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Sayed AI, Mobarki SJ, Oberi IA, Omar YZ, Moafa SH, Ayoub RA, Ajeebi Y, Hakami F, Hakami A, Somaili M. Effect of Stress on Sleep Quality among Medical Students: A Cross-sectional Study at Jazan University, Saudi Arabia. Ann Afr Med 2024; 23:586-593. [PMID: 39138930 DOI: 10.4103/aam.aam_7_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/18/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION It has long been understood that sleep is a necessary therapeutic element of human physiology and is crucial for healthy functioning, mental health, and quality of life. Medical students frequently minimize their sleep and habits to cope with their workload and their stressful lives, which has a negative influence on both mental health and academic performance. The purpose of this study was to evaluate the prevalence of stress and its effect on sleep quality among medical students (in both the preclinical and clinical years) at Jazan University in Saudi Arabia. MATERIALS AND METHODS A cross-sectional research design was applied in this study. The sample constituted medical students at Jazan University, Jazan region, Saudi Arabia. A self-administered online survey was distributed actively to measure the variables of interest. RESULTS This study examined the sleep quality and psychological distress among 347 students. The findings revealed that a significant proportion of students experienced sleep difficulties, with 52.8% reporting mild sleep problems and 46.6% reporting moderate sleep difficulties. In addition, a notable percentage of participants (28.2%) reported very high psychological distress, while 27.4% experienced severe psychological distress. CONCLUSIONS This study found that medical students had a high level of stress and poor sleep quality, which led to unhealthy habits, such as consuming many energy drinks. Hence, it is recommended that concerns should be addressed to minimize the risk of developing chronic illnesses.
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Affiliation(s)
- Ahmed I Sayed
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Yazan Z Omar
- Faculty of Medicine, Jazan University, Saudi Arabia
| | | | - Raum A Ayoub
- Faculty of Medicine, Jazan University, Saudi Arabia
| | - Yara Ajeebi
- Faculty of Medicine, Jazan University, Saudi Arabia
| | | | - Abdulrahman Hakami
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Somaili
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
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Tan E, Frambach J, Driessen E, Cleland J. Opening the black box of school-wide student wellbeing programmes: a critical narrative review informed by activity theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:663-687. [PMID: 37393378 DOI: 10.1007/s10459-023-10261-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes. METHOD This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation. RESULTS We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students' wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students' trust underpins the whole activity system. CONCLUSIONS Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.
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Affiliation(s)
- Emmanuel Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Janneke Frambach
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Erik Driessen
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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Davis-Cheshire R, Bennington S, Hartsek A, Kelly T, Marinelli J, Perez A. The Impact of Weighted Blanket Use on Adults with Sensory Sensitivity and Insomnia. Occup Ther Int 2023; 2023:3109388. [PMID: 38152339 PMCID: PMC10752672 DOI: 10.1155/2023/3109388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose This study's purpose was to determine the impact of weighted blanket use on moderate to severe insomnia in adults with sensory sensitivity greater than the average population. Methods For this study, a four-week, single-case, multiple-participant ABA study design was used. Through convenience sampling, four participants scoring 15 or greater on the Insomnia Severity Index (ISI), which categorizes them as having moderate to severe insomnia, and much more than most people in sensory sensitivity on the Adolescent/Adult Sensory Profile were recruited. First, seven-day baseline sleep data was gathered, followed by two weeks of weighted blanket use, concluding with a seven-day withdrawal phase. Additional outcome measures included: Tuck and Snooze Survey, Consensus Sleep Diary Morning, and Additional Sleep Diary Questions. Data analysis included visual analysis, mean comparisons, Tau-U calculations, and pre- to post-ISI category comparisons. Results All participants' ISI scores were categorized as one level less severe postintervention. All participants demonstrated increased sleep quality, and three participants showed an increase in sleep duration based on individual mean comparisons between baseline and intervention phases. Conclusion Weighted blankets appear beneficial in reducing insomnia severity in adults with much more than the average population sensory sensitivity. In addition, those with self-reported anxiety may have increased benefit from this intervention.
