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Xiao H, Shu W, Li M, Li Z, Tao F, Wu X, Yu Y, Meng H, Vermund SH, Hu Y. Social Distancing among Medical Students during the 2019 Coronavirus Disease Pandemic in China: Disease Awareness, Anxiety Disorder, Depression, and Behavioral Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145047. [PMID: 32674285 PMCID: PMC7399842 DOI: 10.3390/ijerph17145047] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
Background: During the coronavirus disease (COVID-19) pandemic, harsh social distancing measures were taken in China to contain viral spread. We examined their impact on the lives of medical students. Methods: A nation-wide cross-sectional survey of college students was conducted from 4–12 February 2020. We enrolled medical students studying public health in Beijing and Wuhan to assess their COVID-19 awareness and to evaluate their mental health status/behaviors using a self-administered questionnaire. We used the Patient Generalized Anxiety Disorder-7 and Health Questionnaire-9 to measure anxiety disorders and depression. We used multivariable logistic regression and path analysis to assess the associations between covariates and anxiety disorder/depression. Results: Of 933 students, 898 (96.2%) reported wearing masks frequently when going out, 723 (77.5%) reported daily handwashing with soap, 676 (72.5%) washed hands immediately after arriving home, and 914 (98.0%) reported staying home as much as possible. Prevalence of anxiety disorder was 17.1% and depression was 25.3%. Multivariable logistic regression showed anxiety to be associated with graduate student status (odds ratio (aOR) = 2.0; 95% confidence interval (CI): 1.2–3.5), negative thoughts or actions (aOR = 1.6; 95% CI: 1.4–1.7), and feeling depressed (aOR = 6.8; 95% CI: 4.0–11.7). Beijing students were significantly less likely to have anxiety than those in the Wuhan epicenter (aOR = 0.9; 95% CI: 0.8–1.0), but depression did not differ. Depression was associated with female students (aOR = 2.0; 95% CI: 1.2–3.3), negative thoughts or actions (aOR = 1.7; 95% CI: 1.5–1.9), and anxiety disorder (aOR = 5.8; 95% CI: 3.4–9.9). Path analysis validated these same predictors. Conclusions: Despite medical students’ knowledge of disease control and prevention, their lives were greatly affected by social distancing, especially in the Wuhan epicenter. Even well-informed students needed psychological support during these extraordinarily stressful times.
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Affiliation(s)
- Huidi Xiao
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (Z.L.)
| | - Wen Shu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (Z.L.)
| | - Menglong Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (Z.L.)
| | - Ziang Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (Z.L.)
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (F.T.); (X.W.)
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (F.T.); (X.W.)
| | - Yizhen Yu
- Department of Child and Women Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Y.); (H.M.)
| | - Heng Meng
- Department of Child and Women Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Y.); (H.M.)
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520, USA;
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06520, USA
| | - Yifei Hu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing 100069, China; (H.X.); (W.S.); (M.L.); (Z.L.)
- Correspondence: ; Tel./Fax: +86-10-83911747
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Patte KA, Faulkner G, Qian W, Duncan M, Leatherdale ST. Are one-year changes in adherence to the 24-hour movement guidelines associated with depressive symptoms among youth? BMC Public Health 2020; 20:793. [PMID: 32460742 PMCID: PMC7251664 DOI: 10.1186/s12889-020-08887-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background There remains a need for prospective research examining movement behaviours in the prevention and management of mental illness. This study examined whether changes in adherence to the 24-h Movement Guidelines (moderate-to-vigorous physical activity [MVPA], sleep duration, screen time) were associated with depression symptoms among youth. Methods Conditional change models were used to analyze two waves of longitudinal questionnaire data (2016/17, 2017/18) from students in grades 9–12 (N = 2292) attending 12 schools in Ontario and British Columbia, Canada, as part of the COMPASS study. One-year change in adherence to the MVPA, screen time, and sleep duration guidelines were modeled as predictors of depressive symptoms, adjusting for covariates and prior year depressive symptoms. Models were stratified by sex. Results Continued adherence to sleep guidelines and transitioning from inadequate to sufficient sleep were associated with lower depressive symptoms than continued nonadherence, and continued adherence was associated with lower depression than transitioning from sufficient to short sleep. For screen time, transitioning from exceeding guidelines to guideline adherence was associated with lower depressive symptoms than continued nonadherence. MVPA guideline adherence was not associated with depression scores, when controlling for sleep and screen time guideline adherence change and covariates. When combined, meeting additional guidelines than the year prior was associated with lower depressive symptoms among females only. Conclusions Adherence to the sleep guidelines emerged as the most consistent predictor of depression symptoms. Promoting adherence to the Movement Guidelines, particularly sleep, should be considered priorities for youth mental health at a population level.
