Factors Affecting Sleep Quality among University Medical and Nursing Students: A Study in Two Countries in the Mediterranean Region.

Poor sleep quality, a global public health concern, poses a significant burden on individuals, particularly health care university students facing intense academic stress. A three-center cross-sectional study was conducted at the Higher Institute of Nursing and Health Sciences in Tetouan (Morocco), Faculty of Medicine in Tangier (Morocco) and Faculty of Nursing in Valencia (Spain). We collected various data using a sociodemographic questionnaire, the Pittsburgh sleep quality questionnaire, the international physical activity questionnaire (IPAQ) and the smartphone addiction questionnaire short-version (SAS-SV). A total of 1210 students were included in our study (mean age 20.4 years, 67.2% female, nursing students (66.2%) and medical students (33.8%), 76.1% students from Morocco and 33.9% from Spain). Analysis revealed a higher prevalence of poor sleep quality among Moroccans students compared to Spanish ones (p < 0.001), that nursing students showed less favorable sleep quality than medical students (p < 0.011) and that living with a chronic disease was linked to less favorable sleep quality (p < 0.001). Lastly, intense or weak physical activity and smartphone addiction were correlated with poor sleep quality (p < 0.001). In the multivariate analysis, an association persisted between poor sleep quality and factors such as the country of study (Odds ratio (OR): 6.25 [95% Confidence Interval (CI): 4.34-9.09]), involvement in nursing studies (OR: 3.50 [95% CI: 2.36-5.27]), and the presence of chronic diseases (OR: 2.70 [95% CI: 1.72-4.16]), (p < 0.01 each). Our findings highlight the multifaceted factors affecting sleep quality in young university students. The implications underscore the imperative of interventions tailored to this demographic group.

The COVID-19 Pandemic and Adolescents' Psychological Distress: A Multinational Cross-Sectional Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has continued for more than two years, and the impact of this pandemic on mental health has become one of the most important research topics in psychiatry and psychology. The aim of the present study was to assess psychological distress in adolescents across five countries (Sweden, Morocco, Serbia, Vietnam, and the United States of America) during the COVID-19 pandemic. METHODS: Using nonparametric analyses we examined the impact of COVID-19 on distress, measured by the Brief Symptom Inventory, in a sample of 4670 adolescents. RESULTS: Our results showed that the association between the COVID-19 impact and psychological distress in adolescents' lives was positive and moderate in Morocco and Serbia, positive and weak in Vietnam and the United States of America, and negative and weak in Sweden. We also found that female adolescents reported higher distress levels than male adolescents. CONCLUSIONS: COVID-19 impacted adolescents and their psychological distress differently depending on their residence.

Measurement properties of the life history of aggression in adolescents: Data from Morocco, Serbia, Sweden, Vietnam, and the USA.

The Life History of Aggression (LHA) is a frequently used scale for assessing trait aggression, but its psychometric properties have not been evaluated among adolescents. The aim of this study was to evaluate the psychometric properties of the LHA among high school students from Morocco, Serbia, Sweden, Vietnam, and the United States of America (USA). The total sample included 4867 adolescents, aged 15-19 years, from Morocco (n = 508), Serbia (n = 1067), Sweden (n = 1570), Vietnam (n = 1401), and the USA (n = 321). A two-factor, nine-item model containing an aggression factor (5 items) and a consequences/antisocial behavior factor (4 items) was created. The two-factor model had an acceptable-to-good model fit for the data for the total sample and all five countries, including gender. Cronbach's alpha (α) was satisfactory across countries. Still, the construct was noninvariant across countries and genders. The LHA with nine items in two subscales showed sound construct validity and internal consistency and can be used for group-level or within-group assessments of trait aggression in adolescents by either gender or country. However, it should not be used for cross-gender or cross-country comparisons due to a lack of measurement invariance.

Psychological distress in a sample of Moroccan prisoners with drug-dependence.

Research regarding mental illness and drug addiction among inmates in Morocco requires increased knowledge; previous literature reported that prisoners suffer from severe psychological distress. The present study aimed to provide information about Moroccan prisoners' psychological distress and define the differences in psychological distress levels among inmates with and without drug-dependence. A sample of 177 male inmates completed a set of surveys, including the Drug Use Disorders Identification Test (DUDIT) and the Brief Symptom Inventory (BSI). The "Drug dependence" group scored significantly higher psychological distress levels in each of the BSI domains. The strongest differences were measured in the General Severity Index (GSI), hostility, and depression scales. Moroccan prison inmates have high psychological distress, and those with drug-dependence have even higher. There is a need of psychiatric assessment, selection, and care possibilities in prison inmate populations.

