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.\ud \ud \ud Methods\ud 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.\ud \ud \ud Results\ud 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.\ud \ud \ud Conclusion\ud 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

Violência contra mulheres entre usuárias de serviços públicos de saúde da Grande São Paulo

OBJECTIVE: To estimate the prevalence of (physical, psychological, and sexual) violence against women by an intimate partner and non-partner perpetrators among users of public health services and to compare these women's perception of having ever experienced violence with reports of violence in their medical records in the different services studied. METHODS: The study was conducted in 19 health services, selected as a convenience sample and grouped into nine research sites, in metropolitan area of São Paulo from 2001 to 2002. Questionnaires on having ever experienced violence in their lifetime and in the last 12 months and perpetrators were applied to a sample of 3,193 users aged 15 to 49. A total of 3,051 medical records were reviewed to verify the notification of violence. Comparative analyses were performed by Anova with multiple comparisons and Chi-square test followed by its partition. RESULTS: The following prevalences were found: any type of violence 76% (95% CI: 74.2;77.8); psychological 68.9% (95% CI: 66.4;71.4); physical 49.6% (95% CI: 47.7;51.4); physical and/or sexual 54.8% (95% CI: 53.1;56.6), and sexual 26% (95% CI: 24.4;28.0). The prevalence of physical and/or sexual violence by an intimate partner in their lifetime was 45.3% (95% CI: 43.5;47.1), and by non-partners was 25.7% (95% CI: 25.0;26.5). Only 39.1% of women reporting any episode of violence perceived they had ever experienced violence in their lifetime and 3.8% of them had any reports of violence in their medical records. The prevalences were significantly different between sites as well as the proportion of perception and reports of violence in medical records. CONCLUSIONS: The expected high magnitude of the event and its invisibility was confirmed by low rate of reports in the medical records. Few perceived abuses as violence. Further studies are recommended taking into account the diversity of service users.OBJETIVO: Estimar a prevalência de violência contra mulheres (física, psicológica e sexual), por parceiro íntimo ou outro agressor, entre usuárias de serviços públicos de saúde e contrastá-la com a percepção de ter sofrido violência e com o registro das ocorrências nos serviços estudados. MÉTODOS: Estudo realizado em 19 serviços de saúde, selecionados por conveniência e agrupados em nove sítios de pesquisa na Grande São Paulo, entre 2001-2002. Questionários sobre violência sofrida alguma vez na vida, no último ano e agressor foram aplicados à amostra de 3.193 usuárias de 15 a 49 anos. Foram examinados 3.051 prontuários dessas mulheres para verificação do registro dos casos de violência. Realizaram-se análises comparativas pelos testes Anova, com comparações múltiplas e qui-quadrado, seguido de sua partição. RESULTADOS: As prevalências observadas foram: qualquer violência 76% (IC 95%: 74,2;77,8); psicológica 68,9% (IC 95%: 66,4;71,4); física 49,6% (IC 95%: 47,7;51,4); física e/ou sexual 54,8% (IC 95%: 53,1;56,6) e sexual 26% (IC 95%: 24,4;28,0). A violência física e/ou sexual por parceiro íntimo na vida foi de 45,3% (IC 95%: 43,5;47,1) e por outros que não o parceiro foi de 25,7% (IC 95%: 25,0;26,5). Apenas 39,1% das que relataram qualquer episódio consideraram ter vivido violência na vida, observando-se registro em 3,8% dos prontuários. As prevalências diferiram entre os sítios de pesquisa, bem como a percepção e registro das violências. CONCLUSÕES: A esperada alta magnitude do evento e sua invisibilidade foram confirmadas pelas baixas taxas de registro em prontuário. Constatou-se ser baixa a percepção das situações vividas como violência. Sugerem-se estudos ulteriores que avaliem a heterogeneidade das usuárias dos serviços

A violência contra mulheres: demandas espontâneas e busca ativa em unidade básica de saúde

Acolher demandas e assistir mulheres que sofrem violência é parte dos direitos em saúde, embora a assistência não esteja estruturada e ocorra pouca detecção de casos. Buscou-se um diagnóstico de situação em serviços, avaliando-se a emergência de demandas referidas à violência por parte das usuárias de uma unidade básica da rede pública, contrastando-se a demanda espontânea com a busca ativa de casos. Realizou-se 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 observou-se 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. Então, 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

Violência contra as mulheres e políticas de saúde no Brasil: o que podem fazer os serviços de saúde?

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