ARTICULO ORIGINALREVISTA DE LA FACULTAD DE MEDICINA HUMANA 2021 - Universidad Ricardo Palma
1 Universidad Adventista de Chile
Objective: To analyze the relationship of lifestyle and habits associated with health care and religiosity in Chilean Adventist medical students during the COVID-19 pandemic. Methods: Analytical and cross-sectional, census, non-experimental design. The population consisted of 72 Adventist medical students who attended or are in any year of the career in 2020 and 2021. The FANTASTIC instrument was applied, in its validated version, and an evaluation of habits associated with health care and religiosity. The work was approved by an ethics committee. Results: 55.6% are female. The mean age is 22.64. 43.1% of the students have some type of diet associated with vegetarianism. Tobacco use was not evidenced. 66.7% study the Bible and pray always or almost always. 77.8% of the students have a very good or fantastic lifestyle. When performing the Spearman correlation between the variable habits associated with health care and religiosity versus the total score of the FANTASTICO instrument, a statistically significant relationship is presented at the 0.01 level (p <0.00 r=0.48). Conclusions: Although some habits can be improved, in general most of the students have a very good lifestyle. It is appreciated that the scores of habits associated with health care and religiosity have a positive relationship with the scores obtained in the fantastic instrument.
Keywords: Life Style, Students, Medicine, Religion (fuente: MeSH NLM).
Objetivo: Determinar la correlación el estilo de vida y hábitos asociados al cuidado de la salud y religiosidad en estudiantes adventistas de medicina chilenos durante la pandemia por COVID-19. Métodos: Diseño de tipo analítico y de corte transversal, censal, no experimental. La población estuvo compuesta por 72 estudiantes de medicina de religión adventista que cursaron o cursan cualquier año de la carrera en 2020 y 2021. Se aplicó el instrumento FANTASTICO, en su versión validada y una evaluación de hábitos asociados al cuidado de la salud y religiosidad. El trabajo fue aprobado por un comité ético. Resultados: Un 55,6% son de sexo femenino. La edad media es de 22,64. Un 43,1% de los estudiantes tiene algún tipo de alimentación asociada al vegetarianismo. No se evidenció consumo de tabaco. Un 66,7% estudia la Biblia y ora siempre o casi siempre. Un 77,8% de los estudiantes tiene un estilo de vida muy bueno o fantástico. Al realizar la correlación de Spearman entre la variable hábitos asociados al cuidado de la salud y religiosidad versus el puntaje total del instrumento FANTASTICO, se presenta una relación estadísticamente significativa en el nivel 0,01 (p <0,00 r=0,48). Conclusiones: A pesar de que algunos hábitos pueden ser mejorables, en general la mayoría de los estudiantes tiene un muy buen estilo de vida. Se aprecia que los puntajes de hábitos asociados al cuidado de la salud y religiosidad tienen relación positiva con los puntajes obtenidos en el instrumento FANTASTICO.
Palabras Clave: Estilo de vida, Estudiantes, Medicina, Creencias Religiosas(fuente: DeCS BIREME).
Lifestyle changes that are created from entry to permanence in the university impact the health of students. These changes are on a physical as well as mental level and have direct incidence in academic and social performance of young people (1). After years of experimenting an intensive coursework in different subject areas, physical as well as cognitive demands tend to negatively impact the health habits of students of demanding career such as medicine. This process may result in acquiring risk factors that affect health in the short, medium and long-term (2).
Regarding this, diverse studies evidence that health risk factors present in medical students, among which are (3,4), sedentary habits, overweight/obesity, dyslipidemia, tobacco or alcohol consumption, bad eating habits with low vegetable, fruit and water intake, high intake of red meat, fried foods, and sweets, and other alterations such as anxiety (5).
On the other hand, diverse scientific studies present religiosity as a protective health factor, especially when this is guided towards health management from an early age. This is directly connected with: prevention of chronic diseases(6), lower prevalence of drug and alcohol consumption(7), and well-being associated to a meaning and purpose in life(8).