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Affiliation(s)
- Karen A Patte
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada. .,School of Public Health and Health Systems, University of Waterloo, 200 University Ave, Waterloo, Ontario, N2L 3G1, Canada.
| | - Guy Faulkner
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Wei Qian
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave, Waterloo, Ontario, N2L 3G1, Canada
| | - Markus Duncan
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave, Waterloo, Ontario, N2L 3G1, Canada
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Janiri D, Doucet GE, Pompili M, Sani G, Luna B, Brent DA, Frangou S. Risk and protective factors for childhood suicidality: a US population-based study. Lancet Psychiatry 2020; 7:317-326. [PMID: 32171431 PMCID: PMC7456815 DOI: 10.1016/s2215-0366(20)30049-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Childhood suicidal ideation and behaviours are poorly understood. We examined correlates of suicidality in a US population-based sample of children participating in the Adolescent Brain and Cognitive Development (ABCD) study. The ABCD study aims to examine trajectories of mental health from childhood to adulthood and collects information on multiple domains, including mental and physical wellbeing, brain imaging, behavioural and cognitive characteristics, and social and family environment. We sought to identify and rank risk and protective factors for childhood suicidal thoughts and behaviours across these multiple domains and evaluate their association with self-agreement and caregiver agreement in reporting suicidality. METHODS The ABCD sample comprises a cohort of 11 875 children aged 9-10 years. The sociodemographic factors on which the sample was recruited were age, sex, race, socioeconomic status, and urbanicity. Participants were enrolled at 22 sites, the catchment area of which encompassed over 20% of the entire US population in this age group. Multistage sampling was used to ensure both local randomisation and representativeness of sociodemographic variation of the ABCD sample. The data used in this study were accessed from the ABCD Study Curated Annual Release 2.0. Suicidal thoughts and behaviours (suicidality) in each child were evaluated through independent child and caregiver reports based on the computerized Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5 (KSADS-5). We used bootstrapped logistic regression to quantify the association between suicidal ideation and behaviours, with measures of mental and physical wellbeing, behaviour, cognition, and social and family environment in participants from the ABCD study. FINDINGS Our study sample comprised 7994 unrelated children (mean age 9·9 years [SD 0·5]; 4234 [53%] male participants) with complete data on child-reported and caregiver-reported suicidal ideas and behaviours. Overall, 673 (8·4%) children reported any past or current suicidal ideation, 75 (0·9%) had any past or current suicidal plans, and 107 (1·3%) had any past or current suicidal attempts. According to caregivers, 650 (8·1%) of the children reported any past or current suicidal ideation, 46 (0·6%) reported any past or current suicidal plans, and 39 (0·5%) reported past or current suicidal attempts. However, inter-informant agreement was low (Cohen's κ range 0·0-0·2). Regardless of informant, child psychopathology (odds ratio [OR] 1·7-4·8, 95% CI 1·5-7·4) and child-reported family conflict (OR 1·4-1·8, 95% CI 1·1-2·5) were the most robust risk factors for suicidality. The risk of child-reported suicidality increased with higher weekend screen use time (OR 1·3, 95% CI 1·2-1·7) and reduced with greater parental supervision and positive school involvement (for both OR 0·8, 95% CI 0·7-0·9). Additionally, caregiver-reported suicidality was positively associated with caregiver educational level (OR 1·3, 95% CI 1·1-1·5) and male sex in children (1·5, 1·1-2·0), and inversely associated with the number of household cohabitants (0·8, 0·7-1·0). INTERPRETATION We identified risk and protective factors that show robust and generalisable associations with childhood suicidality. These factors provide actionable targets for optimising prevention and intervention strategies, support the need to identify and treat psychopathology in school-age children, and underscore the importance of school and family interventions for childhood suicidality. FUNDING National Institutes of Health.
