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El-Sehrawy AAMA, Ayoub II, Uthirapathy S, Ballal S, Gabble BC, Singh A, V K, Panigrahi R, Kamali M, Khosravi M. The microbiota-gut-brain axis in myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review of an emerging field. Eur J Transl Myol 2025; 35:13690. [PMID: 39937103 PMCID: PMC12038572 DOI: 10.4081/ejtm.2025.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2025] [Accepted: 02/03/2025] [Indexed: 02/13/2025] Open
Abstract
The intricate relationship between gut microbiota and the brain has emerged as a pivotal area of research, particularly in understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). This complex condition is characterized by debilitating fatigue, cognitive dysfunction, and a wide array of systemic manifestations, posing significant challenges for diagnosis and treatment. Recent studies highlight the microbiota-gut-brain axis as a crucial pathway in ME/CFS pathophysiology, suggesting that alterations in gut microbial composition may impact immune responses, neurochemical signaling, and neuronal health. This narrative review systematically explores English-language scholarly articles from January 1995 to January 2025, utilizing databases such as PubMed, Scopus, and Web of Science. The findings underscore the potential for targeted therapeutic interventions aimed at correcting gut dysbiosis. As research progresses, a deeper understanding of the microbiota-gut-brain connection could lead to innovative approaches for managing ME/CFS, ultimately enhancing the quality of life for affected individuals.
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Affiliation(s)
| | | | - Subasini Uthirapathy
- Faculty of Pharmacy, Department of Pharmacology, Tishk International University, Erbil, Kurdistan Region.
| | - Suhas Ballal
- Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka.
| | - Baneen C Gabble
- Department of Medical Analysis, Medical Laboratory Technique College, The Islamic University, Najaf, Iraq; Department of Medical Analysis, Medical Laboratory Technique College, The Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq; Department of Medical Analysis, Medical Laboratory Technique College, The Islamic University of Babylon, Babylon.
| | - Abhayveer Singh
- Centre for Research Impact & Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, Punjab.
| | - Kavitha V
- Department of Chemistry, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu.
| | - Rajashree Panigrahi
- Department of Microbiology, IMS and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar.
| | - Mostafa Kamali
- Department of Psychiatry, School of Medicine, Zahedan University of Medical Sciences, Zahedan.
| | - Mohsen Khosravi
- Department of Psychiatry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran; Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan.
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Ye Z, Peng Y, Rao W, Zhang T. The effect of physical activity on depression: a lagged mediation study of school burnout. BMC Public Health 2024; 24:3491. [PMID: 39695559 DOI: 10.1186/s12889-024-21003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 12/05/2024] [Indexed: 12/20/2024] Open
Abstract
PURPOSE In recent years, the problem of college student suicide has become more and more serious, and depression has become the main root cause, triggering the attention of colleges and universities at home and abroad. Based on the burnout theory, this study explores the intrinsic connection between physical activity, depression and academic burnout. Through two questionnaire surveys, the cross-sectional relationship between physical activity level, depression and academic burnout was analyzed. A parallel mediation model was developed to compare the mediating effects of physical activity and depression. Meanwhile, physical activity grading was quantified to assess the effect on improving academic burnout and depression. METHODS A longitudinal study was conducted utilizing a physical education classroom with questionnaires measuring students' physical activity, school burnout, and depression. The test was administered twice, at the beginning and end of the semester, with 305 valid participants each time. SPSS 27.0 was used to process the data, perform descriptive statistics and correlation analyses, and explore the relationships between variables. Multiple linear regression was used to analyze the mediating relationships and lagged effects of physical activity, school burnout, and depression. Finally, the amount of physical activity was graded to examine the effects of different intensities on school burnout and depression. RESULTS In a cross-sectional study at two time points, school burnout would serve as a mediator between college students' physical activity depression. We compared the lagged mediating effects of the two groups and found that school burnout (Time 2) had a more significant effect as a mediator. Finally, we graded the amount of physical activity according to the scale and found that only high-intensity physical activity affected depression (Time 2) through school burnout (Time 2). CONCLUSION There was temporal stability between physical activity, depression, and school burnout among college students. School burnout fully mediated the relationship between physical activity and depression at different time points and acted as a fully lagged mediator. School burnout at time 2 mediated the relationship between physical activity and depression more than school burnout at time 1. High-intensity physical activity was more effective in reducing depression and school burnout.
