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Background As United States (US) medical students suffer higher rates of depression and anxiety than the general population, the wellness of medical students is particularly salient. One definition describes wellness as having eight dimensions: Intellectual, emotional, physical, social, occupational, financial, environmental, and spiritual. As the coronavirus (COVID-19) pandemic poses unique challenges for medical students, we aimed to compare medical student wellness before and during the COVID-19 pandemic. Methods An informal survey was created to assess eight wellness dimensions and was distributed via Survey Monkey to US allopathic and osteopathic medical students via email and social media. The survey was administered from March 29, 2020 to June 23, 2020. Univariable and multivariable linear mixed-effects models were used to estimate the change in students’ overall wellness using an 11-point scale ranging from 0 (least well) to 10 (most well). Generalized estimating equations were used to estimate the change in students’ responses to the eight dimensions before and during the COVID-19 pandemic. Results On multivariable analysis, students reported a decline in their overall wellness during COVID-19 (Mdiff = -1.08; p < .001). Asian respondents reported little change in overall wellness (M = -0.65) when compared to White respondents (M = -1.16) and Black respondents (M = -1.57). Students felt less supported and comfortable with their social (OR = 0.47) and daily (OR = 0.45) environments and expressed decreased satisfaction with their exercise (OR = 0.85), sense of purpose (OR = 0.33), and financial status (OR = 0.75). Students also expressed lower confidence (OR = 0.15) and satisfaction (OR = 0.11) with their medical education and increased anxiety (OR = 3.37) and depression (OR = 2.05). Conclusions Medical students reported declines in overall wellness and individual wellness dimensions. These findings can be used to implement changes to improve medical student wellness.

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Background: As United States (US) medical students suffer higher rates of depression and anxiety than the general population, medical student wellness has been studied in recent years. One definition describes wellness as having eight dimensions: Intellectual, emotional, physical, social, occupational, financial, environmental, and spiritual. As the coronavirus (COVID-19) pandemic poses unique challenges for medical students, we aimed to compare medical student wellness before and during the COVID-19 pandemic.Methods: An informal survey was created to assess the eight wellness dimensions and distributed via Survey Monkey to US allopathic and osteopathic medical students via email and social media. The survey was administered from March 29, 2020 to June 23, 2020. Univariable and multivariable linear mixed-effects models were used to estimate the change in students’ overall wellness using an 11-point scale ranging from 0 (least well) to 10 (most well). Generalized estimating equations were used to compare students’ responses to the eight dimensions before and during the COVID-19 pandemic.Results: On multivariable analysis, students reported a decline in their overall wellness during COVID-19 (Mdiff = -1.04; p < .001), with Asian respondents reporting almost no change in overall wellness (M = -0.69) compared to White respondents (M = -1.18; p = .049) and Black respondents (M = -1.78; p = .03). Students felt less supported and comfortable with their social (OR = 0.47) and daily (OR = 0.45) environments and expressed decreased satisfaction with their exercise (OR = 0.85), sense of purpose (OR = 0.33), and financial status (OR = 0.75). Students also expressed lower confidence (OR = 0.15) and satisfaction (OR = 0.11) with their medical education and increased anxiety (OR = 3.37) and depression (OR = 2.05).Conclusions: Medical students reported declines in overall wellness and individual wellness dimensions. These findings can be used to implement changes to improve medical student wellness.

Purpose Proinflammatory cytokines play a critical role in chronic inflammation and pain and contribute to behavioral symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and comorbidities (diabetes, cardiac diseases, cancer). Evidence is lacking on the specific proinflammatory cytokines associated with these behavioral symptoms/comorbidities co-occurring with axial low back pain (aLBP). This review aimed to systematically analyze the following: (1) specific proinflammatory cytokines associated with aLBP in adults, (2) associations among proinflammatory cytokines and behavioral symptoms in aLBP, and (3) relationships among proinflammatory cytokines and comorbidities in aLBP, to develop a new clinical framework for future diagnostic and intervention targets for patients with aLBP. Methods Electronic databases, including PubMed/MEDLINE, ProQuest Nursing & Allied Health Source, and CINAHL Complete (EBSCO) were searched for the period January 2012 to February 2023. Eligible studies included cross-sectional, case-control, longitudinal, and cohort studies in which proinflammatory cytokines were reported in adults above 18 years with aLBP. Intervention studies and randomized controlled trails were excluded. The Joanna Briggs Institute (JBI) criteria were used for quality evaluation. Results Findings from 11 studies showed 3 proinflammatory cytokines associated with pain intensity in adult patients with aLBP: C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), and Interleukin (IL-6). Some studies assessed associations between proinflammatory cytokines and depressive symptoms; none explored the association of proinflammatory cytokines with fatigue, anxiety, sleep disturbance, or comorbidities (diabetes, cardiac diseases, and cancer) in aLBP. Conclusions Proinflammatory cytokines in aLBP can serve as composite biomarkers for pain, associated symptoms, and comorbidities and may serve as a target for future interventions. There is need for well-designed studies assessing associations among chronic inflammation, behavioral symptoms, and comorbidities.

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