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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Anxiety and Coping Strategies among Medical Students during COVID-19 Pandemic: A Cross-sectional Study
Correspondence Address :
Dr. Kranti Tekulapally,
Plot No. 23, Royal Gardens, Jai Jawahar Nagar, Yapral, Hyderabad, Telangana, India.
E-mail: dr_t_kranti@yahoo.com
Introduction: Coronavirus Diseaese 2019 (COVID-19) pandemic has impacted the mental health of medical students due to multiple factors like the fear of getting infected, the stress of maintaining the preventive measures, the demands of the online classes, and the uncertainty of the future.
Aim: To assess the anxiety levels of the medical students and strategies, they used to cope up with the anxiety during the pandemic.
Materials and Methods: A cross-sectional study was carried out among all the first and final year MBBS students of a Women’s Medical College and Teaching Hospital in Hyderabad, Telangana, India. The questionnaire contained a total of 25 questions- three questions to collect the demographic data, a 7-item Generalised Anxiety Disorder Scale (GAD), and 15 questions assessing their coping strategies; was distributed to all the study participants as a Google form. Data from completed questionnaires were entered into an excel sheet and analysed using Jamovi software version 1.6.23.0.
Results: A total of 164 students completed the questionnaire of which, 59.1% were first year MBBS students and 40.8% final year MBBS students. Mean age of the participants were 19.4 years among the first year MBBS students, and 21.7 years among the final year MBBS students. Majority of the participants had mild anxiety (43.2%). There was no statistically significant difference in the anxiety levels of the first year MBBS and final year MBBS students. The most commonly used coping strategy factor was putting trust in the God (59.7% of first year MBBS, and 62.6% of final year MBBS) while the least commonly used coping strategy was substance abuse-use of alcohol or drugs to feel better (0 among first year MBBS and 2.9% among the final year MBBS). There was statistically significant association between one of the coping strategy and anxiety-I can adjust to the situation and deal with the changes and anxiety levels (p-value=0.010).
Conclusion: COVID-19 pandemic has impacted the mental health of medical students by causing anxiety. There is a need to mitigate these negative effects by introducing supportive programs in the form of educational programs, yoga and meditation to relieve anxiety and maintain mental health of medical students.
Coronavirus disease 2019, Mental health, Psychological impact, Stress
The World Health Organisation (WHO) defines mental health as the state of well-being in which an individual realises his or her abilities, can cope with the normal stresses of life, can work productively, and can contribute to his or her community (1).
The novel Coronavirus Disease 2019 (COVID-19), declared pandemic by WHO on 11th March, 2020 (2) has given unprecedent experiences to the mankind in the form of home confinement directives- stay at home or quarantine or isolation, use of masks and social distancing. Besides the rising number of cases and fatalities, there has been significant socio-economic, political and psychosocial impact due to the pandemic (3).
The COVID-19 has disrupted even the medical education system. It has triggered the introduction of new learning methods in medical education online education and examinations and virtual clinical learning (4). Medical students are known to be at a higher risk for developing anxiety disorders than general population even in normal situations (5). The COVID-19 pandemic has been associated with heavy psychological impact among medical workers and the general public (6). An Indian study reported that of the 83 final year students and junior doctors, 77% of them had mild anxiety and 9.8% had moderate anxiety (7). Imposition of unfamiliar public health measures including social distancing and lockdown, social fear related to COVID-19, closure of universities, fear of being infected by the SARS-CoV-2, anxiety for their removal from clinical practice, worry about older relatives and the abrupt swift to a new reality have negative impact on the psychological well-being of medical students (8),(9).
Previous coronavirus epidemics-Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) were associated with significant psychiatric burden in both acute and post illness stages (10). It is, therefore very imperative to recognise the impact of the novel coronavirus pandemic on the mental health status of the students.
Coping refers to the thoughts and behaviour people use to manage the internal and external demands of stressful events. There are many kinds of coping strategies. Problem-focused coping addresses the problem causing distress using strategies such as information gathering and decision making while emotion-focused coping regulates negative emotion using strategies such as distancing, seeking emotional support, and escape-avoidance. Meaning-focused coping draws on deeply held values and beliefs in the form of strategies such as goal revision, focusing on strengths gained from life experiences, and reordering priorities. An individual may also depend on emotional or instrumental support from others to reduce stress; the strategy termed social coping (11). The various types of coping often work in tandem to regulate the anxiety, make decisions and review underlying goals and values (12).
A study done on 217 undergraduate medical students in Chennai reported an increase in the prevalence of anxiety and stress during COVID-19 pandemic (13). There are no reports on the psychological impact of novel COVID-19 on medical students, especially from Telangana state. The present study was therefore planned to assess the anxiety levels and ways of coping during the period of COVID-19 pandemic and identify association of coping strategies with the anxiety levels.
A cross-sectional questionnaire-based study was carried out in a Women’s Medical College and Teaching Hospital in Hyderabad, Telangana, India, during December 2020. Approval from Institutional Ethics Committee was obtained prior to the initiation of the study. (IEC Project No. MRMCWIEC/AP/02/2020; Approval dated 17/11/2020).
Inclusion criteria: All the 300 MBBS students studying first year and final year MBBS in the college at the time of the study were enrolled. There were only these two academic batches in the college, during the study period.
Exclusion criteria: All non consenting students were excluded.