Considering the aforementioned, in the context of professional training of young Adventisits, this concept is reinforced before the focus of Prohealth Reform(9), a reform that includes the progressive incorporation of a healthy lifestyle, guiding people to have better practices of eating, hydration, daily and weekly rest, stress control and management of emotions, physical activity, abstaining from alcohol, drug and tobacco use, and faith in God (9). All the knowledge that a medical student has associated with behavioral support by their religious community attenuates the negative effects on health derived from personal, family, social and academic demands of daily life (10,11). In this sense, the objective of this research is to analyze lifestyle and habits associated with health care and religiosity in Chilean Adventist medical students during the COVID-19 pandemic.
MATERIALS AND METHODSY
Design and area of study
Analytical and cross-sectional, census, non-experimental design was used and developed in virtual mode for Chilean medical students that carried out their academic work in diverse countries of Latin America, belonging to a contact Adventist religious group, constituted beforehand.
Population and sample
The population was comprised of 100 students that from a contact group, of which only 72 responded to the survey. Among the eligibility criteria, the inclusion criteria were to be an Adventist medical student that are in or had been in any year of the career during the last trimester of the year 2020 and 2021 of public and private universities and that they study in Chile, Argentina, or Bolivia. Students from other careers and other nationalities were excluded. All participants of the group met the selection criteria.
Variables and instrument
The sociodemographic variables were studied, such as lifestyle, age, sex, marital status, year in the career during the period 2020-2021, religiosity, dietary program, anthropometry, general health assessment before and during the pandemic. Anthropometry, from which Body Mass Index (BMI) was calculated, was self-reported. General health assessment before and during the pandemic was asked only once, at the time of making the survey for this study.
We used the FANTASTIC instrument to measure lifestyle, in its version validated in Spanish(12). This instrument was also used by the Health Ministry of Chile(13). This includes the evaluation of lifestyle during the last month through the following sections: family and friends, associativity and physical activity, nutrition, toxicity, alcohol, sleep and stress, personality type and activity, inner image, health control and sexuality and other drugs. It had 26 questions; each answer had a score of 0 to 2. The score obtained was multiplied by 2 and the final score was obtained. The categories are from 103 to 120 points, congratulations, you have a Fantastic lifestyle; from 85 to 102, good job, you are in the right path; from 73 to 84, adequate, you are well; from 47to 72, somewhat low, you could improve, and from 0 to 46 you are in the danger zone.
Regarding the evaluation of habits associated to health care and religiosity, this was a variable created by authors based on habits that the normally perform and are recommended by members of the Seventh Day Adventist Church to maintain good health, based on habitual practices and in the precepts dictated by this church. In the survey 12 items were included which were evaluated by expert judgment. In order to evaluate the frequency of fulfillment of these habits in the population studied, we evaluated if these are performed Always = 5 points, almost always = 4 points, sometimes = 3 points, almost never = 2 points, Never = 1 point. The score of items 5 and 6 were inverted. The minimum score that could be obtained was 12 points and maximum 60 points. Considering the highest value as the most related to habits associated to health care and religiosity.
Data collection was carried out during the month of April in 2021. For the collection of these, an online questionnaire was applied through the Google Forms platform, through a link sent out to participants through WhatsApp within the group of students that met the selection criteria, which were all. Likewise, we explained to the participants the importance of completing it with the objective to study the obtained results and its later publication.
After data collection, these will be later entered into the data base of the Microsoft Excel 2010 program. The qualitative variables Will be presented as frequencies and percentages and for the quantitative variables mean and standard deviation. The correlation between the scales was carried out using Spearman’s test, considering a p-value statistically significant if it is below 5%.
The work was based on the ethical principles that include the non-maleficence, respect for life and privacy of people. In this sense, this research was evaluated by the ethical-scientific committee of Universidad Adventista de Chile. The data collection included an informed consent. The data confidentiality was maintained at all times.
The following are the results of the population of 72 Chilean Adventist medical students. 55,6% are of feminine sex. The average age is 22.64. Regarding marital status, 93.1% are single, while 6.9% married. The mean of the registered weight was 66 kg, the mean of the height was 1.67 meters, and the mean of BMI was 23.4. Low weight was present in 6.9%, Normal weight in 59.7%, Overweight 25% and Obesity in 8.3%. 100% of the population identifies themselves as Seventh Day Adventist; 90.3% se considers themselves as practicing faithful and 9.7% as non-practicing faithful. 43,1% of students had some type of nutrition associated to vegetarianism.
