Medical School’s Toll on the Health of Students

By Yesha Shukla

Published 4:20 EST, Sunday, December 12th, 2021

Introduction

Medical students have been known to possess one of the highest levels of stress when compared to those of other professions. This stress can lead to damaging repercussions such as impaired sleeping, poor academic performance, medical errors, cardiovascular disease, and poor mental health. Thus, the toll of medical school must be thoroughly understood, not only by those intending to pursue or actively pursuing the medical field but by the general population.

What Is Stress?

As defined by the National Cancer Institute, stress is the “body’s response to physical, mental, or emotional pressure.” Caused by a range of normal life activities or an out-of-the-ordinary, negative event, stress can lead to chemical changes in the body, triggering a “fight-or-flight” response—raising blood pressure, heart rate, and blood sugar levels. Stress impacts everyone. Whether it be from work, school, or an individual’s personal life, it comes with the same consequences and is equally dangerous.
For medical students, particularly the preclinical years are the most stressful. Here, they face several stressors simultaneously– adjustment to the new environment, educational debt, heavy workload, sleep deprivation, difficult patients, and career planning. All of these can lead to catastrophic consequences for their general health, from mental to physical.

Impact On Mental Health

One of the key findings among medical students is their raised levels of anxiety and depression. Studies on the prevalence of psychological distress among this population found that 40-79% of medical students experience high levels of anxiety in comparison to roughly 14% in the general population of a similar age group. Additionally, depression among medical students is more prominent as well at 12.9% versus 7.8% in the general population.

Other relevant studies have found that first-year medical students actually face greater psychological distress when compared to third or fourth-year medical students. In a large UK study using the 12-item General Health Questionnaire, 30.6% of first-year students were found to have some sort of mental distress compared to 21.9% of fifth-year medical students. Using the same scale in Turkey, 47.9% of second-year students experienced emotional disorders while a smaller percentage of about 29.2% of students in an alternate field, economics, were found to experience emotional disorders.

Such a high prominence of stress in medical students is very alarming due to the additional alternate impacts it can lead to. Poor mental health can lead to changes in appetite, procrastinating, increased use of alcohol or drugs, and the exhibition of greater nervous behaviors such as nail-biting, fidgeting, and pacing. Over time, these effects can add up, leading to medical students entering a downward spiraling effect where their psychological conditions only worsen.

Increased Risk Of Cardiovascular Disease

Physical impacts have also been observed due to these stressors faced by medical students. Constant stress, such as what medical students often face, is identified as chronic stress and can lead to an increased risk of cardiovascular disease. In a 2017 study, researchers used images of the amygdala—the part of the brain involved with fear and stress—and discovered associations between emotional stress and cardiovascular disease episodes.

Physiologically, stress leads to an increase in the hormone cortisol released in the body. Studies suggest that high levels of this hormone can increase blood cholesterol, triglycerides, blood sugar, and blood pressure—all common risk factors for heart disease. More specifically, for example, high blood pressure poses a risk for heart attack and stroke; thus, it is essential that the chronic stress faced by medical studies be reduced to prevent such life-threatening effects.

Techniques To Lower Stress

Due to an increase in chronic stress among the general population, many relaxation and destressing techniques have been researched. Meditation has proven to be one of the most effective. However, this broad activity has specific exercises which have been identified as especially effective. Among these is breathing focus in which long, slow, deep breaths are taken, disengaging the mind from distracting thoughts and sensations. Another is guided imagery where individuals create soothing scenes, places, or experiences in their minds to relax and focus on. Many apps have been developed which provided online recordings of calming scenes and sounds for maximum effect. Mindfulness meditation is another technique in which an individual focuses on their breathing while sitting comfortably and bringing their attention to the present moment, away from concerns about the past or future. Lastly, yoga, tai chi, and qigong are all ancient arts that combine breathing with a series of postures or flowing movements. These physical exercises offer a mental focus that, similar to the other techniques, distracts from racing thoughts. 

Conclusion 

It is no surprise that medical students face the impacts of stress in their daily lives. This stress is in no way healthy and can develop into conditions such as chronic stress, putting them at severe risk for poor mental health and cardiovascular diseases. Therefore, they must make time to do things they love and practice meditation techniques in some form to distract themselves from their immense workload and personal life struggles.