Changes in Adolescents' Psychosocial Functioning and Well-Being as a Consequence of Long-Term COVID-19 Restrictions.

This work studied self-reports from adolescents on how the COVID-19 pandemic has changed their behaviors, relationships, mood, and victimization. Data collection was conducted between September 2020 and February 2021 in five countries (Sweden, the USA, Serbia, Morocco, and Vietnam). In total, 5114 high school students (aged 15 to 19 years, 61.8% females) responded to our electronic survey. A substantial proportion of students reported decreased time being outside (41.7%), meeting friends in real life (59.4%), and school performance (30.7%), while reporting increased time to do things they did not have time for before (49.3%) and using social media to stay connected (44.9%). One third of the adolescents increased exercise and felt that they have more control over their life. Only a small proportion of adolescents reported substance use, norm-breaking behaviors, or victimization. The overall COVID-19 impact on adolescent life was gender-specific: we found a stronger negative impact on female students. The results indicated that the majority of adolescents could adapt to the dramatic changes in their environment. However, healthcare institutions, municipalities, schools, and social services could benefit from the findings of this study in their work to meet the needs of those young people who signaled worsened psychosocial functioning, increased stress, and victimization.

Mental Health Profiles in a Sample of Moroccan High School Students: Comparison Before and During the COVID-19 Pandemic.

Background: Adolescent high school students may be particularly susceptible to suffering from the effect of isolation, physical distancing restrictions, and school closures imposed during the COVID-19 (Corona Virus Disease 2019) pandemic. Given the biological and psychological changes that occur during this period of development, adolescents' experiences of these pandemic measures could significantly threaten their mental health and cause long-term consequences. Aim: The main objectives of the study were to determine the impact of confinement because of the COVID-19 pandemic restrictions on the psychological distress of Moroccan adolescents and identify the risk and protective factors that could influence their mental health. Methods: The participants in this study were Moroccan high school students who were recruited at two different times-before the COVID-19 pandemic (350 students, mean age: 16.55 years; 53.71% female; data collected in 2014/2015) and after the announcement of the pandemic (457 students, mean age: 16.84; 64.1% female; data collected in 2020). Students responded to an anonymous survey that included several validated instruments, such as the Brief Symptom Inventory and the Godin-Shephard Leisure-Time Physical Activity questionary, and elicited information about the students' psychosocial environment, gender, and age. The scores on the Brief Symptom Inventory dimensions from the pre-pandemic period and during 2020 were compared. A comparison between the scores of the two genders of the 2020 sample was also carried out. In addition, binary regression analysis was performed to predict the associations between gender, frequency of physical activity, the presence of the number of negative psychosocial factors, and those dimensions of the Brief Symptom Inventory that significantly changed between the samples. Results: Female students reported higher psychological distress than male students in both data collection periods. During the COVID-19 pandemic, students scored significantly (p < 0.001) higher in depression and paranoid ideation, and they scored significantly (p = 0.01) lower in hostility and anxiety compared with the pre-pandemic period. Female gender and the experience of physical or psychological abuse significantly increased the risk of reporting higher scores in depression and paranoid ideation symptoms during 2020. Moderate and frequent physical activities were significantly and negatively associated with depression (p = 0.003 and p = 0.004; respectively). Conclusions: This study confirms the stressful impact of the COVID-19 pandemic on Moroccan high school students, who reported more symptoms of depression and paranoid ideation compared with the pre-COVID-19 period. Female students reported higher psychological distress than male students did. The experience of physical /psychological abuse during the pandemic worsened mental health, while moderate/frequent physical activity improved it.

Somatic health and its association with negative psychosocial factors in a sample of Moroccan adolescents.