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Affiliation(s)
- Delfina Janiri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; Centro Lucio Bini-Aretæus, Rome, Italy
| | - Gaelle E Doucet
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gabriele Sani
- Centro Lucio Bini-Aretæus, Rome, Italy; Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Paediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Guo N, Luk TT, Wang MP, Ho SY, Fong DYT, Wan A, Chan SSC, Lam TH. Self-Reported Screen Time on Social Networking Sites Associated With Problematic Smartphone Use in Chinese Adults: A Population-Based Study. Front Psychiatry 2020; 11:614061. [PMID: 33519554 PMCID: PMC7840886 DOI: 10.3389/fpsyt.2020.614061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Problematic smartphone use (PSU) has been associated with screen time in general, but little is known about the effect of different screen-based activities. We examined the associations of self-reported time spent on overall and specific screen-based activities with PSU and its addictive symptoms in Hong Kong Chinese adults. Methods: We analyzed data from 562 smartphone owners (56.5% female; 82.1% aged 25-64 years) in a population-based telephone survey in 2017. PSU was measured using Smartphone Addiction Scale-Short Version (range 10-60) which includes symptoms of daily-life disturbance, withdrawal, cyberspace-oriented relationship, overuse, and tolerance. Screen time was self-reported as average hours per day spent on the internet, online book/newspaper/magazine, online video, and social networking sites (SNS). Multivariable linear regression analyzed the associations of self-reported screen time with PSU severity and symptoms. Interaction effects of sex, age group, educational attainment, and monthly household income were examined. Results: Self-reported time spent on overall screen-based activities was associated with PSU severity (β = 1.35, 95% CI 0.15, 2.55) and withdrawal and overuse symptoms, after adjusting for sociodemographic and health-related variables. Independent association was observed for self-reported SNS time with PSU severity (β = 1.42, 95% CI 0.35, 2.49) and symptoms of withdrawal and cyberspace-oriented relationship, after mutually adjusting for time on other activities. The strongest association between self-reported SNS time and PSU severity was observed in younger than older adults (β = 4.36, 95% CI 2.58, 6.13; P for interaction = 0.004). Conclusions: The independent association of self-reported SNS time with PSU and core addictive symptoms highlighted the addiction potential of SNS use, particularly in younger users.
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Affiliation(s)
- Ningyuan Guo
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Tzu Tsun Luk
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | | | - Alice Wan
- Aberdeen Kai-fong Welfare Association Social Service, Hong Kong, China
| | | | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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Wang X, Li Y, Fan H. The associations between screen time-based sedentary behavior and depression: a systematic review and meta-analysis. BMC Public Health 2019; 19:1524. [PMID: 31727052 PMCID: PMC6857327 DOI: 10.1186/s12889-019-7904-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/05/2019] [Indexed: 01/27/2023] Open
Abstract
Background The use of computers/TV has become increasingly common worldwide after entering the twenty-first century and depression represents a growing public health burden. Understanding the association between screen time-based sedentary behavior (ST-SB) and the risk of depression is important to the development of prevention and intervention strategies. Methods We searched the electronic databases of Medline, Embase and the Cochrane Library. The odds ratio (OR) with corresponding 95% confidence intervals (CIs) was adopted as the pooled measurement. Subgroup analyses were investigated by stratified meta-analyses based on age, gender and reference group (reference category of screen time, e.g. 2 h/day, 4 h/day). Results There were 12 cross-sectional studies and 7 longitudinal studies met the inclusion criteria. Overall, the pooled OR was 1.28 with high heterogeneity (I2 = 89%). Compared to those who reported less SB, persons reporting more SB had a significantly higher risk of depression. When the gender was stratified, the pooled OR was 1.18 in female groups while no significant association was observed in males. Among the 19 studies, 5 studies used a reference group with ST = 2 h/days (pooled OR = 1.46), 9 studies used ≥4 h as a reference group (pooled OR = 1.38), 2 studies used 1 h as a reference group (pooled OR = 1.07) and for the remaining 3 studies, hours of ST were calculated as a continuous variable (pooled OR = 1.04). Conclusions ST-SB is associated with depression risk and the effects vary in different populations. In addition, valid objective measures of SB should be developed in future studies.