Yesha Shukla, Youth Medical Journal 2021

References

American Heart Association News. (2020, February 4). Chronic stress can cause heart trouble. American Heart Association. Retrieved October 31, 2021, from https://www.heart.org/en/news/2020/02/04/chronic-stress-can-cause-heart-trouble.

Corliss, J. (2019, September 10). Six relaxation techniques to reduce stress. Harvard Health Publishing. Retrieved October 31, 2021, from https://www.health.harvard.edu/mind-and-mood/six-relaxation-techniques-to-reduce-stress.

Hardeman, R. R., Przedworski, J. M., Burke, S. E., Burgess, D. J., Phelan, S. M., Dovidio, J. F., Nelson, D., Rockwood, T., & van Ryn, M. (2015). Mental well-being in first year medical students: A comparison by race and gender. Journal of Racial and Ethnic Health Disparities, 2(3), 403–413. https://doi.org/10.1007/s40615-015-0087-x

Jafari, N., Loghmani, A., & Montazeri, A. (2012). P-1011 – Mental Health of medical students in different levels of training. European Psychiatry, 27, 107–112. https://doi.org/10.1016/s0924-9338(12)75178-7

Kang, S., & Wojcik, S. (n.d.). Stress can increase your risk for heart disease. Health Encyclopedia. Retrieved October 31, 2021, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=2171

Marks, H. (2021, August 19). Stress symptoms: Physical effects of stress on the body. WebMD. Retrieved October 31, 2021, from https://www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body.

National Cancer Institute. (n.d.). NCI Dictionary of Cancer terms. National Cancer Institute. Retrieved October 31, 2021, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/stress.

Tawakol, A., Ishai, A., Takx, R. A. P., Figueroa, A. L., Ali, A., Kaiser, Y., Truong, Q. A., Solomon, C. J. E., Calcagno, C., Mani, V., Tang, C. Y., Mulder, W. J. M., Murrough, J. W., Hoffmann, U., Nahrendorf, M., Shin, L. M., Fayad, Z. A., & Pitman, R. K. (2017). Relation between resting amygdalar activity and cardiovascular events: A longitudinal and cohort study. The Lancet, 389(10071), 834–845. https://doi.org/10.1016/s0140-6736(16)31714-7

Advertisement

Donated Blood: How Is It Collected? Where Does It Go?

By Yesha Shukla

Published 11:53 EST, Mon November 1st, 2021

Introduction

Donating blood is common and a highly beneficial thing to do. Many selfless individuals donate their blood yearly which benefits sick patients all around the world. Each year, an estimated 6.8 million people in the United States alone donate blood, resulting in their collection of 13.6 million units of whole blood and red blood cells. However, many often question how exactly this donated blood is collected, processed, stored, and used which is exactly what this article aims to investigate.

Types of Blood Donations

The standard types of blood donation must be first understood before answering such a question because the type of blood being donated heavily influences the method in which it is collected. Beginning with a standard blood donation, this consists of plasma, red and white blood cells, platelets, antibodies, and other components. Plasma, also known as plasmapheresis, is another type of donation that separates plasma from the other components. This is done using a special machine and red blood cells are returned to the donor in cycles throughout the donation. Plasma is often given to individuals in emergency and trauma situations to help stop bleeding. Lastly, platelet donation–or plateletpheresis–is conducted in a similar way to plasma donations, but red cells and plasma are returned to the donor. These are typically given to individuals with clotting problems, cancer patients, or those who will have organ transplants or major surgeries. Additionally, a less common donation includes autologous which occurs before operation or transfusion where a person donates blood for their use. A directed or designated donation is also possible where a donor gives blood that is intended for a specific person to use.

How Much Blood Can Be Given?

It is crucial to understand exactly how much blood an individual can give before determining collection procedures as well. Healthy adults aged 18-75 are especially encouraged to donate as well as those with O negative blood because it can be given to anybody–of any blood type–if necessary. Regular donations collect around 470 mL of whole blood, which is 8% of an adult’s average blood volume. The body replaces this amount within 24 to 48 hours and replenishes red blood cells in 10 to 12 weeks. Additionally, individuals can donate whole blood every 12 weeks and plasma every 2 weeks.

