RC=1,7), pensar em abandonar o curso (RC=5,0), não receber o apoio emocional de que necessita (RC=4,6). Embora na primeira análise a prevalência tenha se mostrado associada ao ano do curso, esta associação não se manteve na análise multivariada. CONCLUSÕES:A prevalência de transtornos mentais comuns mostrou-se elevada entre os estudantes de medicina, associando-se a variáveis relacionadas à rede de apoio. As experiências emocionalmente tensas como o contato com pacientes graves, formação de grupos, entre outras, vividas nos últimos anos do curso, são provavelmente potentes estressores, especialmente para sujeitos com uma rede de apoio considerada deficiente. Sugere-se que instituições formadoras estejam atentas a esse fato, estabelecendo intervenções voltadas ao acolhimento e ao cuidado com o sofrimento dos estudantes. ABSTRACT OBJECTIVE: To estimate the prevalence and assess risk factors of common mental disorders among medical students. METHODS:A cross-sectional study was carried out comprising 551 university medical students in the state of São Paulo, Southeastern Brazil. A self-administered questionnaire to collect sociodemographic and course-related data as well as the Self- Reporting Questionnaire were used. Both Chi-square test and logistic regression were used in data analyses. Maria Cristina Pereira Lima Mariana de Souza Domingues Ana Teresa de Abreu Ramos Cerqueira RESULTS:A total of 82.6% of the students enrolled in the course participated in the study. Most of them were women (61%), 60% aged between 20 and 23 years, and 99% were from other cities. The prevalence of common mental disorders was 44.7% and they were independently associated with: difficulty in making friends (OR=2.0), poor self-evaluation of academic performance (OR=1.7), thoughts of dropping out of the medical course (OR=5.0) and perceived lack of emotional support (OR=4.6). Although prevalence of these disorders was associated with the course period in the first analysis, this association was not maintained in the multivariate analysis. CONCLUSIONS:The prevalence of common mental disorders was shown...

OBJECTIVE:To evaluate the infl uence of socioeconomic conditions on the association between common mental disorders and the use of health services and psychoactive drugs. METHODS:This was a population-based cross-sectional study conducted in the city of Botucatu, Southeastern Brazil. The sample was probabilistic, stratifi ed and cluster-based. Interviews with 1,023 subjects aged 15 years or over were held in their homes between 2001 and 2002. Common mental disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20). The use of services was investigated in relation to the fortnight preceding the interview and the use of psychotropic drugs, over the preceding three days. Logistic regression was used for multivariable analysis, and the design effect was taken into consideration. RESULTS:Out of the whole sample, 13.4% (95% CI: 10.7;16.0) had sought health services over the fortnight preceding the interview. Seeking health services was associated with female gender (OR=2.0) and the presence of common mental disorders (OR=2.2). 13.3% of the sample (95% CI: 9.2;17.5) said they had used at least one psychotropic drug, especially antidepressives (5.0%) and benzodiazepines (3.1%). In the multivariable analysis, female gender and the presence of common mental disorders remained associated with the use of benzodiazepines. Per capita income presented a direct and independent association with the use of psychoactive drugs: the greater the income, the greater the use of these drugs was. CONCLUSIONS:Lower income was associated with the presence of common mental disorders, but not with the use of psychotropic drugs. The association of common mental disorders and the use of psychotropic drugs in relation to higher income strengthens the hypothesis that inequality of access to medical services exists among this population.

O artigo discute a constituição da identidade do médico tendo como pontos de partida sua escolha e formação profissionais. A partir da experiência das autoras no ensino médico, em especial na disciplina de Psicologia Médica, e da literatura na área são enfocadas: a idealização do papel do médico, as motivações conscientes e inconscientes na opção profissional, as dificuldades dos primeiros anos na escola médica, o início das atividades didáticas no hospital e os mecanismos psicológicos defensivos acionados no contato com pacientes. É muito importante que as Escolas Médicas e seus professores tenham conhecimento desses aspectos, devendo preocupar-se não apenas com questões curriculares e pedagógicas, mas também com o modelo de relação professor-aluno, considerando o seu papel fundamental na formação da identidade médica.

The objective was to determine the prevalence of self-reported hearing loss in four urban areas in São Paulo State, Brazil, and to describe the causes and socio-demographic variables. This was a population-based cross-sectional study with data on individuals 12 years or older living in the areas in 2001 and 2002. Participation included 5,250 subjects selected by two-stage probability sampling, stratified in clusters. Data analysis was exploratory, including bivariate and multiple logistic regression analysis. Prevalence of hearing loss was 5.21%, and higher levels were associated with: age > 59 years (18.7%), illness in the 15 days prior to the interview (8.4%), common mental disorders (8.8%), and use of medication in the previous 3 days (8.4%). The study of factors associated with hearing loss can lead to health interventions for addressing that the population's real needs, mostly in primary care. More population-based studies on hearing are needed in Brazil, since there are few publications on the subject.

