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1.  Experienced stressors and coping strategies among Iranian nursing students 
BMC Nursing  2007;6:11.
Background
College students are prone to stress due to the transitional nature of college life. High levels of stress are believed to affect students' health and academic functions. If the stress is not dealt with effectively, feelings of loneliness, nervousness, sleeplessness and worrying may result. Effective coping strategies facilitate the return to a balanced state, reducing the negative effects of stress.
Methods
This descriptive cross-sectional study was performed to determine sources of stress and coping strategies in nursing students studying at the Iran Faculty of Nursing & Midwifery. All undergraduate nursing students enrolled in years 1-4 during academic year 2004-2005 were included in this study, with a total of 366 questionnaires fully completed by the students. The Student Stress Survey and the Adolescent Coping Orientation for Problem Experiences Inventory (ACOPE) were used for data collection.
Results
Most students reported "finding new friends" (76.2%), "working with people they did not know" (63.4%) as interpersonal sources of stress, "new responsibilities" (72.1%), "started college" (65.8%) as intrapersonal sources of stress more than others. The most frequent academic source of stress was "increased class workload" (66.9%) and the most frequent environmental sources of stress were being "placed in unfamiliar situations" (64.2%) and "waiting in long lines" (60.4%). Interpersonal and environmental sources of stress were reported more frequently than intrapersonal and academic sources. Mean interpersonal (P=0.04) and environmental (P=0.04) sources of stress were significantly greater in first year than in fourth year students. Among coping strategies in 12 areas, the family problem solving strategies, "trying to reason with parents and compromise" (73%) and "going along with family rules" (68%) were used "often or always" by most students. To cope with engaging in demanding activity, students often or always used "trying to figure out how to deal with problems" (66.4%) and "trying to improve themselves" (64.5%). The self-reliance strategy, "trying to make their own decisions" (62%); the social support strategies, "apologizing to people" (59.6%), "trying to help other people solve their problems" (56.3%), and "trying to keep up friendships or make new friends" (54.4%); the spiritual strategy, "praying" (65.8%); the seeking diversions strategy, "listening to music" (57.7%), the relaxing strategy "day dreaming" (52.5%), and the effort to "be close with someone cares about you" (50.5%) were each used "often or always" by a majority of students. Most students reported that the avoiding strategies "smoking" (93.7%) and "drinking beer or wine" (92.9%), the ventilating strategies "saying mean things to people" and "swearing" (85.8%), the professional support strategies "getting professional counseling" (74.6%) and "talking to a teacher or counselor" (67.2%) and the humorous strategy "joking and keeping a sense of humor" (51.9%) were used "seldom or never".
Conclusion
First year nursing students are exposed to a variety of stressors. Establishing a student support system during the first year and improving it throughout nursing school is necessary to equip nursing students with effective coping skills. Efforts should include counseling helpers and their teachers, strategies that can be called upon in these students' future nursing careers.
doi:10.1186/1472-6955-6-11
PMCID: PMC2203983  PMID: 17999772
2.  Stress among Mansoura (Egypt) baccalaureate nursing students 
Background
Over the last years, details regarding levels of stress and sources of stress have emerged in studies of nursing students in Western population To date, there only few similar reports on clinical stress, anxiety, depression among the Arab population .This study was conducted to examine the level of perceived stress among baccalaureate Mansoura nursing students and to highlight the possible predicting factors.
Methods
In this cross- sectional study, Data were obtained from 373 students using a self-administered questionnaire, including questions on sociodemographics, list of possible stressors, perceived stress, physical wellbeing factors, anxiety and depressive symptoms.
Results
Prevalence of high stress level, anxiety and depression were 40.2%, 46.6% and 27.9%, respectively. On average each student reported a mean of 4.6 stressors and academic pressures were the most frequent stressors .In regression analysis the number of stressors and global sickness index score were predictors of high stress level.
Conclusion
These findings call for introduction of stress management programs and psychiatric care into nursing health services of the University.
PMCID: PMC3201591  PMID: 22121435
Nursing students; stress; Depression; Anxiety; Arab culture; Egypt
3.  Gastrointestinal complaints in shift-working and day-working nurses in Iran 
Background
There is evidence in the scientific literature of the adverse physiological and psychological effects of shift work. The work of nurses in hospitals is connected with shift and night work. Several publications have described gastrointestinal disturbances in shift workers. The aim of this study was to compare the frequency of gastrointestinal (GI) complaints of nurses on a rotating shift with that of nurses on a regular day shift.
Methods
The study involved 160 nurses (133 working in shifts and at night and 27 working on day shifts) in the Shahid Beheshti Hospital in Kashan, Iran. These nurses answered a Gastrointestinal Symptom Questionnaire regarding the presence of gastrointestinal symptoms (including heartburn, regurgitation, constipation, diarrhea and bloating). Positive responses required frequent symptom occurrence in the past 4 weeks. Significance of group differences was assessed by chi-square and Fisher-exact tests.