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Affiliation(s)
- Zicong Ye
- School of Physical Education and Sport (College of Evergrande Football), Wuhan University of Science and Technology, Wuhan, China
| | - Ying Peng
- Wuhan Qiaokou District Basketball Association, Wuhan, China
| | - Wei Rao
- School of Physical Education and Sport (College of Evergrande Football), Wuhan University of Science and Technology, Wuhan, China
| | - Ting Zhang
- Physical Education College of JiangxiNormal University, No.437, West Beijing Road, Nanchang, 330027, People's Republic of China.
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Gong Z, Wang H, Zhong M, Shao Y. College students' learning stress, psychological resilience and learning burnout: status quo and coping strategies. BMC Psychiatry 2023; 23:389. [PMID: 37268888 DOI: 10.1186/s12888-023-04783-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/13/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The relationships of college students' learning stress, psychological resilience and learning burnout remain unclear. We aimed to investigate the status quo and relationship of college students' learning stress, psychological resilience and learning burnout, to provide insights to the management and nursing care of college students. METHODS From September 1 to October 31, 2022, students in our college were selected by stratified cluster sampling and underwent survey with the learning stress scale, college students' learning burnout scale and the psychological resilience scale of college students. RESULTS A total of 1680 college students were surveyed in this study. The score of learning burnout was positively correlated with the score of learning stress (r = 0.69), and negatively correlated with the score of psychological resilience (r = 0.59), and the score of learning stress was negatively correlated with the score of psychological resilience (r = 0.61). Learning pressure was correlated with the age(r=-0.60) and monthly family income(r=-0.56), the burnout was correlated with the monthly family income(r=-0.61), and psychological resilience was correlated with the age(r = 0.66) (all P < 0.05). Psychological resilience played an intermediary role in the prediction of learning burnout by learning stress, with an total intermediary role of-0.48, accounting for 75.94% of the total effect. CONCLUSIONS Psychological resilience is the mediating variable of the influence of learning stress on learning burnout. College managers should take various effective measures to improve college students' psychological resilience to reduce college students' learning burnout.
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Affiliation(s)
- Zhen Gong
- College of E-commerce, Zhejiang Business College, Hangzhou, 310053, Zhejiang, China
| | - Huadi Wang
- College of E-commerce, Zhejiang Business College, Hangzhou, 310053, Zhejiang, China
| | - Mingxia Zhong
- College of E-commerce, Zhejiang Business College, Hangzhou, 310053, Zhejiang, China
| | - Yuling Shao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College,, Hangzhou, 310024, Zhejiang, China.
- , No. 158 Shangtang road, Gongshu district, Hangzhou, Zhejiang Province, China.
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Ihbour S, Boulhanna A, Hnini R, Chigr F, Najimi M. Sedentary Lifestyle and Beneficial Effects of Physical Activity on Psychiatric Disorders in a Population of Moroccan University Students: Psychophysiological Interpretation. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction : La santé mentale est une préoccupation mondiale majeure de santé publique. De nombreuses stratégies ont été développées pour contrer ces effets négatifs. En ce sens, il est de plus en plus reconnu que l'activité physique a des effets positifs sur les troubles affectifs et pourrait être utilisée comme voie thérapeutique. Objectif : Nos objectifs se sont concentrés sur l'évaluation du niveau d'activité physique, des troubles émotionnels, et des liens entre les deux variables au sein d'une population d'étudiants universitaires marocains. Méthodes : Nous avons utilisé les échelles de Ricci & Gagnon et DAS-21 pour évaluer le profil d'activité physique, l'état de stress et la symptomatologie anxiété-dépressive de 648 participants (âge moyen = 24,12 ans). Résultats:Premièrement, les résultats montrent que les étudiants de sexe masculin pratiquent plus d'activité physique que les étudiantes et se révèlent plus anxieux et stressés. Malgré le sexe, nous avons constaté qu'il existe une relation très pertinente entre l'activité physique et la symptomatologie des troubles émotionnels. Cette relation implique que les sujets les plus actifs physiquement présentaient une symptomatologie anxieuse-dépressive légère associée à des niveaux de stress relativement plus faibles. Conclusion:Ces résultats incitent les responsables de l'enseignement supérieur à intégrer des sessions régulières obligatoires d'éducation physique et de sport dans le programme universitaire tout en fournissant des infrastructures et des ressources humaines suffisantes. Ils encouragent l'ouverture de filières enseignement/formation et sport qui permettent une flexibilité aux étudiants pour pratiquer leur sport et/ou activité physique préféré tout en poursuivant leurs études universitaires.