How Is It Collected?

Now that the necessary basic information on blood collection is known, the specifics on how exactly it is collected can be investigated. First, pre-screenings are conducted to ensure the donor’s blood is healthy and will not damage a recipient. All donated blood is screened for blood-borne diseases–HIV, Hepatitis, Syphilis–and the donor must not suffer from a cold, flu, or any other illness at the time of donation. They must weigh at least 50kg and have a normal temperature and blood pressure. In the times of COVID, they must also be screened for the virus.

Taking blood is also a relatively simple process for regular blood donations. A blood pressure cuff or tourniquet is placed around the upper arm to fill a donor’s veins with more blood. A phlebotomist will then cleanse the area on the arm with an antiseptic and insert a sterile needle for the blood draw. This sterile needle is attached to a thin plastic tube and a blood bag. Once the needle is in, the donor should tighten their fists several times to help blood flow from the vein. Initially, blood is collected into tubes for testing and is then allowed to fill the blood bag. This process takes about 8 to 10 minutes and can be done sitting upright or laying down. When approximately a pint of blood is collected, the donation is complete and staff will remove the needle, elevate the donation arm, and apply slight pressure to promote clotting before bandaging the arm.

The process for platelet donations is however slightly different. Though the same pre-screening and sterile needle method still exist, a needle and plastic tube are connected to both arms. For such donations, an apheresis machine is used which collects a small amount of blood and separates the red cells, plasma, and platelets. It then returns the rest of the blood through the donor’s other arm and this cycle is repeated several times over about 2 hours.

How Is Blood Transported Post-Draw?

Directly after blood is taken, the donation, test tubers, and donor records are labeled with an identical bar code label. The donation is kept in ice before being taken to a processing center and the test tubes go to the lab. At the processing center, information about the donation is scanned onto a computer database before further steps are taken to prepare the blood to be shipped out to hospitals. Most whole blood donations are spun in centrifuges to separate them into transfusable components–red cells, platelets, plasma. Plasma may be processed into components–cryoprecipitate–which helps control the risk of bleeding by helping blood to clot. The red cells and platelets are leuko-reduced, meaning white blood cells are removed to reduce the participant’s possibility of reacting to transfusion. Each component is then packaged as a “unit” which is a standardized amount that doctors will use when transfusing a patient.

In parallel with all of this, the test tubes arrive at a testing laboratory where a dozen tests are performed to establish the blood type and test for infectious diseases. The test results from this are electronically transferred to a processing center within 24 hours and if results are positive, the donation is discarded.

When test results are received, units suitable for transfusion are labeled and stored. Specifically, red cells are stored in refrigerators at 6 degrees Celsius for up to 42 days, platelets are stored at room temperature for up to 5 days, and plasma and cryo are frozen and stored in freezers for up to 1 year. When blood is needed at hospitals, it is available for distribution 24/7. Hospitals typically keep blood units on their shelves, but some often call to receive units in times of urgency.

How Does Blood Transfusion Occur? What Products Are Made From Blood?

After the blood donation has reached the hospital, it is removed from storage and given to a patient in need through an intravenous line. This is a tiny tube that is inserted into a vein with a small needle and the transfusion process takes about 1 to 4 hours in total depending on the amount of blood needed.

Additionally, specific products can also be made from blood. From whole blood, red cells can boost the oxygen-carrying abilities of a patient’s blood. Platelets can clot blood assisting in those recovering from a severe hemorrhage. Lastly, plasma can be used in treating people with burns, cancer, and protecting people with brain and nerve diseases. Plasma contains antibodies and other important proteins used to make human immunoglobulin, human albumin, human coagulation factor IX, and many other specific products.

Conclusion

Blood donations travel a long way and though it only takes a couple of minutes to donate whole blood, a pint of blood could save a life in need. Due to the lack of donations during the pandemic, blood donations are at an all-time low; thus, individuals should donate blood if they can and are healthy enough to do so.