Study Procedure
The questionnaire used by Savitsky B et al., was adopted and was modified to suit the current applicability (questions in the demographic section were removed like family status, parental status, country of birth, population group, level of religiosity and occupational status, PPE availability as they were irrelevant to the current study population) (14). The modified questionnaire was prevalidated by departmental faculty. The questionnaire was distributed using Google form and a request to participate in the study was sent to all the students. Filling out of the form was accepted as a consent to participate in the study. The study questionnaire included demographic data like age, year of study, area of residence and a 7-item GAD scale to measure their anxiety. Coping was assessed using 15 common coping strategies like four factors of resilience, four factors of information seeking and consultation, a factor of substance abuse, two factors of spiritual and non scientific support, a factor of humour and three factors of mental disengagement. Students were instructed to choose on a 4-point scale for GAD and on a 5-point scale (not at all, rarely true, sometimes true, often true and true nearly all the time) for coping strategies. The GAD scores of 0-4 were categorised as minimal anxiety, 5-9 as mild anxiety, 10-14 as moderate, and 15-21 as severe anxiety (15). For analysis, the fourth and fifth Likert scale of coping strategy were combined and considered to be positive and dominant responses.
Statistical Analysis
Data obtained from completed forms was taken up for analysis. Descriptive statistics was used and results were expressed in percentages. Chi-square test of association was used to investigate the association of each coping strategy with anxiety levels. All the statistical analyses were performed with Jamovi software version 1.6.23.0. A value of p<0.05 was considered statistically significant for complete analysis.
Data of 164 students includes 97 (59.2%) students of first year MBBS and 67 (40.8%) students of final year MBBS were taken up for statistical analysis. The response rate was 54.6%. A total 159 (96.9%) of the students were urban residents, while only 5 (3.0%) of them were from rural areas. The age of distribution of the participants is given in (Table/Fig 1).
Anxiety levels among the students based on the scores of GAD are presented in (Table/Fig 2). There was no statistically significant differences in the levels of anxiety among the first year and final year students (p=0.741).
The dominant coping strategy used by the students is presented in (Table/Fig 3). Majority of the students put their trust in God to cope up with the situation. Significantly, students did not report substance abuse-using alcohol or drugs to reduce stress (1.2%).
A Chi-square test for association between the levels of anxiety and each of the coping strategy was performed. To perform this test, anxiety levels were considered under three categories- minimal, mild and moderate/severe; while each coping strategy was considered under two categories-dominant and non dominant. The results of this test are presented in (Table/Fig 4). All the expected cell frequencies were greater than five. There was statistically significant association between one of the factor of resilience-“I can adjust to the situation and deal with the changes and anxiety levels”, Chi-square value being 9.29 and p=0.010 and the strength of association was moderate (Cramer’s V value=0.23).
The results of the present study showed that majority of the students had mild levels of anxiety (43.8%). The reasons for mild levels of anxiety can be expected to be due to number of factors like the fear of contracting COVID-19 infection by them, facing unusual circumstances during the pandemic in the form of social distancing and using masks, challenges of online learning, uncertainty about future.
Similar study done among 215 nursing students of Israel revealed that 43% of them had moderate anxiety and 13% had severe anxiety (14). Cao W et al., reported that among 7,143 undergraduates of a medical college in China, 2.7% had moderate anxiety while 0.9% had severe anxiety (15). A meta-analysis of eight studies reported that the prevalence of anxiety among medical students during the COVID-19 pandemic was 28% (16).
The most commonly used coping strategies were putting themselves in the trust of God (60.9%). Religious coping, specifically turning to God, is a means of seeking comfort, support, and/or guidance from a divine being either within the domain of an organised religion, or on a more informal path through one’s own spirituality (17). Javed S and Parveen H reported that among the 475 male and female participants from various backgrounds, positive attitude and trust in God to be most frequently used coping strategies (18). Similarly, a cross-sectional community survey in India and Nigeria reported that, during the COVID-19 pandemic, a significant number of people adopted religious coping measures to combat their difficulties (19). Chow SK et al., reported that majority of healthcare workers in Malaysia reported to have positive religious coping and associated reduction in anxiety (20).
In contrast to the results of the present study, Baloran ET reported that the students from two colleges of South Philippines practiced safety measures during this great threat of global health security as a personal coping strategy (21). Another study done among students of six Jordan medical schools reported that cooking, baking, and hobby practicing were the most popular methods used to improve their mental well-being (22).
Resilience is a dynamic process wherein individuals display positive adaptation despite experiences of significant adversity or trauma (Goldberg and Williams, 1988) (23). The present study found statistically significant association of a factor of resilience- “I can adjust to the situation and deal with the changes” with anxiety levels. Haddadi P and Besharat MA evaluated the relationship between resilience, psychological well-being, psychological distress, depression, anxiety and general health and found negative correlation of resilience with vulnerability indexes including psychological distress, depression and anxiety (23).
Limitation(s)
The present study is limited by the facts, that, it is a single site study carried out in only females and with a limited sample size. Changes in the state of anxiety and their use of coping strategies over a period of time were also not measured.
In conclusion, the prevalence of anxiety among the students indicates the need to introduce student supportive programs at times of uncertainty like the COVID-19 pandemic. Faculty of the Medical colleges can be in touch with students, and can use some time during the online classes to provide emotional support and boost their confidence to face the situations. Programs which involve talks from the experts or even peers, yoga and meditation will also help to relieve anxiety of the students.
DOI: 10.7860/JCDR/2022/50677.15981
Date of Submission: Jun 03, 2021
Date of Peer Review: Sep 11, 2021
Date of Acceptance: Dec 23, 2021
Date of Publishing: Feb 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 04, 2021
• Manual Googling: Dec 15, 2021
• iThenticate Software: Dec 22, 2021 (24%)
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