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Affiliation(s)
- Xiao Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, 85 Jiefang South Road, Taiyuan, 030001, Shanxi, China. .,Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, 100191, China.
| | - Yuexuan Li
- Judicial Expertise Center of Qiongshan District, Haikou Municipal Public Security Bureau, Haikou, 570000, Hainan, China
| | - Haoliang Fan
- Department of Forensic Science, Forensic Science Center of Hainan Medical University, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, 571199, Hainan, China. .,School of Forensic Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Katapally TR, Chu LM. Methodology to Derive Objective Screen-State from Smartphones: A SMART Platform Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132275. [PMID: 31252617 PMCID: PMC6651165 DOI: 10.3390/ijerph16132275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022]
Abstract
Time on screens (screen time) on multiple digital devices (computers, mobile phones, tablets, television screens, etc.) due to varied motivations (work, leisure, entertainment, gaming, etc.) has become an integral part of population behaviour. However, a significant evidence gap exists in screen time accumulated over ubiquitous mobile devices such as smartphones. This study aimed to develop an accurate, reliable and replicable methodology to derive objective screen time (i.e., screen-state) from all types of citizen-owned smartphones. A convenience sample of 538 adults (≥18 years) from two largest urban centres in Saskatchewan, Canada (Regina and Saskatoon) was recruited in 2017 and 2018. Participants used a custom-built smartphone application to provide objective and subjective data. A novel methodology was developed to derive objective screen-state, and these data were compared with subjective measures. The findings showed that objective screen-state from smartphones can be derived and assessed across a range of cut-points that take into consideration varied measurement errors. When objective measures were compared with subjective reporting, the results indicated that participants consistently underreported screen time. This study not only provides a methodology to derive objective screen-state from ubiquitous mobile devices such as smartphones but also emphasises the need to capture context via subjective measures.
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Affiliation(s)
- Tarun Reddy Katapally
- Johnson Shoyama Graduate School of Public Policy, University of Regina, 2155 College Ave, Regina, SK S4M0A1, Canada.
- Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, 101 Diefenbaker Pl, Saskatoon, SK S7N 5B8, Canada.
- College of Medicine, Health Science Building, 107 Wiggins Road, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
| | - Luan Manh Chu
- College of Medicine, Health Science Building, 107 Wiggins Road, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK S7N 2Z4, Canada
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Vandendriessche A, Ghekiere A, Van Cauwenberg J, De Clercq B, Dhondt K, DeSmet A, Tynjälä J, Verloigne M, Deforche B. Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? A 12-Country Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1072. [PMID: 30934658 PMCID: PMC6466024 DOI: 10.3390/ijerph16061072] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 01/26/2023]
Abstract
This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) "Health Behaviour in School-aged Children" 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents' psychological symptoms. Future interventions improving adolescents' mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.
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Affiliation(s)
- Ann Vandendriessche
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 4K3, B-9000 Ghent, Belgium.
| | - Ariane Ghekiere
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 4K3, B-9000 Ghent, Belgium.
| | - Jelle Van Cauwenberg
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 4K3, B-9000 Ghent, Belgium.
- Fund for Scientific Research Flanders (FWO), Egmontstraat 5, B-1000 Brussels, Belgium.
| | - Bart De Clercq
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 4K3, B-9000 Ghent, Belgium.
| | - Karlien Dhondt
- Department of Psychiatry: Pedicatric Sleep Center, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
| | - Ann DeSmet
- Fund for Scientific Research Flanders (FWO), Egmontstraat 5, B-1000 Brussels, Belgium.
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium.
| | - Jorma Tynjälä
- Faculty of Sport and Health Sciences, PO Box 35, FI-40014 University of Jyväskylä, Finland.
| | - Maïté Verloigne
- Fund for Scientific Research Flanders (FWO), Egmontstraat 5, B-1000 Brussels, Belgium.
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium.
| | - Benedicte Deforche
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 4K3, B-9000 Ghent, Belgium.
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium.
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