BackgroundEthyl carbamate (EC) is a multi-site carcinogen in experimental animals and probably carcinogenic to humans (IARC group 2A). Traces of EC below health-relevant ranges naturally occur in several fermented foods and beverages, while higher concentrations above 1 mg/l are regularly detected in only certain spirits derived from cyanogenic plants. In Brazil this concerns the sugarcane spirit cachaça and the manioc (cassava) spirit tiquira, which both regularly exceed the national EC limit of 0.15 mg/l. This study aims to estimate human exposure in Brazil and provide a quantitative risk assessment.MethodsThe human dietary intake of EC via alcoholic beverages was estimated based on WHO alcohol consumption data in combination with own surveys and literature data. This data comprises the EC contents of the different beverage groups cachaça, tiquira, other spirits, beer, wine, and unrecorded alcohol (as defined by the WHO; including alcohol which is not captured in routine government statistics nor taxed). The risk assessment was conducted using the margin of exposure (MOE) approach with benchmark doses obtained from dose-response modelling of animal experiments. Lifetime cancer risk was calculated using the T25 dose descriptor.ResultsConsidering differences between pot-still and column-still cachaça, its average EC content would be 0.38 mg/l. Tiquira contained a considerably higher average EC content of 2.34 mg/l. The whole population exposure from all alcoholic beverages was calculated to be around 100 to 200 ng/kg bw/day, with cachaça and unrecorded alcohol as the major contributing factors. The MOE was calculated to range between 400 and 2,466, with the lifetime cancer risk at approximately 3 cases in 10,000. An even higher risk may exist for binge-drinkers of cachaça and tiquira with MOEs of up to 80 and 15, respectively.ConclusionsAccording to our risk assessment, EC poses a significant cancer risk for the alcohol-drinking population in Brazil, in addition to that of alcohol alone. Model calculations show that the implementation of the 0.15 mg/l limit for cachaça would be beneficial, including an increase of the MOE by a factor between 3 to 6. The implementation of policy measures for tiquira and unrecorded alcohol also appears to be advisable.

Among medical doctors graduated from São Paulo State University, PH and MH were inseparable aspects, which were also related to the self-evaluation of QoL. Good habits, such as regular practice of physical exercise, enough leisure time, and not smoking were associated with positive health in general and should be encouraged. Professional satisfaction had an important impact on the emotional well-being of participants.

There has been a considerable increase in the number of academic leagues active within undergraduate medical courses in Brazil over the last few years. However, this phenomenon has not been accompanied by adequate reflection on its determinants, on the role of the leagues within the institutions or even on their pedagogical function. From these observations, the authors analyze the scant literature on this topic, describe the experience of the academic leagues of Botucatu Medical School, Unesp, and reflect on the role of these leagues in medical training, in an attempt to partially fill this gap and contribute towards this important discussion.Key words: Academic leagues. Medical education. Extracurricular activities. RESUMONos últimos anos tem havido um considerável aumento do número de ligas acadêmicas atuantes nos cursos de graduação em medicina no Brasil. Esse fenômeno, no entanto, não vem sendo acompanhado de adequada reflexão sobre seus determinantes, o papel das ligas dentro das instituições, ou mesmo sua função pedagógica. A partir destas constatações, os autores analisam a precária literatura sobre o tema, descrevem a experiência das ligas acadêmicas da Faculdade de Medicina de Botucatu -Unesp e refletem a respeito do papel destas na formação médica, na tentativa de suprir um pouco dessa lacuna e contribuir para esta importante discussão.Palavras-chave: Ligas acadêmicas. Educação médica. Atividades extracurriculares. RESUMENEn los últimos años ha habido un considerable aumento del número de ligas académicas actuantes en los cursos de graduación en medicina en Brasil. Este fenómeno, no obstante, no está siendo acompañado de adecuada reflexión sobre sus determinantes, el papel de las ligas dentro de las instituciones o incluso su función pedagógica. A partir de tales constataciones, los autores analizan la precaria literatura sobre el tema, describen la experiencia de las ligas académicas de la Facultad de Medicina de Botucatu, de la Universidad del estado de São Paulo, Brasil y reflexionan sobre el papel de las ligas en la formación médica: en la tentativa de suplir un poco este vacío y contribuir para tan importante discusión.Palabras clave: Ligas acadêmicas. Educación médica. Actividades extracurriculares.

AbstrAct:Introduction: Different kinds of psychological distress have been identified for students in the health field, especially in the medical school. Objective: To estimate the prevalence of mental suffering among medical students in the Southeastern Brazil and asses its association with social support. Methods: It is a cross-sectional study. Structured questionnaires were applied for students from the 1 st up to the 6 th years of the medical school of Universidade Estadual Paulista "Júlio de Mesquita Filho", assessing demographic variables related to aspects of graduation and adaptation to the city. Psychological suffering was defined as a common mental disorder (CMD) assessed by the Self Reporting Questionnaire (SRQ-20). Social support was assessed by the social support scale of the Medical Outcomes Study (MOS). The association between the outcome and explanatory variables was assessed by the χ 2 test and Logistic Regression, for the multivariate analyses, using p ≤ 0.05. Results: The response rate was of 80.7%, with no differences between sample and the population regarding gender (p = 0.78). The average age was 22 years old (standard deviation -SD = 2.2), mainly women (58.2%) and students who were living with friends (62%). The prevalence of CMD was 44.9% (95%CI 40.2 -49.6). After the multivariate analyses, the explanatory variables that were associated with CMD were: feeling rejected in the past year (p < 0.001), thinking about leaving medical school (p < 0.001) and "interaction" in the MOS scale (p = 0.002). Conclusions: The prevalence of CMD among medical students was high and insufficient social support was an important risk factor. Our findings suggest that interventions to improve social interaction among those students could be beneficial, decreasing the prevalence of CMD in this group.