Results
Prevalence of GI symptoms was significantly higher (p = 0.009) in rotating-shift nurses (81.9%) than in day-shift nurses (59.2%). Irregular meal consumption (p = 0.01) and GI medications (p = 0.002) were all significantly higher among the rotating shift nurses. In both groups, regurgitation was the most common symptom.
Conclusion
Nurses on rotating shifts in Iran experience more GI disturbances than do nurses on day shifts.
doi:10.1186/1740-3391-8-9
PMCID: PMC2958856  PMID: 20929565
4.  Mental Health of Muslim Nursing Students in Thailand 
ISRN Nursing  2012;2012:463471.
The purpose of this research was to explore the mental health and well-being of Muslim nursing students in Thailand. Specifically, the study investigated the factors that impact anxiety and depression among Muslim nursing students. This cross-sectional research was conducted with a half sampling method of Muslim undergraduate students who were studying at a public nursing college in Thailand. From the 220 self-identified Muslim nursing students, 110 were sampled for this study, representing 14% of the total nursing students at this college. Results indicated a moderate prevalence of anxiety and high prevalence of depression among Muslim nursing students. Stress (β = .42) was positively associated with anxiety, while self-esteem (β = -.42) was negatively associated with anxiety; together this model accounted for 46% of the variance in anxiety. Self-esteem (β = -.41) and social support (β = -.17) were negatively associated with depression, while stress (β = .37) was positively correlated with depression; together this model accounted for 57% of the variance in depression. Recommendations were given to help train Muslim nursing students to be competent nurses with good mental health and well-being who will succeed and contribute to the nursing profession.
doi:10.5402/2012/463471
PMCID: PMC3389714  PMID: 22792481
5.  The emerging dental workforce: why dentistry? A quantitative study of final year dental students' views on their professional career 
BMC Oral Health  2007;7:7.
Background
Dental graduates are joining a profession experiencing changes in systems of care, funding and skill mix. Research into the motivation and expectations of the emerging workforce is vital to inform professional and policy decisions. The objective of this research was to investigate final year dental students' perceived motivation for their choice of career in relation to sex, ethnicity and mode of entry.
Methods
Self-administered questionnaire survey of all final year dental students at King's College London. Data were entered into SPSS; statistical analysis included Chi Squared tests for linear association, multiple regression, factor analysis and logistic regression.
Results
A response of 90% (n = 126) was achieved. The majority were aged 23 years (59%), female (58%) and Asian (70%). One in 10 were mature students. Eighty per cent identified 11 or more 'important' or 'very important' influences, the most common of which were related to features of the job: 'regular working hours' (91%), 'degree leading to recognised job' (90%) and 'job security' (90%). There were significant differences in important influences by sex (males > females: 'able to run own business'; females > males: 'a desire to work with people'), ethnic group (Asians > white: 'wish to provide public service', 'influence of friends', 'desire to work in healthcare', having 'tried an alternative career/course' and 'work experience') and mode of entry (mature > early entry: 'a desire to work with people'). Multivariate analysis suggested 61% of the variation in influences is explained by five factors: the 'professional job' (31%), 'healthcare-people' (11%), 'academic-scientific' (8%), 'careers-advising' (6%), and 'family/friends' (6%). The single major influence on choice of career was a 'desire to work with people'; Indian students were twice as likely to report this as white or other ethnic groups.
Conclusion
Final year dental students report a wide range of important influences on their choice of dentistry, with variation by sex, ethnicity and mode of entry in relation to individual influences. Features of the 'professional job', followed by 'healthcare and people' were the most important underlying factors influencing choice of career.
doi:10.1186/1472-6831-7-7
PMCID: PMC1929066  PMID: 17573967
6.  Evaluation of needle stick injuries among nurses of Khanevadeh Hospital in Tehran 
BACKGROUND:
Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens (such as HBV, HCV and HIV) via sharp injuries of needle stick.
METHODS:
This descriptive analytical cross-sectional study was done on 158 nursing workers of Khanevadeh Hospital in Tehran to assess needle stick injuries prevalence and related factors via a questionnaire in 2008. Data were processed through SPSS 16.0software using Pearson’s correlation coefficient, chi-square, independent t, and Fisher exact tests.
RESULTS:
About 40.5% of all participants were men and 59.5% were women. Mean age was 33.26 (8.03) years; 56.96% of participants had history of at least one needle stick injury and 22.15% of them had needle stick injury during last year. Injections were the most common action resulted to exposure (24.44%) and recapping of needles was at the second order (21.11%). Operation room had the highest prevalence (18.9%) of needle stick injuries among all wards of hospital. Emergency ward and ICU were next orders (15.6%). Exposed people believed that the most important and basic reason for needle stick injuries was patients crowdedness and hospital chaos (37.8%). There was no relation between ages, gender, years of professional life, education level and needle stick injuries but men used latex gloves less than women and did recapping needles more than them.
CONCLUSIONS:
The needle-stick injuries in nursing workers of Khanevadeh hospital (Tehran) were significantly less than other similar studies in Iran.