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Affiliation(s)
| | | | - Allison Hartsek
- Kettering College, 3737 Southern Blvd, Kettering, OH 45429, USA
| | - Teresa Kelly
- Kettering College, 3737 Southern Blvd, Kettering, OH 45429, USA
| | | | - Amanda Perez
- Kettering College, 3737 Southern Blvd, Kettering, OH 45429, USA
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Beute F, Aries MB. The importance of residential dusk and dawn light exposure for sleep quality, health, and well-being. Sleep Med Rev 2023; 72:101865. [PMID: 37864914 DOI: 10.1016/j.smrv.2023.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/23/2023]
Abstract
Light exposure during twilight plays a critical role in the entrainment of the human circadian system. People are most often at home during dusk and dawn, and light exposure at home - either natural or from electric light - may therefore contribute substantially to sleep and well-being. However, very little research has focused on the effects of home lighting on sleep and well-being, and even less research has investigated the effects of light exposure during twilight. Therefore, a literature study was performed to collect studies on light exposure at home during dusk and dawn. Studies looking at light exposure during dusk and dawn have focused on either electric light intervention (i.e., dusk and dawn simulation) at home or in the laboratory or daylight exposure in the bedroom (i.e., the presence and type of curtains in the bedroom). Most research has focused on dawn simulation during the darker months of the year, often using sunrise alarms. In general, study results pointed to the importance of twilight light exposure at home for sleep and well-being. These results may depend on the characteristics of the user, such as age or chronotype.
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Affiliation(s)
| | - Myriam Bc Aries
- Jönköping University, School of Engineering, Jönköping, Sweden.
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Castro L, Serrão C, Rodrigues AR, Marina S, dos Santos JPM, Amorim-Lopes TS, Miguel C, Teixeira A, Duarte I. Burnout, resilience, and subjective well-being among Portuguese lecturers' during the COVID-19 pandemic. Front Psychol 2023; 14:1271004. [PMID: 38146397 PMCID: PMC10749532 DOI: 10.3389/fpsyg.2023.1271004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Background Lecturers face a large wide of occupational stressors. If the prolonged stress and the symptomatology associated with the working conditions to which lecturers were exposed were already a concern before the pandemic, the pandemic may have exacerbated this psychosocial vulnerability. Burnout is a psychological syndrome that develops in response to chronic work stress. This study aims to describe burnout amongst lecturers working in Portugal and to analyse potential determinants of burnout during the COVID-19 pandemic. Methods A cross-sectional study was performed using an online questionnaire distributed via social networks. The survey collected sociodemographic and sleep patterns data in addition to applying the Copenhagen Burnout Inventory (personal, work- and student-related burnout), the Resilience Scale, the Depression Anxiety and Stress Scales, and the Satisfaction with Life Scale. Results The sample included 331 lecturers from 35 different colleges and faculties. Three significant models explained personal (R2 = 54%), work- (R2 = 47%) and student- (R2 = 19%) related burnout. Lower levels of resilience and higher levels of depression and stress were significantly associated with personal and work-related burnout. Changes in sleep patterns were additionally associated with both personal and work-related burnout. Conclusion Higher education institutions must recognize the impact of the work environment and organizational culture on faculty mental health and take proactive measures to improve this environment. These institutions can implement support strategies such as educational technology training, professional development programmes, emotional support resources, and workload flexibility. Implementing measures to enhance lecturers' resilience and overall life satisfaction could potentially help mitigate burnout and improve the well-being of educators, ultimately contributing to the overall quality of education.
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Affiliation(s)
- Luísa Castro
- Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Carla Serrão
- Escola Superior de Educação do Instituto Politécnico do Porto, Porto, Portugal
- Centre for Research and Innovation in Education (inED), Porto, Portugal
| | - Ana Rita Rodrigues
- University of Maia, Maia, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
| | - Sílvia Marina
- Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - José Paulo Marques dos Santos
- University of Maia, Maia, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Carla Miguel
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreia Teixeira
- Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- ADiT-LAB, InstitutoPolitécnico de Viana do Castelo, Rua Escola Industrial e Comercial Nun’Álvares, Viana do Castelo, Portugal
| | - Ivone Duarte
- Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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Binjabr MA, Alalawi IS, Alzahrani RA, Albalawi OS, Hamzah RH, Ibrahim YS, Buali F, Husni M, BaHammam AS, Vitiello MV, Jahrami H. The Worldwide Prevalence of Sleep Problems Among Medical Students by Problem, Country, and COVID-19 Status: a Systematic Review, Meta-analysis, and Meta-regression of 109 Studies Involving 59427 Participants. CURRENT SLEEP MEDICINE REPORTS 2023; 9:1-19. [PMID: 37359215 PMCID: PMC10238781 DOI: 10.1007/s40675-023-00258-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
Abstract Purpose of Review Several studies have found that medical students have a significant prevalence of sleep issues, such as poor sleep quality, excessive daytime sleepiness, and inadequate sleep duration. The purpose of this review is to carefully evaluate the current research on sleep problems among medical students and, as a result, estimate the prevalence of these disturbances. The EMBASE, PsychINFO, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science and retrieved article reference lists were rigorously searched and rated for quality. Random effects meta-analysis was performed to compute estimates. Recent Findings The current meta-analysis revealed an alarming estimated pooled prevalence of poor sleep quality (K = 95, N = 54894) of 55.64% [95%CI 51.45%; 59.74%]. A total of 33.32% [95%CI 26.52%; 40.91%] of the students (K = 28, N = 10122) experienced excessive sleepiness during the day. The average sleep duration for medical students (K = 35, N = 18052) is only 6.5 h per night [95%CI 6.24; 6.64], which suggests that at least 30% of them get less sleep than the recommended 7-9 h per night. Summary Sleep issues are common among medical students, making them a genuine problem. Future research should focus on prevention and intervention initiatives aimed at these groups. Supplementary Information The online version contains supplementary material available at 10.1007/s40675-023-00258-5.