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Addis A, Alemnew W, Kassie A, Handebo S. Physical exercise and its associated factors among Ethiopian pregnant women: a cross-sectional study based on the theory of planned behavior. BMC Psychol 2022; 10:146. [PMID: 35681211 PMCID: PMC9185930 DOI: 10.1186/s40359-022-00847-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Women in Ethiopia prefer sedentary behavior and are physically inactive during pregnancy; this increases the risks of pregnancy-related complications. Therefore, this study aimed to assess physical exercise and its associated factors among pregnant women attending Antenatal Care at Debermarkose Referral Hospital, Northwest Ethiopia: using the theory of planned behavior. METHODS An institution-based cross-sectional study was conducted from 23rd February to 10th June, 2020. A systematic random sampling technique was used to select 333 study participants. Data were collected with face-to-face interviews using a pretested structured questionnaire. Epi-info and STATA version 14.0 were used for data entry and analysis respectively. Multivariable linear regression analysis was done to identify the association between dependent and independent factors, and p < 0.05 was used as a cutoff to determine statistical significance at multivariable logistics regressions. RESULT A total of 333 pregnant women were participated in this study with response rate of 98%. The proportion of variance (R2) in intention accounted for the factors was 0.79. The magnitude of intention to do physical exercise during the current pregnancy was 3.8 ± 2. primary level of education (β = 0.43; 95% CI 0.25, 0.61), 2nd trimester gestational age (β = 0.19; 95% CI 0.04, 0.33), 3rd trimester gestational age (β = 0.17; 95% CI 0.02, 0.32), Attitude (β = 0.34; 95% CI 0.19, 0.49), subjective norm (β = 0.12; 95% CI 0.01, 0.23) and perceived behavioral control (β = 0.45; 95% CI 0.33, 0.57) were significantly associated with pregnant womens' intention to do physical exercise during pregnancy period. CONCLUSION AND RECOMMENDATIONS This study provided that the theory of planned behavior could be successfully applied to identify the factors related to the intention to do physical exercise during pregnancy The program designers who work on pregnancy better consider providing Information education and communication to change the attitude, work on influencing significant individuals and barriers and enabling factors.
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Affiliation(s)
- Abebaw Addis
- Amhara Regional State Health Bureau, Bahir Dar, Ethiopia
| | - Wallelign Alemnew
- Department of Health Education and Behavioural Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Kassie
- Department of Health Education and Behavioural Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Simegnew Handebo
- School of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Khosravi M. Research output of Iran over the past two years: Contributions from the European Journal of Translational Myology. Eur J Transl Myol 2022; 32:10447. [PMID: 35293195 PMCID: PMC8992672 DOI: 10.4081/ejtm.2022.10447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
Over the last two decades, all branches of science and technology have rapidly progressed, including the medical area. In Middle Eastern countries, including Iran, the increased growth of technology and science production has led to this rapid medical progress. Recent evidence has revealed that the increase in the number of scientific papers generated in Iran after the Iraqi imposed war against Iran has been eight times that in six main countries in the Middle East, including Egypt, Turkey, Jordan, Saudi Arabia, Iraq, and Syria. Although Iran's output in sciences has been still small in comparison to developed countries, it has significantly grown in the last decade, which is hoped to continue to increase and improve. The current paper shows a portion of the science production in Iran over the past two years based on papers published in the European Journal of Translational Myology in 2020 and 2021. Although the Issue 32 (1), 2022 in a special section contains several typescripts from Iran, they were not included in our analysis since they have not been yet indexed in the Scopus database. However, our report would encourage researchers of diverse nationalities to take part in research works and author joint papers. Further, this paper can be used to rate the universities and research centers regarding their science output, as well as being beneficial to university students, lecturers, and governments.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Zahedan University of Medical Sciences, Zahedan.
