Longitudinal followup of Mind and Body components in medical students of the Universidad del Rosario

Introduction
University students generally do not maintan good eating habits or adecuate levels of physical activity. In addition, they are exposed to significant psychosocial stressors given by the demands of the academic environment. In Colombia, studies with college populations have shown a high prevalence of modifiable cardiovascular risk factors and of metabolic syndrome in these students, an alarming fact that justifies the promotion of healthy lifestyles in these university communities. However, to the best of our knowledge, there exist no longitudinal follow-up studies of cardiovascular health (CVH) factors in this population, in particular, of the 7 CVH components proposed by the American Heart Association, nor of cognitive and psychosocial factors associated with it.

Aims
We aim to evaluate the changes in CVH and cognitive and psychosocial factors such as emotional intelligence, perceived stress, and impulsivity in university students of the medical program, between the time of admission to their first year and one year into the program.

Methods
This is a longitudinal cohort study, where we will be taking measurements at two timepoints, the time of admission to the first semester of the university and a follow-up one year later. Participants will be men and women of Rosario University's medical program who are entering their first year. Students who are repeating the first semester or who have completed the first semester of college in another program or university will be excluded. Our calculated aample size is 197 students. All students enrolled in the first semester will be eligible.

The 7 components of CVH ( according to the American Heart Association) will be evaluated through validated instruments: current smoking, body mass index, physical activity, healthy eating, total cholesterol, fasting blood glucose, and blood pressure. Intrapersonal emotional intelligence will be assessed through the TMMS-24 questionnaire, empathy will be quantifyed with the Davis interpersonal reactivity test (DIRI), levels of perceived stress using the PSS-10 questionnaire, and choice impulsivity will be quantifyed via a widely used validated 2AFC decision-making task.

Analysis plan:
Mean differences and standard deviations of the CVH scale will be calculated between the time of admission to the first semester and one year later via a paired t-test. The prevalence (95% CI) of each of the 7 components of the CVH at different levels (poor, intermediate, or ideal) will be determined by calculating the difference found between the time of admission to the first semester and one year after. Possible differences between changes in prevalences will be evaluated using the chi2 test. The prevalence (95% CI) of each of the different levels (low, adequate and high) will be determined in the three dimensions of the emotional intelligence scale. Possible differences between changes in prevalences found using the chi2 test will be evaluated.

The average empathy score and each of its four dimensions (fantasy, perspective, empathic concern and personal distress ) will be determined, as well as the change in such scores between admission to the first semester and a year later, through paired t-tests. The prevalence perceived low, moderate and high levels of stress will be determined and comparisons will be made between the time of admission to the first semester and one year later using the chi2 test. The change between choice impulsivity levels measured with the decision-making task will be evaluated between the time of admission to the first semester and one year later, through a paired t-test.

The correlation between the dimensions of interpersonal emotional intelligence (attention, clarity and emotional repair), empathy (fantasy, perspective, empathic concern and personal "distress") and choice impulsivity will be assessed using Pearson or Spearman coefficientes accordingly .

Finally, we will investigate the relationship between psychosocial factors (emotional intelligence, perceived stress and choice impulsivity) and cardiovascular health, through a multivariate regression analysis, with the CVH score as a dependent variable and psychosocial factors (score obtained in emotional intelligence, in empathy, in perceived stress and levels of choice impulsivity) as independent variables, adjusting for covariates of interest.

Anticipated results
As part of this line of research in the promotion of CVH, the proposed longitudina follow-up of a cohort of medical students at Universidad del Rosario, will allow for a better understanding of these important factors in this population. We hope to identify whether there takes place a deterioration of CVH during that first year and to describe the relationship between CVH and psychosocial factors, facilitating the design of promotion and prevention strategies that we intend to evaluate in another future experimental design.