Table 1. Distribution of the year of the career and type of diet in Chilean Adventist medical students. 2021
|Year of study of career||First||10||13,9|
|Seventh year or recently graduated||12||16,7|
|Type of diet||Omnivorous||28||38,9|
|Consumes white meat (chicken and fish)||10||13,9|
|Ovo-lacto-pescatarian (includes consumption of fish and seafood)||3||4,2|
|Strict Vegetarian (no consumption of derived meat, dairy, and eggs)||1||1,4|
Table 2. Habits associated with health care and religiosity, in Chilean Adventist medical students.2021
|Habits associated with health care and religiosity||Always||Almost always||Sometimes||Almost never||Never|
|1. Studies the Bible and prays to God||29||40,3%||19||26,4%||19||26,4%||5||6,9%||0||0,0%|
|2. Sleeps between 7 to 8 hours per day||9||12,5%||31||43,1%||18||25,0%||11||15,3%||3||4,2%|
|3. You eat a healthy breakfast||16||22,2%||38||52,8%||6||8,3%||11||15,3%||1||1,4%|
|4. You have schedules for regular eating||20||27,8%||33||45,8%||11||15,3%||8||11,1%||0||0,0%|
|5. Eating between meals||9||12,5%||7||9,7%||31||43,1%||21||29,2%||4||5,6%|
|6. Eating desserts, cakes, pies, etc.||0||0,0%||13||18,1%||37||51,4%||19||26,4%||3||4,2%|
|7. Drinking approximately 2 Liters of water per day||10||13,9%||20||27,8%||22||30,6%||18||25,0%||2||2,8%|
|8. Exposing yourself to solar light 15 min every day||10||13,9%||20||27,8%||20||27,8%||15||20,8%||7||9,7%|
|9. Adequately ventilating your place of study||42||58,3%||24||33,3%||1||1,4%||5||6,9%||0||0,0%|
|10. Perform programmed physical activity||12||16,7%||16||22,2%||24||33,3%||13||18,1%||7||9,7%|
|11. Participates in religious activity during the week||23||31,9%||23||31,9%||13||18,1%||13||18,1%||0||0,0%|
|12. Administering your income respecting what corresponds to God||37||51,4%||13||18,1%||15||20,8%||6||8,3%||1||1,4%|
Regarding the variables habits associated with health care and religiosity, a result was calculated to evaluate those that mostly met the habits mentioned. On this variable the minimum score obtained was 31 points and the maximum 54 points. The mean obtained for students was 43,25+5,39
The following are the data on the FANTASTIC questionnaire. We have grouped the questions to present the results in a more organized manner.
Table 3.FANTASTIC questionnaire items in Chilean Adventist medical students. 2021
|Almost never||Sometimes||Almost always|
|I have someone to talk to about the things that are important to me||3||4,2%||9||12,5%||60||83,3%|
|I give and receive love||2||2,8%||12||16,7%||58||80,6%|
|I am an active participant of a support group for my health and quality of life (self-help organizations, groups on chronic illness, sports, religious, women, senior adults, neighborhoods, and others).||20||27,8%||12||16,7%||40||55,6%|
|I walk at least 30 minutes daily||26||36,1%||31||43,1%||15||20,8%|
|I sleep well and feel rested||13||18,1%||31||43,1%||28||38,9%|
|I feel capable of managing stress or tension in my life||7||9,7%||33||45,8%||32||44,4%|
|I relax and enjoy my free time||4||5,6%||25||34,7%||43||59,7%|
|I feel happy with my work and activities||3||4,2%||26||36,1%||43||59,7%|
|I am a positive and optimistic thinker||3||4,2%||24||33,3%||45||62,5%|
|In my sexual conduct I worry about self care and about the care of my partner.||3||4,2%||3||4,2%||66||91,7%|
|I have more than 4 drinks on one occasion||0||0,0%||1||1,4%||71||98,6%|
|I drive after drinking alcohol||0||0,0%||0||0,0%||72||100,0%|
|I use drugs such as marijuana, cocaine, or base paste||0||0,0%||1||1,4%||71||98,6%|
|I use the medications indicated or those that I can buy without a prescription excessively||0||0,0%||1||1,4%||71||98,6%|
|It seems like I’m accelerated||9||12,5%||43||59,7%||20||27,8%|
|I feel angry or aggressive||5||6,9%||26||36,1%||41||56,9%|
|I feel tense or tight||15||20,8%||39||54,2%||18||25,0%|
|I feel depressed or sad||16||22,2%||30||41,7%||26||36,1%|
|I undergo health check-ups periodically||38||52,8%||23||31,9%||11||15,3%|
|I talk to my partner or family about sexuality topics||26||36,1%||29||40,3%||17||23,6%|
|As a pedestrian, public transport Passenger, and/or driver, I am respectful of transit laws.||1||1,4%||4||5,6%||67||93,1%|
|I use a safety belt||1||1,4%||5||6,9%||66||91,7%|
Regarding other questions from the FANTASTIC questionnaire, 56.9% revealed they perform physical activity during 30 min at least 3 times per week. 62,5% of students surveyed confirmed they ate 2 portions of vegetables and 3 of fruits sometimes. When they were asked about abundant sugar, salt, fast food, or high fat consumption, 48,6% of students responded that they often consumed some of these. In the question about how many cigarettes they smoked per day, 100% of students declared not currently smoking cigarettes. While in the question regarding alcohol consumption, 100% of students consumed from 0 to 7 drinks a week. Caffeinated drinks are consumed in 90.3% of students less than 3 times per day.