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Wang Q, Wu H. Associations Between Maladaptive Perfectionism and Life Satisfaction Among Chinese Undergraduate Medical Students: The Mediating Role of Academic Burnout and the Moderating Role of Self-Esteem. Front Psychol 2022; 12:774622. [PMID: 35069356 PMCID: PMC8777005 DOI: 10.3389/fpsyg.2021.774622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/01/2021] [Indexed: 01/07/2023] Open
Abstract
Empirical research has shown that maladaptive perfectionism may lead to lower life satisfaction. However, the relationship between maladaptive perfectionism and life satisfaction among medical students and the mechanism underlying this relationship still need to be further explored. The present study used a large sample of undergraduate medical students to examine the associations between maladaptive perfectionism and life satisfaction and to explore the mechanism underlying the associations. Specifically, the present study tried to probe the mediating role of academic burnout and the moderating role of self-esteem in the relationship between maladaptive perfectionism and life satisfaction in medical students. We invited 1628 undergraduate medical students from two medical universities in Northeastern China to participate in the survey. Among the students recruited, 1377 medical students (response rate: 84.6%) completed questionnaires including the Frost Multidimensional Perfectionism Scale (FMPS) maladaptive perfectionism subscales, the Chinese College Student Academic Burnout Inventory (CCSABI), the Satisfaction With Life Scale (SWLS), the Rosenberg Self-Esteem Scale (RSES) and demographic information. Results show that maladaptive perfectionism was significantly negatively related to life satisfaction among medical students and academic burnout played a significant mediating role (β = -0.10, BCa 95%CI: -0.12, -0.07) in this relationship. Moderated mediation analyses reveal that the mediating effect of maladaptive perfectionism on life satisfaction via academic burnout was moderated by self-esteem. Maladaptive perfectionism exerted a stronger effect on life satisfaction via the mediating role of academic burnout for medical students with high self-esteem [β = -0.026, SE = 0.009, 95%CI = (-0.047, -0.011)] than for medical students with low self-esteem [β = -0.019, SE = 0.009, 95%CI = (-0.038, -0.001)]. Medical institutions can implement effective interventions to decrease medical students' maladaptive perfectionism levels and academic burnout levels, and increase their self-esteem levels in order to enhance their life satisfaction.
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Affiliation(s)
- Qinghua Wang
- Institute of Foreign Languages, China Medical University, Shenyang, China
| | - Huazhang Wu
- Department of Health Service Administration, College of Health Management, China Medical University, Shenyang, China
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Khosravi M, Ghiasi Z, Ganjali A. A narrative review of research on healthcare staff’s burnout during the COVID-19 pandemic. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021; 31:20101058211040575. [PMCID: PMC9198672 DOI: 10.1177/20101058211040575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background During the 2019 coronavirus disease (COVID-19) pandemic, burnout emerges as a critical health problem that might involve workers in many occupations, particularly healthcare personnel. Although burnout syndrome is not necessarily proved to be nosologic, it yields serious physical, mental, and social outcomes. However, it is essential to provide practical strategies and effective instruments for people so that they can adapt to such highly stressful conditions. Objectives The present review was conducted to explore preliminary evidence for nature, treatment, and prevention of burnout among healthcare workers during the COVID-19 pandemic. Methods Related English literatures published from the beginning of January 2020 to the end of September 2020 were searched in PubMed, Web of Science, Scopus, and Google scholar databases. “Burnout,” “COVID-19,” “healthcare workers,” “medical staff,” and “pandemic” constituted the search terms. A narrative technique was implemented for material synthesis and creating a compelling and cohesive story. Results Final results provided the burnout history and its major effects, causes, and prevalence among healthcare workers. Also, some strategies were listed to be employed by hospital medical staff and organizations to deal with the COVID-19 pandemic. Conclusions Recent evidence demonstrated that healthcare staff could gain significant benefits from interventions to modify burnout syndrome, especially from organization-directed interventions. So, health policymakers and practitioners should adopt such interventions and develop context-specific approaches promoting a healthy workplace and averting burnout during the COVID-19 crisis.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Ghiasi
- Department of Psychiatry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Ganjali
