Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

OBJECT The relationship between headaches, pituitary adenomas, and surgical treatment of pituitary adenomas remains unclear. The authors assessed the severity and predictors of self-reported headaches in patients referred for surgery of pituitary adenomas and evaluated the impact of endoscopic transsphenoidal surgery on headache severity and quality of life (QOL). METHODS In this prospective study, 79 patients with pituitary adenomas underwent endoscopic transsphenoidal resection and completed the Headache Impact Test (HIT-6) and the 36-Item Short Form Health Survey (SF-36) QOL questionnaire preoperatively and at 6 weeks and 6 months postoperatively. RESULTS Preoperatively, 49.4% of patients had mild headache severity, 13.9% had moderate severity, 13.9% had substantial severity, and 22.8% had intense severity. Younger age and hormone-producing tumors predisposed greater headache severity, while tumor volume, suprasellar extension, chiasmal compression, and cavernous sinus invasion of the pituitary tumors did not. Preoperative headache severity was found to be significantly associated with reduced scores across all SF-36 QOL dimensions and most significantly associated with mental health. By 6 months postoperatively, headache severity was reduced in a significant proportion of patients. Of the 40 patients with headaches causing an impact on daily living (moderate, substantial, or intense headache), 70% had improvement of at least 1 category on HIT-6 by 6 months postoperatively, while headache worsened in 7.6% of patients. The best predictors of headache response to surgery included younger age, poor preoperative SF-36 mental health score, and hormone-producing microadenoma. CONCLUSIONS The results of this study confirm that surgery can significantly improve headaches in patients with pituitary adenomas by 6 months postoperatively, particularly in younger patients whose preoperative QOL is impacted. A larger multicenter study is underway to evaluate the long-term effect of surgery on headaches in this patient group.

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Prospective comparison of sinonasal outcomes after microscopic sublabial or endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenomas

Journal of Neurosurgery ◽

10.3171/2015.6.jns142695 ◽

2016 ◽

Vol 125 (2) ◽

pp. 323-333 ◽

Cited By ~ 19

Author(s):

Carrie L. Pledger ◽

Mohamed A. Elzoghby ◽

Edward H. Oldfield ◽

Spencer C. Payne ◽

John A. Jane

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Endoscopic Surgery ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Short Form ◽

Nasal Symptoms ◽

Sf 36 ◽

Total P

OBJECT Both endoscopic and microscopic transsphenoidal approaches are accepted techniques for the resection of pituitary adenomas. Although studies have explored patient outcomes for each technique individually, none have prospectively compared sinonasal and quality of life outcomes in a concurrent series of patients at the same institution, as has been done in the present study. METHODS Patients with nonfunctioning adenomas undergoing transsphenoidal surgery were assessed for sinonasal function, quality of life, and pain using the Sino-Nasal Outcome Test-20 (SNOT-20), the short form of the Nasal Obstruction Symptom Evaluation (NOSE) instrument, the SF-36, and a headache scale. Eighty-two patients undergoing either endoscopic (47 patients) or microscopic (35 patients) surgery were surveyed preoperatively and at 24–48 hours, 2 weeks, 4 weeks, 8 weeks, and 1 year after surgery. RESULTS Patients who underwent endoscopic and microscopic transsphenoidal surgery experienced a similar recovery pattern, showing an initial increase in symptoms during the first 2 weeks, followed by a return to baseline by 4 weeks and improvement beyond baseline functioning by 8 weeks. Patients who underwent endoscopic surgery experienced better sinonasal outcomes at 24–48 hours (SNOT total p = 0.015, SNOT rhinologic subscale [ssRhino] p < 0.001), 2 weeks (NOSE p = 0.013), and 8 weeks (SNOT total p = 0.032 and SNOT ssRhino p = 0.035). By 1 year after surgery, no significant differences in sinonasal outcomes were observed between the 2 groups. Headache scales at 1 year improved in all dimensions except duration for both groups (total result 73%, p = 0.004; severity 46%, p < 0.001; frequency 53%, p < 0.001), with 80% of either microscopic or endoscopic patients experiencing improvement or resolution of headache symptoms. Endoscopic and microscopic patients experienced reduced vitality preoperatively compared with US population norms and remained low postoperatively. By 8 weeks after surgery, both groups experienced significant improvements in mental health (13%, p = 0.005) and vitality (15%, p = 0.037). By 1 year after surgery, patients improved significantly in mental health (14%, p = 0.03), role physical (14%, p = 0.036), social functioning (16%, p = 0.009), vitality (22%, p = 0.002), and SF-36 total (10%, p = 0.024) as compared with preoperative measures. There were no significant differences at any time point between the 2 groups for the total SF-36 or for any of the 8 subscales. CONCLUSIONS Patients who underwent either an endoscopic or a microscopic approach experienced the greatest nasal symptoms at 2 weeks postoperatively and exhibited similar time courses of recovery in nasal, headache, and quality of life assessments. Although patients who underwent endoscopic surgery experienced significantly fewer nasal symptoms during the first 8 weeks, by 1 year after surgery, there were no significant differences between the 2 groups.