PMCID: PMC3093184  PMID: 21589791
Needle-stick injury; health personnel; needles
7.  Practice nurses' workload, career intentions and the impact of professional isolation: A cross-sectional survey 
BMC Nursing  2010;9:2.
Background
Practice nurses have a key role within UK general practice, especially since the 2004 GMS contract. This study aimed to describe that role, identify how professionally supported they felt and their career intentions. An additional aim was to explore whether they felt isolated and identify contributory factors.
Methods
A cross-sectional questionnaire survey in one large urban Scottish Health Board, targeted all practice nurses (n = 329). Domains included demographics, workload, training and professional support. Following univariate descriptive statistics, associations between categorical variables were tested using the chi-square test or chi-square test for trend; associations between dichotomous variables were tested using Fisher's Exact test. Variables significantly associated with isolation were entered into a binary logistic regression model using backwards elimination.
Results
There were 200 responses (61.0% response rate). Most respondents were aged 40 or over and were practice nurses for a median of 10 years. Commonest clinical activities were coronary heart disease management, cervical cytology, diabetes and the management of chronic obstructive pulmonary disease. Although most had a Personal Development Plan and a recent appraisal, 103 (52.3%) felt isolated at least sometimes; 30 (15.5%) intended leaving practice nursing within 5 years.
Isolated nurses worked in practices with smaller list sizes (p = 0.024) and nursing teams (p = 0.003); were less likely to have someone they could discuss a clinical/professional (p = 0.002) or personal (p < 0.001) problem with; used their training and qualifications less (p < 0.001); had less productive appraisals (p < 0.001); and were less likely to intend staying in practice nursing (p = 0.009). Logistic regression analysis showed that nurses working alone or in teams of two were 6-fold and 3.5-fold more likely to feel isolated. Using qualifications and training to the full, having productive appraisals and planning to remain in practice nursing all mitigated against feeling isolated.
Conclusions
A significant proportion of practice nurses reported feeling isolated, at least some of the time. They were more likely to be in small practices and more likely to be considering leaving practice nursing. Factors contributing to their isolation were generally located within the practice environment. Providing support to these nurses within their practice setting may help alleviate the feelings of isolation, and could reduce the number considering leaving practice nursing.
doi:10.1186/1472-6955-9-2
PMCID: PMC2823612  PMID: 20205777
8.  Perceived Stress, Sources and Severity of Stress among medical undergraduates in a Pakistani Medical School 
Background
Recently there is a growing concern about stress during undergraduate medical training. However, studies about the same are lacking from Pakistani medical schools. The objectives of our study were to assess perceived stress, sources of stress and their severity and to assess the determinants of stressed cases.
Methods
A cross-sectional, questionnaire-based survey was carried out among undergraduate medical students of CMH Lahore Medical College, Pakistan during January to March 2009. Perceived stress was assessed using the perceived stress scale. A 33-item questionnaire was used to assess sources of stress and their severity.
Results
The overall response rate was 80.5% (161 out of 200 students). The overall mean perceived stress was 30.84 (SD = 7.01) and was significantly higher among female students. By logistic regression analysis, stressed cases were associated with occurrence of psychosocial (OR 5.01, 95% CI 2.44-10.29) and academic related stressors (OR 3.17 95% CI 1.52-6.68). The most common sources of stress were related to academic and psychosocial concerns. 'High parental expectations', 'frequency of examinations', 'vastness of academic curriculum', 'sleeping difficulties', 'worrying about the future', 'loneliness', 'becoming a doctor', 'performance in periodic examinations' were the most frequently and severely occurring sources of stress. There was a negative but insignificant correlation between perceived stress and academic performance (r = -0.099, p > 0.05).
Conclusion
A higher level of perceived stress was reported by the students. The main stressors were related to academic and psychosocial domains. Further studies are required to test the association between stressed cases and gender, academic stressors and psychosocial stressors.
doi:10.1186/1472-6920-10-2
PMCID: PMC2820489  PMID: 20078853
9.  Food consumption frequency and perceived stress and depressive symptoms among students in three European countries 
Nutrition Journal  2009;8:31.
Background
Certain foods might be more frequently eaten under stress or when higher levels of depressive symptoms are experienced. We examined whether poor nutritional habits are associated with stress and depressive symptoms and whether the relationships differ by country and gender in a sample from three European countries collected as part of a Cross National Student Health Survey.
Methods
A cross-sectional survey was conducted among first-year students in Germany (N = 696), Poland (N = 489) and Bulgaria (N = 654). Self-administered questionnaires included a 12-item food frequency questionnaire, Cohen's Perceived Stress Scale, and a modified Beck Depression Index. Linear regression analyses were conducted for two outcomes, perceived stress and depressive symptoms.
Results
Food consumption frequencies differed by country and gender, as did depressive symptoms and perceived stress. For male students, none of the food consumption groups were associated with perceived stress or depressive symptoms. In females, perceived stress was associated with more frequent consumption of sweets/fast foods and less frequent consumption of fruits/vegetables. Additionally, depressive symptoms were associated with less frequent consumption of fruits/vegetables and meat.