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Affiliation(s)
- Mohammed A. Binjabr
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Idrees S. Alalawi
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Rayan A. Alzahrani
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Othub S. Albalawi
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Rakan H. Hamzah
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Yazed S. Ibrahim
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Fatima Buali
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mariwan Husni
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed S. BaHammam
- Department of Medicine, University Sleep Disorders Center and Pulmonary Service, King Saud University, KSA, Riyadh, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Michael V. Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA
| | - Haitham Jahrami
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Government Hospitals, Manama, Bahrain
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Shi C, Luo JM, Xiao Y. The association of sleep quality and burnout among Chinese medical residents under standardized residency training in a tertiary hospital. Sleep Breath 2023; 27:379-386. [PMID: 35460049 PMCID: PMC9033310 DOI: 10.1007/s11325-022-02621-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 04/15/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the impact of sleep quality and chronotype on job burnout among medical residents under standardized residency training (SRT) in a tertiary hospital in Beijing, China. METHODS Medical residents in the Department of Internal Medicine of Peking Union Medical College Hospital were assessed by Morning and Evening Questionaire-5 (MEQ-5), Pittsburgh sleep quality index (PSQI), and Maslach Burnout Inventory-General Survey (MBI-GS). Factors associated with burnout were analyzed. RESULTS A total of 142 respondents returned completed questionnaires. Burnout was present in 85 (60%) residents. Prevalence of high emotional exhaustion, high depersonalization, and low personal accomplishment were 51%, 28%, and 18%, respectively. The global PSQI score of residents was 5.9 ± 2.4, and the self-reported sleep duration was 6.2 ± 0.8 h/day. The MEQ-5 distribution skewed towards morningness, with a median score of 14.5 [13.0, 16.3]. Poor daytime function significantly predicted emotional exhaustion and depersonalization. Chronotypes were not associated with any of the burnout components. CONCLUSION Sleep-related daytime dysfunction was strongly related to burnout. Strategies protecting the sleep of residents should be incorporated into the SRT programs for both efficiency and sustainability considerations.
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Affiliation(s)
- Chuan Shi
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China
| | - Jin-Mei Luo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China.
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China
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Li M, Han Q, Pan Z, Wang K, Xie J, Zheng B, Lv J. Effectiveness of Multidomain Dormitory Environment and Roommate Intervention for Improving Sleep Quality of Medical College Students: A Cluster Randomised Controlled Trial in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15337. [PMID: 36430060 PMCID: PMC9691206 DOI: 10.3390/ijerph192215337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Medical students are vulnerable to sleep disorders, which could be further exaggerated by poor dormitory environment and roommate behaviour. However, there is little evidence of whether dormitory environment intervention is effective in improving the sleep quality of medical college students in developing countries. The present study aimed to evaluate the effects of a comprehensive multidomain intervention on dormitory environment and roommate behaviour among medical college students in China. In this cluster randomised controlled trial, a total of 106 dormitories (364 students) were randomly allocated into an intervention group (55 dormitories, 193 students) and a control group (51 dormitories, 171 students). The intervention group received a three-month intervention with multiple components to improve or adapt to sleep environments in dormitories; the control group received no intervention. Primary and secondary outcomes were measured at study enrolment and three months later for both groups. The linear mixed-effects models showed that, compared with the control group, the intervention was associated with a significantly decreased Pittsburgh Sleep Quality Index (β = -0.67, p = 0.012), and a marginally significant effect on reducing roommates' influence on sleep schedule (β = -0.21, p = 0.066). Students in the intervention group rated "making dormitory sleep rules" and "wearing eye masks" as the most effective intervention measures. These findings could contribute to the limited body of scientific evidence about sleep intervention in Chinese medical students and highlight the importance of dormitory sleep environments in maintaining sleep quality.
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Affiliation(s)
- Man Li
- Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Yuexiu District, Guangzhou 510060, China
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Qing Han
- Department of Social Policy and Intervention, University of Oxford, Oxford OX1 2ER, UK
| | - Ziqi Pan
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Kailu Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Junqing Xie
- Centre for Statistics in Medicine and National Institute for Health and Care Research Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford OX3 7LD, UK
| | - Bang Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
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