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The impact of smoking cessation on patient quality of life

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132009000500008 ◽

2009 ◽

Vol 35 (5) ◽

pp. 436-441 ◽

Cited By ~ 17

Author(s):

Maria Penha Uchoa Sales ◽

Maria Irenilza Oliveira ◽

Isabela Melo Mattos ◽

Cyntia Maria Sampaio Viana ◽

Eanes Delgado Barros Pereira

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Smoking Cessation ◽

Short Form ◽

Analysis Of Covariance ◽

Sf 36 ◽

Related Quality ◽

A Prospective Study ◽

The Impact

OBJECTIVE: To evaluate changes in health-related quality of life (HRQoL) after twelve months of smoking cessation. METHODS: This was a prospective study to evaluate the effectiveness of a smoking cessation program on the quality of life of 60 self-referred subjects, at a public hospital, during the period of August 2006 to December 2007. The program consisted of 2-h group sessions once a week during the first month and then every 15 days over six months, followed by monthly phone contacts for another six months. The treatment was based on behavior modification and the use of bupropion in combination with nicotinic replacement therapy. Abstinence was verified by exhaled CO measurements. Patient HRQoL was quantified using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire. Differences in quality of life scores between quitters and non-quitters at twelve months after the initial intervention were evaluated using analysis of covariance with baseline characteristics as covariates. RESULTS: Self-reported quality of life scores were significantly higher among the 40 quitters than among the 20 non-quitters. The following SF-36 domains were most affected: role-emotional (p = 0.008); general health (p = 0.006); vitality (p < 0.001); and mental health (p = 0.002). At twelve months after the smoking cessation intervention, the SF-36 mental component and physical component summary scores were higher among quitters than among non-quitters (p = 0.004 and p = 0.001, respectively). CONCLUSIONS: Our findings illustrate that smoking abstinence is related to better HRQoL, especially in aspects of mental health.

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Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis

Journal of Neurosurgery ◽

10.3171/2015.1.jns141543 ◽

2016 ◽

Vol 124 (3) ◽

pp. 589-595 ◽

Cited By ~ 25

Author(s):

Arman Jahangiri ◽

Jeffrey R. Wagner ◽

Sung Won Han ◽

Mai T. Tran ◽

Liane M. Miller ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Time Course ◽

Hormone Replacement ◽

Endocrine Function ◽

Gland Volume ◽

Younger Age ◽

Thyroid Axis ◽

Nonfunctional Pituitary Adenomas ◽

The Impact

OBJECT The impact of transsphenoidal surgery for nonfunctional pituitary adenomas (NFAs) on preoperative hypopituitarism relative to the incidence of new postoperative endocrine deficits remains unclear. The authors investigated rates of hypopituitarism resolution and development after transsphenoidal surgery. METHODS Over a 5-year period, 305 transsphenoidal surgeries for NFAs performed at The California Center for Pituitary Disorders were retrospectively reviewed. RESULTS Patients with preoperative endocrine deficits (n = 153, 50%) were significantly older (mean age 60 vs 54 years; p = 0.004), more frequently male (65% vs 44%; p = 0.0005), and had larger adenomas (2.4 cm vs 2.1 cm; p = 0.02) than patients without preoperative deficits (n = 152, 50%). Of patients with preoperative endocrine deficits, 53% exhibited symptoms. Preoperative deficit rates were 26% for the thyroid axis; 20% and 16% for the male and female reproductive axes, respectively; 13% for the adrenocorticotropic hormone (ACTH)/cortisol axis, and 19% for the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis. Laboratory normalization rates 6 weeks and 6 months after surgery without hormone replacement were 26% and 36% for male and 13% and 13% for female reproductive axes, respectively; 30% and 49% for the thyroid axis; 3% and 3% for the cortisol axis; and 9% and 22% for the IGF-1 axis (p < 0.05). New postoperative endocrine deficits occurred in 42 patients (13.7%). Rates of new deficits by axes were: male reproductive 3% (n = 9), female reproductive 1% (n = 4), thyroid axis 3% (n = 10), cortisol axis 6% (n = 19), and GH/IGF-1 axis 4% (n = 12). Patients who failed to exhibit any endocrine normalization had lower preoperative gland volumes than those who did not (0.24 cm3 vs 0.43 cm3, respectively; p < 0.05). Multivariate analyses revealed that no variables predicted new postoperative deficits or normalization of the female reproductive, cortisol, and IGF-1 axes. However, increased preoperative gland volume and younger age predicted the chances of a patient with any preoperative deficit experiencing normalization of at least 1 axis. Younger age and less severe preoperative hormonal deficit predicted normalization of the thyroid and male reproductive axes (p < 0.05). CONCLUSIONS After NFA resection, endocrine normalization rates in this study varied with the hormonal axis and were greater than the incidence of new endocrine deficits. Low preoperative gland volume precluded recovery. Patient age and the severity of the deficiency influenced the recovery of the thyroid and male reproductive axes, the most commonly impaired axes and most likely to normalize postoperatively. This information can be of use in counseling patients with hypopituitarism who undergo NFA surgery.