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Khosravi M. Burnout among Iranian medical students: Prevalence and its relationship to personality dimensions and physical activity. Eur J Transl Myol 2021; 31:9411. [PMID: 33709649 PMCID: PMC8056162 DOI: 10.4081/ejtm.2021.9411] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/17/2020] [Indexed: 01/07/2023] Open
Abstract
Several studies have shown the association between personality traits and academic burnout. But the main goal of the present study was to find out an experimental answer to the following questions: Is there a simple relationship between personality dimensions and academic burnout? Can physical activity affect this relationship?. In this cross-sectional correlational study, 417 medical students were selected from three major cities of Iran through stratified multistage sampling and assessed by demographic information form, Baecke Physical Activity Questionnaire, Temperament and Character Inventory, and Breso's Academic Burnout Questionnaire. Bivariate Pearson correlations and hierarchical linear regression were used to examine the relationships between academic burnout, personality traits, and physical activity. In this study, 400 medical students (39% male and 61% female) filled the questionnaires correctly. The total prevalence of academic burnout was 25.5% (n=102), with heterogeneous levels. Regression analysis indicated that in a multivariate model, being male (β=0.08, p=0.013), higher years of medical school (β=0.18, p˂0.001), and lower scores in novelty seeking (β=-0.53, p=0.006), cooperativeness (β=-0.55, p=0.010), and physical activity (β=-1.22, p˂0.001) could be attributed to higher scores of academic burnout. Furthermore, physical activity had a moderating role in "novelty seeking-academic burnout" (β=-0.47, p=0.044) and "cooperativeness-academic burnout" (β=-0.89, p=0.001) relationships (ΔR2=0.02, p˂0.001). The results suggested that male gender, higher years of medical school, and lower levels of novelty seeking, cooperativeness, and physical activity are associated with higher levels of academic burnout among Iranian medical students. Therefore, paying attention to male gender and individual difference factors, as well as planning for physical education classes during the medicine courses (especially in the last years of medical school), seems essential. However, more extensive investigations need to be carried out in this field through longitudinal studies.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Zahedan University of Medical Sciences, Zahedan.
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Khosravi M. Burnout among Iranian medical students: Prevalence and its relationship to personality dimensions and physical activity. Eur J Transl Myol 2021. [DOI: 10.4081/ejtm.2020.9411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Several studies have shown the association between personality traits and academic burnout. But the main goal of the present study was to find out an experimental answer to the following question: Does the relationship between personality dimensions and academic burnout is a simple relationship or physical activity can influence this relationship. In this cross-sectional correlational study, 417 medical students were selected from three major cities of Iran through stratified multistage sampling and assessed by demographic information form, Baecke Physical Activity Questionnaire, Temperament and Character Inventory, and Breso’s Academic Burnout Questionnaire. Bivariate Pearson correlations and hierarchical linear regression were used to examine the relationships between academic burnout, personality traits, and physical activity. In this study, 400 medical students (39% male and 61% female) filled the questionnaires correctly. The total prevalence of academic burnout was 25.5% (n=102), with heterogeneous levels. Regression analysis indicated that in a multivariate model, being male (β=0.08, p=0.013), higher years of medical school (β=0.18, p˂0.001), and lower scores in novelty seeking (β=-0.53, p=0.006), cooperativeness (β=-0.55, p=0.010), and physical activity (β=-1.22, p˂0.001) could be attributed to higher scores of academic burnout. Furthermore, physical activity had a moderating role in “novelty seeking-academic burnout” (β=-0.47, p=0.044) and “cooperativeness-academic burnout” (β=-0.89, p=0.001) relationships (∆R2=0.02, p˂0.001). The results suggested that male gender, higher years of medical school, and lower levels of novelty seeking, cooperativeness, and physical activity are associated with higher levels of academic burnout among Iranian medical students. Therefore, paying attention to male gender and individual difference factors, as well as planning for physical education classes during the medicine courses (especially in the last years of medical school), seems essential. However, more extensive investigations need to be carried out in this field through longitudinal studies.
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