Conclusion
Our data show consistent associations between unhealthy food consumption and depressive symptoms and perceived stress among female students from three European countries, but not among male students. This suggests that efforts to reduce depressive symptoms and stress among female students may also lead to the consumption of healthier foods and/or vice-versa.
doi:10.1186/1475-2891-8-31
PMCID: PMC2716364  PMID: 19604384
10.  Clinical Decision Making of Nurses Working in Hospital Settings 
Nursing Research and Practice  2011;2011:524918.
This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.
doi:10.1155/2011/524918
PMCID: PMC3182333  PMID: 21994830
11.  Prescription of medicines by medical students of Karachi, Pakistan: A cross-sectional study 
BMC Public Health  2008;8:162.
Background
Prescription of medicines by non-doctors is an issue with serious global implications. To our knowledge prescription of drugs by medical and non-medical students has not been studied before. We aimed to determine the practice and attitudes of drug prescription by medical students and: a) how non-medical students respond to this practice, b) How this compares with the attitudes and practices of non-medical students.
Methods
A cross-sectional study was conducted on a sample of 600 students randomly selected from 2 medical and 2 non-medical universities. Ethical requirements were ensured and data was collected using self administered questionnaires. The Chi square tests and logistic univariate regression analyses were performed using SPSS v 14 to identify associations and differences.
Results
A total of 572 forms were completed and the sample consisted of 295 medical students and 277 non-medical students with no significant difference in their demographic profile. Of the 295 medical students 163 (55.3%) had prescribed a medicine independently and most (48.5%) said that they did this 2–3 times a year. The commonest reasons for this were 'previous experience' (68.7%), 'problem too trivial' (34.4%) and 'we knew everything about the condition' (31.3%). One-third (33.6%) of the undergraduate medical students thought that it was alright to independently diagnose an illness while a vast majority (78.3%) thought that it was alright for them to prescribe medicines to others. Common prescriptions were pain-killers, antipyretics, antiallergics and antibiotics. Medical students who prescribed medicines were of lesser age (CI = 1.366–1.887) and more likely to belong to the 1st (CI = 3.588–21.731), 2nd (CI = 2.059– 10.869) or 3rd (CI = 4.331–26.374) year of medical college. One-third (33.9%) of the non-medical students reported that a medical student had prescribed medicines to them and 21.3% said that they trusted medical students and would follow their advice blindly. Many students thought it alright for medical students to diagnose and treat illnesses. A similar proportion of non-medical students (58.5%) reported prescribing medicines to others.
Conclusion
Prescription of medicines by non-doctors is rampant and urgent corrective measures are warranted. We have highlighted areas for future research and intervention and have given a few recommendations.
doi:10.1186/1471-2458-8-162
PMCID: PMC2408580  PMID: 18485246
12.  A case-control study on the dietary taurine intake, nutrient status and life stress of functional constipation patients in Korean male college students 
Journal of Biomedical Science  2010;17(Suppl 1):S41.
Background
Constipation is a common gastrointestinal symptom in Korea as well as in Western countries. This study was performed to investigate the dietary taurine intake, nutrient status, and life stress of functional constipation (FC) patients in Korean male college students.
Methods
Research data were collected in 2008 and a total of 104 male students (52 with FC patients and 52 healthy controls without FC) were included. FC patients were defined by the codes for the RomeⅡ Modular Questionnaire and healthy controls without FC were matched for age, height, weight and BMI. A self-administered life stress score and 3-day recall method were used to assess life stress level and dietary intake, respectively.
Results
The averages of age, height, weight, body fat percentage and body mass index (BMI) of male students were 23.4 years, 174.1 cm, 71.9 kg, 19.0 % and 23.7 kg/m2, respectively. Average intake of dietary taurine was 126.8 mg/day in FC patients and 105.1 mg/day in control group. The average intake of total calorie (p<0.05), plant protein (p<0.01), plant fat (p<0.001), carbohydrate (p<0.05), plant calcium (p<0.05) of FC patients were significantly higher compared to control group. The average total life stress score (p<0.01), economy problem score (p<0.05), future problem score (p<0.05) and value problem score (p<0.05) of FC patients were significantly higher compared to control group.
Conclusions
These results may suggest that FC patients show a higher life stress score and intake of some nutrient such as total calorie, plant protein, plant fat, carbohydrate and plant calcium in Korean male college students. Therefore, a further large-scale study is needed about correlation between life stress and nutrients intake including dietary taurine.
doi:10.1186/1423-0127-17-S1-S41
PMCID: PMC2994376  PMID: 20804618
13.  Stress and health related quality of life of Nepalese students studying in South Korea: A cross sectional study 
Background
In recent years there has been a growing trend among students to travel for educational purposes to other countries where there is the possibility of experiencing considerable amounts of stress affecting their physical and mental functioning. The aims of the current study were to investigate the health related quality of life (HRQOL) of Nepalese students studying in South Korea to explore the relationship between HRQOL and perceived and acculturative stress, and to identify the determinants of HRQOL.