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Is casual employment in Australia bad for workers’ health?

Occupational and Environmental Medicine ◽

10.1136/oemed-2020-106568 ◽

2020 ◽

Vol 78 (1) ◽

pp. 15-21 ◽

Cited By ~ 1

Author(s):

Markus H Hahn ◽

Duncan McVicar ◽

Mark Wooden

Keyword(s):

Mental Health ◽

Short Form ◽

Bodily Pain ◽

Dynamic Panel Data ◽

Women Health ◽

Role Emotional ◽

Sf 36 ◽

Individual Household ◽

Permanent Workers ◽

The Impact

ObjectivesThis paper assessed the impact of working in casual employment, compared with permanent employment, on eight health attributes that make up the 36-Item Short Form (SF-36) Health Survey, separately by sex. The mental health impacts of casual jobs with irregular hours over which the worker reports limited control were also investigated.MethodsLongitudinal data from the Household, Income and Labour Dynamics in Australia Survey, over the period 2001–2018, were used to investigate the relationship between the eight SF-36 subscales and workers’ employment contract type. Individual, household and job characteristic confounders were included in dynamic panel data regression models with correlated random effects.ResultsFor both men and women, health outcomes for casual workers were no worse than for permanent workers for any of the eight SF-36 health attributes. For some health attributes, scores for casual workers were higher (ie, better) than for permanent workers (role physical: men: β=1.15, 95% CI 0.09 to 2.20, women: β=1.79, 95% CI 0.79 to 2.80; bodily pain: women: β=0.90, 95% CI 0.25 to 1.54; vitality: women: β=0.65, 95% CI 0.13 to 1.18; social functioning: men: β=1.00, 95% CI 0.28 to 1.73); role emotional: men: β=1.81, 95% CI 0.73 to 2.89, women: β=1.24, 95% CI 0.24 to 2.24). Among women (but not men), mental health and role emotional scores were lower for irregular casual workers than for regular permanent workers but not statistically significantly so.ConclusionsThis study found no evidence that casual employment in Australia is detrimental to self-assessed worker health.

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Medical studies during the COVID-19 pandemic: the impact of digital learning on burnout and mental health

10.21203/rs.3.rs-63097/v1 ◽

2020 ◽

Author(s):

Panagiotis Zis ◽

Artemios Artemiadis ◽

Panagiotis Bargiotas ◽

Antonios Nteveros ◽

Georgios M. Hadjigeorgiou

Keyword(s):

Mental Health ◽

Emotional Exhaustion ◽

Short Form ◽

Maslach Burnout Inventory ◽

Junior Doctors ◽

Digital Learning ◽

Student Survey ◽

Medical Studies ◽

Sf 36 ◽

The Impact

Abstract Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and the overall mental health (MH) of medical students.Background: During the unprecedent era of COVID-19 pandemic, the majority of countries worldwide adopted very strong measurements. The universities closed their doors and the education continued through digital learning lectures.Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory – Student Survey (MBI-SS).Results: Overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre COVID-19 18.1% vs COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre COVID-19 40.7% vs COVID-19 16.7%, p=0.011) whereas it increased significantly in year 6 (pre COVID-19 27.6% vs COVID-19 50%, p=0.01). When looking each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6 and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre COVID-19 58.8±21.6 vs COVID-19 48.3±23, p<0.001). Conclusions: Digital learning in medical studies carries significant risks. Not only the MH deteriorates the cynicism levels increase. Emotional exhaustion increases particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors.

