Objective To investigate the association between depression and mortality in the elderly living in low‐ and middle‐income countries. Methods A systematic review and meta‐analysis was performed. We searched in five electronic databases for observational studies investigating the association between mortality and depression. Two reviewers worked independently to select articles, extract data, and assess study quality. Results A total of 10 studies including 13 828 participants (2402 depressed and 11 426 nondepressed) from six countries (Brazil, four articles; China, two articles; Botswana, India, South Africa, and South Korea, one article) were included. The overall unadjusted relative risk (RR) of mortality in depressed relative to nondepressed participants was 1.62 (95% CI, 1.39‐1.88; P < 0.001), with high heterogeneity (I2 = 66%; 95% CI, 33‐83; P < 0.005). After adjustment for publication bias, the overall RR decreased to 1.60 (95% CI, 1.37‐1.86; P < 0.001). No significant differences were observed between subgroups except those defined by study quality. The high‐quality studies had a pooled RR of 1.48 (95% CI, 1.32‐1.67; P < 0.001), while the low‐quality studies resulted had a pooled RR of 1.82 (95% CI, 1.25‐2.65; P < 0.005). Conclusions Depression is associated with excess mortality in the elderly living in low‐ and middle‐income countries. In addition, this excess mortality does not differ substantially from that found in high‐income countries. This suggests environmental factors occurring in low‐ and middle‐income countries might not have a direct association with the excess mortality in the depressed elderly.

Neither primary health care or family and community medicine are recognized as knowledge areas in Brazil, for the purpose of postgraduate education (master's, Ph.D.) or research. Our objective was to describe the postgraduate education trajectories of family and community physicians in Brazil. In this observational, exploratory study, we used data from SBMFC and SisCNRM to compile the list of physicians and community physicians, and then downloaded their curricula vitae from the Lattes Platform, verifying all data for consistency. A master's degree was held by one in eight, and a Ph.D., by one in forty; most degrees were in collective health. Women (versus men) were less likely to hold master's degrees, and even less likely to hold Ph.D. degrees. Professional (versus academic) master's degrees and those in other areas (versus in medicine or collective health) were also associated with lower probability of obtaining a Ph.D. degree. Certified specialists (versus those with a medical residency) with a postgraduate degree were more likely to have earned it before becoming family and community physicians. We suggest that researchers in public health critically examine the relative benefits of different postgraduate trajectories for the professional performance of family and community physicians.

ObjectiveOur objective was to describe the postgraduate education trajectories of family and community physicians in Brazil, where neither primary healthcare nor family and community medicine is recognised as a knowledge area for the purpose of research and postgraduate education (master’s and PhD degrees).DesignAn observational, exploratory study, using administrative data. A nationwide list of family and community physicians as of late November 2018 was compiled from multiple sources. Data on the mode of specialisation was obtained from the same sources and were correlated with data on master’s and PhD degrees, obtained from the curricula vitae on the Lattes Platform.SettingThis study was set in Brazil.Participants6238 family and community physicians (58.3% female), of whom 2795 had earned a specialist certificate (identified from the list of physicians certified by Sociedade Brasileira de Medicina de Família e Comunidade) and 3957 had completed medical residency (identified from SisCNRM, the national information system for medical residency).ResultsA master’s degree was held by 747 (12.0%) family and community physicians, and a PhD by 170 (2.7%); most degrees were in collective health (47.0% and 42%, respectively). Men were more likely than women to hold a master’s degree (adjusted odds ratio (aOR) 1.24, 95% uncertainty interval (UI) 1.07–1.45) and even more likely to a hold PhD (aOR 1.86, 95% UI 1.35–2.59). Family and community physicians were also less likely to hold a PhD degree if their master’s degree was professional (oriented towards jobs outside academia) instead of academic (aOR 0.15, 95% UI 0.05–0.39) or in some area other than collective health or medicine (aOR 0.41, 95% UI 0.21–0.78, compared with a master’s degree in collective health). The postgraduate degree was more likely to precede specialisation for family and community physicians specialising through certification (master’s degree 39.9%, PhD 33%) than through medical residency (master’s degree 9.1%, PhD 6%).ConclusionFamily and community physicians in Brazil increasingly earn academic and professional master’s and PhD degrees, with an emphasis on collective health, even though women seemingly face barriers to advance their education. The consequences of different postgraduate trajectories should be critically examined.

As revisões clínicas são sumários de evidências com escopo amplo e orientação à prática profissional, ocupando um dos mais altos níveis da pirâmide da assistência à saúde baseada em evidências. Com base nessa pirâmide, refletimos sobre as instruções aos autores de periódicos em medicina de família e comunidade para propor instruções para a escrita de revisões clínicas. As instruções abrangem a busca, avaliação, síntese e análise das evidências clínicas, além do planejamento e redação da revisão. Esperamos que estas instruções ajudem a elevar a quantidade e qualidade das revisões clínicas em medicina de família e comunidade no país.

In three months, covid-19 evolved from an outbreak of severe pneumonia in Wuhan, China, to a global pandemic with hundreds of thousands of confirmed cases and many thousands of deaths. 1 While China has all but stopped it, the pandemic continues to grow exponentially in most countries. Thanks to its exponential growth, covid-19 has been overwhelming healthcare systems and imposing a series of dilemmas throughout the world. One dilemma is the involvement of medical students in the response to covid-19. On the one hand, higher education students have seen their in-person activities replaced by remote activities. On the other hand, healthcare professionals have been summoned to maximize their clinical activities, which involve increased exposure to covid-19, among other contagious diseases. What then should be done about the medical students' clinical activities? Some say we should stop their clinical activities, while others say we must increase the activities or even fast-track the student' s graduation. WHETHER TO SUSPEND CLINICAL CLERKSHIP Clinical clerkship occupies the last one to two years of medical school and consists of practical activities in various clinical settings. The medical student' s clinical competence increases considerably during this phase, thanks to contact with real patients under direct supervision of qualified medical doctors. Depending on the context, contact with real patients involves exposition to contagious diseases, such as tuberculosis 2 or SARS 3. With the progressive focus of healthcare services towards handling the pandemics, keeping the clinical clerkship going on involves putting medical students in contact with covid-19 patients. We disagree with three arguments that have been put forward for keeping clinical clerkship or even deliberately directing it towards covid-19. The first and most prevalent argument is the need to increase the workforce in health services. This argument comes up against the fact that students are not part of the workforce: their clinical activities are selected based on the educational potential, not on the assistance demand. Besides, direct supervision means students deviate preceptors from performing their own clinical activities. 4 An effective increase in the workforce would require students to perform activities they are already qualified for, and without direct supervision, thus beating the whole purpose of medical education. The second argument is that the presence of students would increase the quality of the health services. While this is a well-known phenomenon, 4 temporarily removing medical students from the health services should not revert it. Furthermore, the covid-19 pandemic is depleting personal protective equipment (PPE) everywhere, and the continuing presence of medical students would multiply the demand for PPE. An early shortage of PPE would then result in preventable exposure of healthcare professionals and medical students alike to contagion by covid-19. Lastly, the third argument is that public health crises would comprise uniq...