Methods
One hundred and thirty students were enrolled in this study. HRQOL was assessed using the Medical Outcomes Study Short Forms (SF-12) questionnaire. Perceived stress and acculturative stress was measured using the Perceived Stress Scale and Acculturative Stress Scale for international students, respectively. Pearson's correlation test and multiple regression analysis were performed.
Results
Perceived stress and acculturative stress were negatively correlated with HRQOL. The highest value in the HRQOL was reported for the vitality subscale and the lowest value was reported for the role-emotional. In the regression model, perceived stress, acculturative stress, relationship with advisor, and marital status accounted for a significant (p < .001) portion of the variance (49%) in the mental component summary of the HRQOL.
Conclusions
The findings of this study indicate that Nepalese students studying in South Korea experience a considerable amount of perceived and acculturative stress, which is negatively related with their HRQOL. Provision of culture specific counseling and orientation programs may benefit the students. The determinants of HRQOL identified in this study were perceived stress, acculturative stress, relationship with advisor, and marital status.
doi:10.1186/1477-7525-10-26
PMCID: PMC3334675  PMID: 22410138
Health related quality of life; Stress; Acculturation; Students; Nepal
14.  Barriers to enrolment into a professional upgrading programme for enrolled nurses in Kenya 
The Pan African Medical Journal  2012;13(Supp 1):10.
Introduction
Nurses play a key role in the provision of health care. Over 70% of the nurses in Kenya are Enrolled Community Health Nurses (ECHNs). AMREF in partnership with Nursing Council of Kenya and the Ministry of Health pioneered an eLearning Nurse Upgrading Programme. The purpose of this study was to identify barriers that hindered enrolment into the programme.
Methods
A descriptive cross-sectional design was used. A sample of 532 ECHNs was interviewed from four provinces. Data was collected using a pre-tested self administered questionnaire. Analysis was done using SPSS computer software. Descriptive statistics were calculated for all variables and chi-square tests used to determine variables that were associated with enrolment. Mann Whitney U-test was used for continuous variables.
Results
A third (29.7%) of the nurses were from Rift Valley province and 17.9% from Coast. Majority (75%) were from public health facilities. The mean age of the nurses was 40.6 years. The average monthly income was KES 22,497.68 (USD 294). Awareness of the upgrading programme was high (97%) among the nurses. The cost of fees was the main (74.1%) barrier to enrolment in all the provinces and across all the health facilities. The type of health facility was significantly (p < 0.05) associated with enrolment. Nurses from faith-based health facilities were less likely to have enrolled.
Conclusion
Awareness of the upgrading programme is high. The cost of upgrading programme, age and working in a faith-based health facility are the main barriers to enrolment. Intervention that fund nurses to upgrade would increase nurse enrolment.
PMCID: PMC3589248  PMID: 23467717
Nurses; enrolment; barriers; enrolment; training program; Curriculum
15.  The Relationship between Thermal Comfort and Light Intensity with Sleep Quality and Eye Tiredness in Shift Work Nurses 
Environmental conditions such as lighting and thermal comfort are influencing factors on sleep quality and visual tiredness. The purpose of this study was the determination of the relationship between thermal comfort and light intensity with the sleep quality and eye fatigue in shift nurses. Method. This cross-sectional research was conducted on 82 shift-work personnel of 18 nursing workstations in Isfahan Al-Zahra Hospital, Iran, in 2012. Heat stress monitoring (WBGT) and photometer (Hagner Model) were used for measuring the thermal conditions and illumination intensity, respectively. To measure the sleep quality, visual tiredness, and thermal comfort, Pittsburg sleep quality index, eye fatigue questionnaire, and thermal comfort questionnaire were used, respectively. The data were analyzed with descriptive statistics, Student's t-test, and Pearson correlation. Results. Correlation between thermal comfort which was perceived from the self-reporting of people with eye tiredness was −0.38 (P = 0.002). Pearson correlation between thermal comfort and sleep quality showed a positive and direct relationship (r = 0.241, P = 0.33) but the correlation between thermal comfort, which was perceived from the self-reporting of shift nurses, and WBGT index was a weak relationship (r = 0.019). Conclusion. Based on the obtained findings, it can be concluded that a defect in environmental conditions such as thermal conditions and light intensity and also lack of appropriate managerial plan for night shift-work nurses are destructive and negative factors for the physical and mental health of this group of practitioners.
doi:10.1155/2013/639184
PMCID: PMC3586505  PMID: 23476674
16.  Depressive symptoms and perceived burdens related to being a student: Survey in three European countries 
Background
Despite a high prevalence of depressive symptoms among university students, few studies have examined how this mental health problem is associated with perceived stress and perceived burdens related to being a student.
Methods
We conducted a cross-sectional study of 2,103 first year students from one western (Germany), one central (Poland), and one south-eastern European country (Bulgaria). The self-administered questionnaires included the modified Beck Depression Inventory and Cohen's Perceived Stress Scale. A 13 item scale measured perceived burdens related to being a student with four subscales: "Course work", "Relationships", "Isolation", and "Future".