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Role of Pituitary Stalk and Gland Radiological Status on Endocrine Function and Outcomes after Endoscopic Transsphenoidal Surgery for Non-functioning Pituitary Adenomas

10.21203/rs.3.rs-293803/v1 ◽

2021 ◽

Author(s):

Catalina Vivancos Sánchez ◽

Alexis Palpán Flores ◽

Víctor Rodríguez Domínguez ◽

Álvaro Zamarrón Pérez ◽

Cristina Álvarez-Escolá ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Pituitary Surgery ◽

Tumour Volume ◽

Endocrine Function ◽

Pituitary Stalk ◽

Endoscopic Transsphenoidal Surgery ◽

Improvement Rate ◽

Hormonal Function ◽

Younger Age

Abstract PurposeTo investigate endocrine function changes after nonfunctioning pituitary adenomas (NFPA) transsphenoidal surgery and to search for predictors of hypopituitarism resolution and development.MethodsWe included 117 patients with NFPA who underwent endoscopic transsphenoidal surgery from 2005 to 2019 by two neurosurgeons. 21 patients were excluded because of previous pituitary surgery or radiotherapy. We assessed symptoms at diagnosis, tumour volume, tumour removal, hormonal status at diagnosis, hormonal outcomes at 2- and 12-months follow-up, and complications. Pituitary stalk and gland MRI status (visible or not) were included, and its association to hormonal function was studied for the first time, to our knowledge.ResultsPituitary gland visualization was more frequent in those patients who showed a smaller number of axes affected at 12 months (p=0.011). Pituitary stalk status showed no association to hormonal function. Hormonal normalization rate at 12 months was 13%. Endocrine improvement rate at 12 months was 16.7%. Worsening of hormonal function occurred in 19.8% of patients. Younger age was associated to hormonal improvement (p=0.004). Higher preoperative tumour volume and absence of gross total resection (GTR) (p=0.049) were associated with worsening in at least one hormonal axis after surgery (p=0.015).Conclusionituitary gland visibility was higher in those patients who showed better hormonal outcomes. Assessment of initial hormonal function and outcome after surgery regarding pituitary stalk status showed no significant association. Higher preoperative tumor volumes and absence of GTR were associated to postoperative endocrine function worsening, while younger age was associated to its improvement.

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The examination of the quality of life changes of patients with urolithiasis regarding different methods of treatment

Vojnosanitetski pregled ◽

10.2298/vsp180309060g ◽

2020 ◽

Vol 77 (2) ◽

pp. 158-164

Author(s):

Branka Gvozdic ◽

Dragica Milenkovic-Petronic ◽

Nebojsa Ladjevic ◽

Aleksandar Vuksanovic ◽

Otas Durutovic

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Statistical Analysis ◽

Physical Health ◽

Short Form ◽

Ureteroscopic Lithotripsy ◽

Sf 36 ◽

The Impact

Background/Aim. Urolithiasis is one of the most common urological illnesses with a continual rise in incidence and prevalence in the population. Its pathogenesis is multifactorial; hence, its consequences are serious problems that can significantly impact the quality of life of patients. In the last years, operational modes of urolithiasis treatment had undergone evolution changes towards minimally invasive treatment techniques aimed at improving its efficacy and patients' life quality. The aim of the study was to examine and evaluate the quality of life of the patients with urolithiasis depending on the applied treatment method. Methods. This research was designed as a panel study ? a combination of a cross-sectional and cohort study. The sample included patients with urolithiasis treated with extracorporeal shock wave lithotripsy (ESWL) or ureteroscopic lithotripsy (Lithoclast). The research was carried during one year period and 100 respondents met the inclusion criteria. They were divided into two equal groups considering the applied method of the stone disintegration: the Lithoclast group (URSL) and the ESWL group. The instrument used for measuring the quality of life was Short Form (SF) 36 questionnaire. It was administrated to the patients immediately before the operation and one month after the operation. Results. The statistical analysis of the scores obtained preoperationally on the SF 36 questionnaire revealed the decrease in the quality of life of patients with urolithiasis in almost all dimensions of life. The statistically relevant difference in preoperative SF scores between the two groups of patients was not established except in the domain of the role of physical health and the domain of mental health. In the domain of the role of physical health, the Lithoclast group had a statistically significant higher score than the ESWL group, but in the domain of mental health, the ESWL group had a statistically significant higher score than the Lithoclast group. The postoperative statistical analysis of SF questionnaire and the examination of the impact of the treatment mode on the quality of life showed that the use of the Lithoclast method resulted in the much higher, statistically significant score at SF36 questionnaires regarding several life dimensions than the ESWL method. The application of the ESWL method even resulted in the decrease in the postoperational score for some life dimensions. Conclusion. The assessment of the quality of life is an adequate tool for the evaluation of treatment modes in the clinical practice. By using the SF 36 questionnaire in this study, we established that the ureteroscopic lithotripsy (the Lithoclast method) is a method that postoperatively results in much higher and statistically significant improvement of the quality of life of patients with urolithiasis in several health domains than the ESWL method.