Yesha Shukla, Youth Medical Journal 2021

References

American Red Cross. (n.d.). The Blood Donation Process. Blood Donation Process Explained | Red Cross Blood Services. Retrieved October 2, 2021, from https://www.redcrossblood.org/donate-blood/blood-donation-process/donation-process-overview.html. 

American Red Cross. (n.d.). What Happens to Donated Blood. American Red Cross | Blood Services. Retrieved October 2, 2021, from https://www.redcrossblood.org/donate-blood/blood-donation-process/what-happens-to-donated-blood.html. 

Australian Red Cross Lifeblood. (2021, June 4). Blood donation. Blood donation – Better Health Channel. Retrieved October 2, 2021, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/blood-donation. 

Community Blood Center. (n.d.). Blood Donation process. Community Blood Center. Retrieved October 2, 2021, from https://givingblood.org/donate-blood/donation-process.aspx. 

Mayo Clinic Staff. (2021, March 4). Blood donation. Mayo Clinic. Retrieved October 2, 2021, from https://www.mayoclinic.org/tests-procedures/blood-donation/about/pac-20385144. 

Poor Eyesight: Why Does It Happen and What Makes It Better/Worse?

By Yesha Shukla

Published 11:26 EST, Thurs October 21st, 2021

Introduction 

Poor eyesight is becoming a common, widespread issue across the globe. Individuals are developing problems related to vision ranging from severe eye conditions to slight impairment more often than ever. Though some visual impairments are not correctable, the most common forms–such as errors of refraction–are. However, before such treatments for poor eyesight can be investigated, a solid understanding of where vision impairments stem must be understood.

Understanding Poor Eyesight 

In comparison to the other four key senses, a larger part of the brain is dedicated to vision, making it one of the most highly developed sensory organs. This not only makes vision a key component of the body, but also one of the most vulnerable. 

The most common forms of vision impairment are errors of refraction, which are when light rays fail to focus inside the eye and, thus, transfer blurry images to the brain. Examples of errors of refraction include nearsightedness, farsightedness, and astigmatism. However, not to worry, such vision impairments are typically correctable using glasses, contact lenses, or refractive surgery- LASIK, Photorefractive keratectomy, or Implantable Collamer Lenses.

Furthermore, another common form of poor eyesight is eye strain. This occurs when individuals overuse their eyes for an extensive period of time and can also be due to an uncorrected refractive problem. Eyestrain may occur while performing distant visual activities or prolonged focusing (driving, watching a movie, reading, computer use, etc). Eyestrain is not common among children due to their flexible focusing capacity, however, if the eyes are not given adequate rest, adults may experience its effects through headaches, brow aches, eye fatigue, or a pulling sensation. Additionally, experiencing these symptoms while wearing glasses could indicate the need for an eye prescription change. 

Other forms of vision problems often relate to eye disease. Examples of such include retinal detachment, macular degeneration, cataracts, and glaucoma. These can lead to blurry or defective vision and require surgery for correction.  

How Common Is The Problem? 

These vision impairments are not uncommon among individuals worldwide. At least 2.2 billion people have poor eyesight, 1 billion of which could have been prevented or have yet to be addressed. Such unaddressed vision impairments are most common in low and middle-income regions as the statistics report about 4 times as many cases like that of high-income regions. In some areas, eye care needs are greater in rural areas but the services are in urban hospitals, leading to low accessibility. Furthermore, eye conditions are projected to worsen in the future due to the aging population, genetics, ethnicity, lifestyle, and environmental factors. Thus, it is crucial to limit the chance of such a situation by understanding what makes eyesight worse and what can help it improve.   

What 4 Key Practices Impact Vision Negatively? 

An excess amount of screentime is one of the most widely known factors that impair vision. According to the American Optometric Association (AOA), the average American spends seven hours a day on their digital device and 58% of adults have experienced digital eye strain as a result. Additionally, according to Common Sense Media’s 2019 Census, eight to twelve-year-olds spend five hours on digital media. These individuals, especially if they spend more than two continuous hours using a digital screen, have a much greater risk of eye strain. This can be very damaging to the eyes and is often the most common cause of worsening vision problems.