Results
Depressive symptoms were highly prevalent in all three countries (M-BDI ≥35: 34% in Poland, 39% in Bulgaria, and 23% in Germany). Students felt more burdened by course work and bad job prospects ("Future") than by relationship problems or by feelings of isolation. The perceived burdens subscales "Future", "Relationship" and "Isolation" remained associated with depressive symptoms after adjusting for perceived stress, which displayed a strong association with depressive symptoms. The association between perceived stress and depressive symptoms differed by gender. These findings were similar in all three countries.
Conclusion
Perceived burdens related to studying are positively associated with higher depression scores among students, not only by mediation through perceived stress but also directly. While the strong association between perceived stress and depressive symptoms suggests the need for interventions that improve stress management, perceived burdens should also be addressed.
doi:10.1186/1745-0179-4-19
PMCID: PMC2483702  PMID: 18598340
17.  Awareness of Menstrual Abnormality Amongst College Students in Urban Area of Ile-Ife, Osun State, Nigeria 
Background:
Disturbances of menstrual bleeding are major social and medical problem for women and account for high percentage of gynecological visit.
Objectives:
The objective of the study was to document menstrual abnormalities experienced by female college students, their awareness and health seeking behavior.
Materials and Methods:
A cross-sectional survey was undertaken, 400 students were selected using stratified sampling technique and interviewed using semi-structured self-administered questionnaire. Inferential statistical analysis such as Chi-square test and logistic regressions were carried out.
Results:
The mean age at menarche was 14.18 years. Irregular menstrual cycles were reported in 9.0%. Dysmenorrhea was present in 62.5%, and 12.5% reported school absenteeism. Students' awareness of menstrual abnormalities was poor (29%). A few of them (10.5%) decided to seek help for menstrual abnormalities. The awareness of students on menstrual abnormalities was significantly influenced by their age (OR = 2.33, P = 0.03); however, age at menarche and level of study did not influence their awareness (OR = 0.45, P = 0.24 and OR = 1.42, P = 0.12). History of dysmenorrheal (OR = 10.2, P = 0.001) and academic disturbance (OR = 5.45, P = 0.001) had significant influence on the health seeking behavior of the students.
Conclusion:
There was a general lack of information about menstrual issues and when to seek help. There is a need to educate female college students about menstrual issues in order to improve their health seeking behavior as regards menstrual abnormalities.
doi:10.4103/0970-0218.62559
PMCID: PMC2888370  PMID: 20606922
Awareness; health seeking behavior; menstrual abnormalities
18.  KNOWLEDGE, ATTITUDE AND SMOKING PATTERNS AMONG NURSING AND LABORATORY TECHNOLOGY STUDENTS, DAMMAM, SAUDI ARABIA 
Objective:
To study the reported practices of knowledge about and attitude towards smoking among nursing and medical laboratory technology (MLT) students, College of Medicine, King Faisal University at Dammam and Al-Khobar.
Setting:
College of Medicine, Dammam and King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
Methods:
A cross-sectional approach involving a sample of 266 students and interns (152 nursing and 114 MLT), which included all enrolled students in the academic year (1998/1999). A self-administered questionnaire was used to collect data covering knowledge, practice and attitude to smoking. SPSS was used for statistical analysis.
Results:
The overall smoking prevalence was low (5.6%), slightly higher among nursing (6.6%) versus MLT (4.4%) students. Knowledge of and attitude towards smoking was generally satisfactory in both groups, although deficient in some key areas, such as the addictive nature of smoking, some of its consequences on health, and difficulty of quitting.
Conclusion and Recommendations:
The prevalence of smoking among nursing and MLT students is generally low but their knowledge and attitude need improvement. Health education on facts, dangers and consequences of smoking should start as early as the primary school, and should continue throughout the education of future health professionals (role models for the community).
PMCID: PMC3437104  PMID: 23008604
Smoking; tobacco consumption; university students; nursing; laboratory technology; knowledge/attitudes/practice (KAP); Saudi Arabia
19.  Perception of violence against women among future health professionals in an Industrial Township 
Industrial Psychiatry Journal  2010;19(2):90-93.
Background:
There is a growing concern that medical education does not prepare the future health professional to effectively deal with violence against women. Against this background, the present study was undertaken.
Aims:
To elicit perception of violence against women among medical and nursing students, and study the association of these perceptions with certain demographic and social variables.
Settings and Design:
The study was conducted among students of a Medical College and a Nursing College both located at Pune, India. A cross-sectional descriptive study design was used to elicit the perceptions of the study subjects toward violence against women.
Materials and Methods:
A random sample of 125 medical and 125 nursing students was selected. Both quantitative and qualitative methods of data collection were employed. Qualitative data collection was done by focus group discussions with key persons such as dean and faculty of medical and nursing colleges. The syllabi of medical and nursing colleges were also reviewed for any topic related to domestic violence.
Statistical analysis:
The WHO/CDC Statistical and Epidemiology Software Package was used for data entry and statistical analysis. Various associations were explored by nonparametric tests (Mann-Whitney) for ordinal data and by Chi-square and ODDS ratio (with 95% confidence intervals), for categorical data.