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IMPACT OF SOCIO-DEMOGRAPHIC VARIABLES AND MORBID CONDITIONS ON PERCEIVED MENTAL HEALTH COMPONENTS USING SF-36 QUESTIONNAIRE

SRMS Journal of Medical Science ◽

10.21761/jms.v1i1.10935 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

S. K. Sharma ◽

V. P. Shrotriya ◽

D. Imtiaz ◽

S. B. Gupta

Keyword(s):

Mental Health ◽

Diabetes Mellitus ◽

Social Functioning ◽

Tertiary Care ◽

Perceived Health ◽

Subjective Assessment ◽

Care Hospital ◽

Sf 36 ◽

The Social ◽

The Impact

<bold>Introduction:</bold> Perceived Health is a subjective assessment of the physical as well as mental health and includes so many aspects as mentioned in SF-36 form that are difficult to capture clinically such as incipient disease, physiological, psychological reserves and social functions. To assess the impact of Diabetes Mellitus, Hypertension and other socio-demographic factors on the Social Functioning component of mental health of the patients attending a tertiary care hospital in Bareilly. <bold>Material and Methods:</bold> Perceived health status of the patients was assessed by the Social Functioning dimension of the Mental Component Summary (MCS) using the SF-36 form. <bold>Results:</bold> The presence of both Diabetes Mellitus and Hypertension was associated with lower Social Functioning scores compared to those with diabetes (p = 0.013) and hypertension alone. Age was negatively related with Social Functioning scores (p<0.001) but male gender (p>0.000) and higher income (p<0.424) were all associated with higher Social Functioning scores. Rural subjects were found to have better SF score compared to urban. <bold>Conclusion:</bold> Age, gender and morbidity was found to have profound influence on Social Functioning scoring of the subjects. However, the results should be interpreted in terms of the study’s limitations.

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The Relationship Between Highly Visual Social Media and Young People’s Mental Health: A Scoping Review (Preprint)

10.2196/preprints.18177 ◽

2020 ◽

Author(s):

Alanna McCrory

Keyword(s):

Mental Health ◽

Social Media ◽

Young People ◽

Scoping Review ◽

Quantitative Methods ◽

Grey Literature ◽

Significant Proportion ◽

Mental Wellbeing ◽

Published Evidence ◽

The Impact

UNSTRUCTURED Users of highly visual social media (HVSM), such as Snapchat and Instagram, share their messages through images, rather than relying on words. A significant proportion of people that use these platforms are adolescents. Previous research reveals mixed evidence regarding the impact of online social technologies on this age group’s mental wellbeing, but it is uncertain whether the psychological effects of visual content alone differ from text-driven social media. This scoping review maps existing literature that has published evidence about highly visual social media, specifically its psychological impact on young people. Nine electronic databases and grey literature from 2010 until March 2019 were reviewed for articles describing any aspect of visual social media, young people and their mental health. The screening process retrieved 239 articles. With the application of eligibility criteria, this figure was reduced to 25 articles for analysis. Results indicate a paucity of data that exclusively examines HVSM. The predominance of literature relies on quantitative methods to achieve its objectives. Many findings are inconsistent and lack the richness that qualitative data may provide to explore the reasons for theses mixed findings.

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Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students’ Burnout and Mental Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010349 ◽

2021 ◽

Vol 18 (1) ◽

pp. 349

Author(s):

Panagiotis Zis ◽

Artemios Artemiadis ◽

Panagiotis Bargiotas ◽

Antonios Nteveros ◽

Georgios M. Hadjigeorgiou

Keyword(s):

Mental Health ◽

Medical Students ◽

Emotional Exhaustion ◽

Short Form ◽

Maslach Burnout Inventory ◽

Junior Doctors ◽

Digital Learning ◽

Student Survey ◽

Medical Studies ◽

The Impact

Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. Background: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory—Student Survey (MBI-SS). Results: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01). When looking at each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6, and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre-COVID-19 58.8 ± 21.6 vs. COVID-19 48.3 ± 23, p < 0.001). Conclusions: Digital learning in medical studies carries significant risks. Not only does the MH deteriorate, but cynicism levels also increase. Emotional exhaustion was found to increase particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors.

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