Intable 3, we can evidence the total score of the FANTASTIC questionnaire and highlight that 77.8% of students obtained a good or fantastic result.
Table 3. Cross table for the variables in Evaluation on the FANTASTIC instrument according to sex in Chilean Adventist medical students, 2021
|Danger zone (from 0 to 46 points)||Count||0||1||1|
|% within Sex||0,0%||3,1%||1,4%|
|Low score, could improve (from 47 to 72 points)||Count||1||1||2|
|% within Sex||2,5%||3,1%||2,8%|
|Adequate (from 73 to 84 points)||Count||7||6||13|
|% within Sex||17,5%||18,8%||18,1%|
|Very good (82 to 102 points)||Count||24||20||44|
|% within Sex||60,0%||62,5%||61,1%|
|Fantastic lifestyle (> 103 points)||Count||8||4||12|
|% within Sex||20,0%||12,5%||16,7%|
|% within Sex||100,0%||100,0%||100,0%|
Upon carrying out the Spearman correlation between the variable habits associated with health care and religiosity versus total score of the FANTASTIC instrument, a statistically significant relationship was presented (p<0,00 r=0,48). This relationship can be observed in figure 2.
The total population identifies as Adventist and uphold with their identity a system of beliefs where healthcare is of great relevance. This population is made up mostly of young adult women, an age characterized for establishing habits and Independence that later affects their health in adult life. In this study we observe that students have a BMI within normal limits, which indicates that they have sustained good habits from their childhood and adolescence, furthermore it is notable that students present lower percentages of obesity compared to other studies of similar populations of medical students(4).
Regarding the relationship between habits associated with healthcare and religiosity and lifestyle, the results are similar to those found by Ramos Sens et al(14). In which they also found a positive correlation between lifestyle and the level of religiosity in physicians. On the other hand, there are studies that reveal that the Adventist population have les incidence of chronic diseases related to, among other factors, a healthy lifestyle, such as cancer(15). This leads us to believe that the Adventist medical student’s good lifestyle may be due to their level of adhesion to the precepts of the Seventh Day Adventist Church.
It is important to mention that almost half of the population have a nutrition style linked to vegetarianism. This, according to studies performed in various population groups, is linked to a lower prevalence of chronic diseases, greater life expectancy, and greater quality of life (16). At the same time this contrasts with other studies carried out in similar populations as the one studied, where their nutrition is high in red meats, and low in fruit and vegetable consumption, and leads to diverse metabolic disorders in the long and short term (2).
Regarding how the studied population perceived health, we observed a decrease in assessment on general health post pandemic, which is coherent with studies of similar populations, where factors such as quarantine(17), distance learning, and including difficulties in financing studies, has negatively affected their quality of life (18).
Regarding religiosity, two-thirds of students maintain always or almost always bible study and prayer habits. According to some research Works, these habits are related to decrease in stress, anxiety, depression(19), and prevention of chronic disease (6,20). The same percentage of students manifested that they always or almost always participate in religious activities during the week, where we expect the students to receive support, acceptance, and affection, which will give them a sense of belonging and help them have a better quality of life(21).