Results:
Overall 35.6% (95% CI 29.1%–42.6%) of the study participants had witnessed/were aware of violence against women among their family/acquaintances. This awareness was significantly more among female respondents (OR=2.65, 95% CI 1.37–5.16), Chi Sq=9.81, df=1, P=0.001. Other socioeconomic variables such as urban/rural background, education, and income were not associated with perception about family violence. Majority (>80%) agreed/strongly agreed that social agencies should do more to help battered women. Course content on violence against women was lacking in both medical and nursing syllabi.
Conclusions:
Female participants were generally more perceptive about the issue. Medical and nursing syllabi should incorporate strategies for dealing with violence against women.
doi:10.4103/0972-6748.90337
PMCID: PMC3237137  PMID: 22174529
Medical; nursing; student; violence; women
20.  Utilizing the Health Belief Model to predicting female middle school students' behavioral intention of weight reduction by weight status 
Nutrition Research and Practice  2011;5(4):337-348.
Weight reduction behavior is common among adolescent girls. The present study examined the status of weight reduction behavior and factors affecting the behavioral intention of weight reduction using the Health Belief Model (HBM) for female middle school students by weight category. Survey data was collected from three girl's middle schools in Gyeongju, Korea. A total of 299 female middle school students participated in this study. The questionnaire had questions about general characteristics, weight reduction behavior, and variables of HBM (perceived threat, perceived benefits, perceived barriers, cues to action, self-efficacy in dietary life and exercise, and behavioral intention of weight reduction). Descriptive statistics, Chi-square tests, ANOVA, and multiple regression analysis were applied to analyze the variables. A higher percentage of students in the overweight group attempted weight reduction than those in the underweight and the normal weight groups (P < 0.001). Among students who had attempted weight reduction, 73% tried diet therapy, while 78% tried exercise. Students in the normal and overweight groups showed significantly higher threat (P < 0.01) and cues to action (P < 0.001) than those in the underweight group. As for perceived benefits, barriers, and self-efficacy in dietary life and exercise, there were no significant differences among weight groups. Students in the overweight group showed the strongest intention of weight reduction and there were significant differences among the three weight groups (P < 0.001). Perceive threat (P < 0.01), cues to action (P < 0.001), and perceived self-efficacy (P < 0.01) were significantly associated to behavioral intention of weight reduction for all respondents. For the underweight group, perceived threat (P < 0.05) and perceived self-efficacy (P < 0.01) were the significant variables. For the overweight group, cue to action was the significant variable (P < 0.05).
doi:10.4162/nrp.2011.5.4.337
PMCID: PMC3180685  PMID: 21994529
Health Belief Model; weight reduction; female middle school students
21.  Prevalence of depression, its correlates among students, and its effect on health-related quality of life in a Turkish university 
Upsala Journal of Medical Sciences  2009;114(3):170-177.
Objective
The aims were to investigate the prevalence of depression among university students, and to determine some of the risk factors connected to depression, and also to evaluate its effect on health-related quality of life (HRQoL).
Methods
This cross-sectional survey was conducted between 1 December 2007 and 31 January 2008 at Osmangazi University, Eskisehir, in western Turkey. The study group consisted of 822 students. The questionnaire included the students’ socio-demographic characteristics, the Beck Depression Inventory, and the Medical Outcomes Study Short Form-36 (SF-36). The data were analyzed by using chi-square, Student's t test, percent (%) ratios, and backward logistic regression analysis with a significant value of P<0.05.
Results
Of the students, 377 (45.9%) were males and 445 (54.1%) females. Overall, the prevalence of depression was 21.8% (n=179/822). Family history of depression, acne on face, any physical defect on body, smoking, alcohol consumption, and future-related occupational preoccupation were all deemed important risk factors for depression (P <0.05, for each one). It was found that, in those with depression, all the mean domain scores of SF-36 scale were lower than those without depression (P <0.05, for each one).
Conclusions
The prevalence of depression among the university students in this region of Turkey was wide-spread, affecting negatively the HRQoL of the students. For prevention and control of depression, depression information and knowledge need to be addressed by health education programs.
doi:10.1080/03009730903174339
PMCID: PMC2852771  PMID: 19736608
Depression; quality of life; Turkey; university students
22.  Oral health knowledge, attitude and practices among health professionals in King Fahad Medical City, Riyadh 
Dental Research Journal  2012;9(4):386-392.
Background:
The aim of this study was to assess the oral health knowledge, attitude and practices among the health care professionals working at KFMC, Riyadh.
Materials and Methods:
A cross-sectional study of 161 health professionals consisting of doctors, nurses, pharmacists, technicians and medical students was carried out using a structured, self-administered, close-ended questionnaire. Responses were collected and descriptive statistics, ANOVA, Chi square tests and z-tests were performed.