Wearing contact lenses incorrectly is another common cause of impaired vision. The AOA found that 90% of the 45 million contact lens wearers in the US don’t follow proper hygiene instructions. ⅓ wear non-overnight contacts while sleeping, which can lead to inflammation, dry eye, pain, blurry vision, and light sensitivity. These all deprive the eyes of oxygen and can worsen eyesight as a whole. Furthermore, many also wear contact lenses in the shower or pool, leading to bacteria getting into the eyes and ultimately causing an infection. 

Next, not wearing sunglasses to protect from UV radiation causes both long and short-term damage. Just one day at the beach without eye protection can lead to photokeratitis– or sunburn of the eye– which can be temporary, but very painful. Long-term damage from UV rays can lead to the formation of cataracts and pterygium which causes abnormal covering on the white of the eye, impairing vision for a lifetime. There is also a risk for cancer on the eyelids, the skin around the eye, or the eye itself. Additionally, children’s eyes are much more vulnerable to damage from sunlight because their eye lenses cannot filter such UV rays easily, causing damage to the retina. The AOA reports that the average child is exposed to three times the annual UV exposure of an adult and 80% of such exposure occurs before the age of 20. 

Finally, the heavy use of eye drops is a common cause of vision impairment. Though it may seem to be helping the eye, this washes away natural tears. Prolonged use of eye drops can cause dependency on them, leading to the eye being unable to self-moisturize and protect its delicate layers. The glands can also get clogged because they will not secrete the proper oils to hold tears in place. In relation, whitening eye drops used to get red out of the eye can decrease blood flow, preventing oxygen from getting into the eye. In turn, the blood vessels can grow enlarged and become even redder due to their inability to deliver oxygen. 

What 4 Key Practices Impact Vision Positively?

Just as crucial as understanding what worsens vision is understanding what can better it. However, there is no specific method for improving vision directly without the use of corrective measures. This is because eye shape determines the level of refractive error and this cannot change with exercises or eye training. Thus, there is only one possible way to improve eyesight: to naturally improve the way in which the brain and eyes work together by improving eye health and, therefore, vision as a whole.

Eating a balanced and healthy diet rich in antioxidants and vitamin A–such as leafy vegetables, carrots, or fish–is incredibly important. Such foods slow down age-related vision loss by strengthening connections between the brain and the eyes. Getting enough sleep can also aid in bettering vision as by being tired, the eyes get strained easily and feel dry and gritty. Exercising regularly has shown signs of enhancing circulation of blood and oxygen flow to the eyes, decreasing dry eyes, and preventing vision loss. Protecting the eyes from UV rays and practicing good eye hygiene are also especially important. Washing the hands and face thoroughly and regularly and keeping cosmetics and other chemicals outside of the eyes can prevent potential damage. Lastly, taking breaks from screen time is essential. The AOA suggests looking 20 feet away every 20 minutes for 20 seconds at a time to prevent eye strain. 

Conclusion 

As a whole, eye conditions are very common among the current population and the best thing that can be done to prevent them is to make healthy life choices from a young age and see the eye doctor regularly. Taking care of the eyes is crucial and must be prioritized more often to avoid more individuals causing damage to their vision. 

Yesha Shukla, Youth Medical Journal 2021

References 

Seltman, Whitney. “Understanding Vision Problems — the Basics.” WebMD, WebMD, 7 Feb. 2020, http://www.webmd.com/eye-health/understanding-vision-problems-basics.

All About Vision Editorial Team. “7 Everyday Things That Can Hurt Your Eyes.” All About Vision, All About Vision, 7 Sep. 2021, http://www.allaboutvision.com/eye-care/things-that-hurt-your-vision/.

NVISION. “How to Improve Eyesight Naturally (& Safely).” NVISION Eye Centers, NVISION, 23 Dec. 2020, http://www.nvisioncenters.com/improve-eyesight/.

World Health Organization. “World Report on Vision.” World Health Organization, World Health Organization, 8 Oct. 2019, http://www.who.int/publications-detail-redirect/9789241516570.