Among the healthy habits, three fourths of those surveyed always or almost always eat a healthy breakfast and have regular eating hours. This differs from other studies where medical students have irregular eating schedules and do not regularly have breakfast(22). Among unhealthy habits, half of students sometimes eat foods high in carbohydrates and 43.1% sometimes eat between meals, with regards to all of the aforementioned, these habits that are moderately present in the population, are related with obesity and diabetes(23).
Regarding the FANTASTIC questionnaire, in the questions about family and Friends, we found very positive behaviors associated to family, friends and couple interactions. The activities related to this interaction, as well as belonging to support groups, not only favor mental health in those that practice them, but also social inclusion and hope for life(24).
On the other hand, alcohol and drug use, the total number of students surveyed marked the minimum alcohol consumption of the week, as well as drinking under the influence of alcohol. Likewise, almost the total of those surveyed refereed being respectful to transit laws and using their safety belt, which could decrease death by vehicle accidents that are frequent during the second and third decades of life(25). It is notable that the total number of students manifested not currently smoking cigarettes, which contrasts with other studies where we find a prevalence of tobacco use in medical students between 20%(2) and 33.5%(3). Furthermore, almost the total of those surveyed revealed that they don’t consume drugs, nor use medications excessively, nor consumption of caffeinated drinks. As we had previously commented, we consider that religiosity prevents these conducts in the young population and differs from other studies where abundant use of coffee is demonstrated(26).
Regarding sleep and stress, we evidenced that only 38.9% refer they sleep well and feel rested almost always. This element is of vital importance in lifestyle given that it is known to be favorable factors in physical and psychological health, which influence concentration, mood, and physical and intellectual endurance(27).
The questions regarding introspection reveal that two thirds of students consider themselves positive and optimistic thinkers almost always, this quality has been researched that is associated with a better perception of general health(28). Despite the aforementioned, they report that more than half of the time they are tense and accelerated, and over 40% feel depressed or sad sometimes, despite having generally good habits and the majority manifested having emotional support from their family and Friends. This could be due to the highly demanding medical career and ends up being an estrogenic factor for the students, as has been documented in other studies(29), in addition the stress that the COVID-19 pandemic generated on students and health professionals.
Regarding the final results it is important to emphasize that, despite that medical students have to face diverse demands in their family, university, or health context regarding quarantine due to COVID-19, more than three fourths of those surveyed possess a very good or fantastic lifestyle, which contrasts with other studies on university students in health fields(30), but the difference is more evident when compared to the result obtained by medical specialty residents(31). When the final result is compared between men and women, we observed that women have a slightly better proportion than men, a result that is similar from other studies.
Among the study limitations was the self-informed questionnaire, which runs the risk of response bias since we rely on the sincerity and good memory of the participants. In order to improve this, we collected the data anonymously. On the other hand, we did not count on a representative sample from the countries studied or of the Chilean students, but it is one of the few studies carried out on Adventist medical students, which provides important information. We suggest that in future research Works, the population studied can be expanded to more students of other nationalities and careers, therefore, we can delve into the issues that later may be intervened in a manner that positively affects the health of medical students, ensuring a work of early health care of this population.
When we analyze these results, we see that there are aspects that could be improved in order for the surveyed university students to maintain a healthy lifestyle. But considering the health status of other similar populations, it is possible to say that Chilean Adventist medical students have a good lifestyle in general, these aspects of lifestyle are linked with their identity as part of a religion oriented to caring for their health, which creates healthy habits from an early age and that maintains throughout time.
Furthermore, this work evidences that the habits associated with health care and religiosity present in the studied population have a positive relationship with the FANTASTIC instrument score. This shows that being part of a religious community oriented to maintaining health, has a positive effect on the university population who is exposed to multiple risk factors linked to the deterioration of physical and mental health.mental.
Authorship contributions: The authors participated in the idea genesis, project design, data collection and interpretation, results analysis, and manuscript preparation of this research work.
Funding sources: Self-financing.
Conflicts of interest: The authors declare not having any conflicts of interest regarding the. performance and drafting of this research work.
Received: 16 of August 2021
Approved: 11 of November 2021
Correspondence: Ana Belén Cáceres Codoceo.
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