Results:
Doctors showed a high mean knowledge score as compared with other health professionals. Comparison of oral health knowledge scores among the different types of health professionals yielded statistically significant differences (P < 0.05). The attitude toward visit to the dentist varied; 52.7% of nurses and 50% of technicians said that they would like to visit the dentist regularly. 66.7% of the medical students visit the dentist whenever they get pain in their tooth. 54.5% doctors and 45.8% pharmacists are likely to visit the dentist occasionally. For 60% medical students, tooth ache was the driving factor for their last visit. Majority of the health professionals said that the fear of drilling was the main reason for avoiding the dentist. Almost all the health professionals said that they cleaned their tooth by toothbrush and toothpaste. Less than 50% of the health professionals used mouth wash and dental floss. Less than 10% used Miswak and toothpick as part of their oral hygiene.
Conclusion:
Oral health knowledge among the health professionals working in KFMC, Riyadh was lower than what would be expected of these groups, which had higher literacy levels in health care, but they showed a positive attitude toward professional dental care.
PMCID: PMC3491323  PMID: 23162577
Attitude; health professionals; knowledge; oral health; practices
23.  Attitudes and perceived barriers of tertiary level health professionals towards incident reporting in Pakistan 
Background:
A limited framework of incident reporting exists in most of the health care system in Pakistan. This poses a risk to the patient population and therefore there is a need to find the causes behind the lack of such a system in healthcare settings in Pakistan.
Aims:
To determine the attitudes and perceived barriers towards incident reporting among tertiary care health professionals in Pakistan
Materials and Methods:
The study was done in Shifa International Hospitals and consisted of a questionnaire given to 217 randomly selected doctors and nurses. Mean ± SD of continuous variables and frequency (percentage %) of categorical variables are presented. Chi square statistical analysis was used to test the significance of association among doctors and nurses with various outcome variables (motivators to report, perceived barriers, preferred person to report and patient's outcome that influence reporting behaviors). P value of <0.05 was considered significant. Student doctors and student nurses were not included in the study.
Results:
Unlike consultant, registrars, medical officers and nurses (more than 95% are willing to report), only 20% of house officers will report the incident happened through them. Sixty nine percent of doctors and 67% of nurses perceive ‘administration sanction’ as a common barrier to incident reporting. Sixty percent of doctors and 80% of nurses would prefer reporting to the head of the department.
Conclusions:
By giving immunity from administrative sanction, providing prompt feedback and assurance that the incident reporting will be used to make changes in the system, there is considerable willingness of doctors and nurses to take time out of their busy schedules to submit reports.
doi:10.4297/najms.2010.2100
PMCID: PMC3354432  PMID: 22624122
Reporting of incident; health care professionals; attitude; barriers to incident reporting; Pakistan
24.  Suicidal behavior amongst adolescent students in south Delhi 
Indian Journal of Psychiatry  2008;50(1):30-33.
Objective:
To study the prevalence of suicidal behavior and its epidemiological correlates amongst adolescent students in south Delhi.
Settings and Design:
A cross-sectional study in three schools and two colleges in south Delhi.
Participants:
A total of 550 adolescent students aged 14 to 19 years selected by cluster sampling.
Statistical Analysis:
Proportions, chi square test, bivariate logistic regression.
Results:
About 15.8% reported having thought of attempting suicide, while 28 (5.1%) had actually attempted suicide, both being more in females than in males. Statistically significant associations were observed with the age of the student, living status of parents, working status of mother, and whether the student was working part-time. The two variables found significant on multivariate analysis were female gender and the number of role models the student had ever seen smoking or drinking.
Conclusion:
The prevalence of suicide-risk behavior was found to be quite high and is a matter that should evoke public health concern.
doi:10.4103/0019-5545.39756
PMCID: PMC2745855  PMID: 19771304
Adolescent; students; suicidal behavior; suicide
25.  Tobacco Use Among Adolescent Students and the Influence of Role Models 
Background:
Seventy per cent of premature deaths among adults are due to behavioral patterns that emerge in adolescence, including smoking.
Objective:
The objective was to study the prevalence of tobacco use among adolescent students in South Delhi and its epidemiological correlates.
Materials and Methods:
This was a cross-sectional study.
Setting:
Three schools and two colleges of South Delhi were chosen. There were 550 adolescent students aged 14-19.
Statistical Analysis:
Statistical analysis was done using proportions, the chi-square test, and multivariate logistic regression.
Results:
A total of 88 (16.0%) students reported having ever tried cigarette or bidi smoking. The prevalence of current smoking was 7.1%. Exactly 10% (55) of the students reported having ever used smokeless forms of tobacco. The prevalence of tobacco use overall was found to be 20.9%, and was significantly higher (P=0.016) among the males than the females. Tobacco use was found to be significantly associated with having seen a brother/sister smoke (OR 5.15), best friend smoke (OR 2.92), and belonging to a nuclear family (OR 1.96).
Conclusions:
Tobacco use is still an important risk behavior among adolescent students. This study found a strong association of tobacco use by the adolescents with their having seen various role models ever smoking.
doi:10.4103/0970-0218.66891
PMCID: PMC2940184  PMID: 20922105
Adolescent; behavior; students; smoking; tobacco use; role models

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