BACKGROUND: Adolescence is a distinct developmental phase characterized by multiple physical and psychological changes and by an increased vulnerability to somatic and mental health problems. These risk and vulnerability factors are part of a complex biopsychosocial matrix, encompassing multiple factors, such as inherited biological determinants and psychological, societal, and cultural influences, which affect an adolescent's overall wellbeing. In Morocco, similar to other developing countries, adolescents (young people aged from 15 to 19 years) constitute a substantial proportion of the population (almost 9%). However, studies about adolescents' health in developing countries are scarce. In this study, we describe adolescents' somatic health in a sample of high school students from the city of Tetouan, Morocco, and investigate how negative psychosocial factors, such as parental alcohol use problems and/or the experience of abuse, may influence them. METHODS: The study sample included 655 adolescents (315 boys and 340 girls, M = 16.64 years, range = 15-18 years) from conviniently selected classes of four high schools in the city of Tetouan in Morocco. The students responded to a survey that assessed the prevalence of somatic complaints/disorders. They also indicated whether they had ever experienced physical and/or psychological abuse and whether they had parents with alcohol use problems. RESULTS: More than half of the adolescents suffered from headaches and one-third had substantial problems with diarrhea or constipation. Both problems were more common in female students. The third most frequent somatic problem, affecting one in four in both genders, was allergy. Almost one-third of Moroccan adolescents (significantly more boys than girls; p = 0.004) reported no somatic complaints. In adolescents who reported parental alcohol use problems and/or experience of physical and/or psychological abuse, the prevalence of several somatic complaints (epilepsy, migraine, headache, diarrhea/constipation, gluten intolerance, allergy, and skin or thyroid disease) increased highly significantly compared to the adolescents who reported no such psychosocial environmental factors. CONCLUSION: The results suggest that only 3 in 10 urban-living Moroccan adolescents are free of somatic complaints, while the majority suffer from some somatic problems, most often headaches and diarrhea/constipation. The association of certain negative psychosocial factors with adolescents' somatic health suggests the need of a holistic approach to the treatment of affected adolescents.

Mental health profile and its relation with parental alcohol use problems and/or the experience of abuse in a sample of Moroccan high school students: an explorative study.

BACKGROUND: Studies on mental health are scarce from Arab countries, especially studies focusing on adolescents. In addition to the neurobiological and physiological changes that occur during adolescent development, psychological, societal and cultural influences have strong effects on adolescents' behavior and on their somatic and mental health. The present study aimed (1) to describe the mental health profile, operationalized as psychological distress, of a sample of Moroccan adolescents, and (2) to investigate how specific psychosocial factors (parental alcohol use problems and the experience of physical and/or psychological abuse) may affect adolescents' mental health. METHODS: The sample included 375 adolescents from conveniently selected classes of four high schools in the city of Tetouan in Morocco. The participants responded to an anonymous survey containing, beside other inventories, the Brief Symptom Inventory (BSI) and identified those reporting parental alcohol use problems and/or the previous experience of abuse. The sample characteristics were defined using descriptive statistics. The effects of the defined psychosocial factors were identified using the Kruskal-Wallis test, followed by the post hoc Fisher's least significant difference test. RESULTS: The most common problems found in high school students from an urban region of Morocco were memory problems, concentration difficulties, restlessness, fear, nervosity and feelings of inadequacy during interpersonal interactions. The female students reported significantly higher psychological distress levels when compared to the male students (p < 0.001). The adolescents reporting parental alcohol use problems and the experience of physical/psychological abuse showed significantly higher levels of psychological distress (p = 0.02), especially symptoms of somatization (p < 0.001), hostility (p = 0.005) and anxiety (p = 0.01), than those not reporting any of these psychosocial factors. CONCLUSION: The mental health profile of female adolescents from an urban area of Morocco is worse than that of their male fellow students. Adolescents reporting parental alcohol use problems and/or the experience of physical/psychological abuse need synchronized support from social- and healthcare services.

Risk and protective factors for drug dependence in two Moroccan high-risk male populations.

BACKGROUND: Substance use is linked to biological, environmental, and social factors. This study provides insights on protective and risk factors for drug dependence in two Moroccan, high-risk, male samples. METHODS: Data from the "Mental and Somatic Health without borders" (MeSHe) survey were utilized in the present study. The MeSHe survey assesses somatic and mental health parameters by self-report from prison inmates (n = 177) and outpatients from an addiction institution (n = 54). The "Drug dependence" and the "No drug dependence" groups were identified based on the Arabic version of the Drug Use Disorder Identification Test's (DUDIT) validated cutoff for identifying individuals with drug dependence, specifically in Morocco. RESULTS: The majority of participants who had at least high school competence (67.6%), were living in a partnership (53.7%), were a parent (43.1%), and/or had a job (86.8%) belonged to the "No drug dependence" group, while the presence of mental health problems was typical among the "Drug dependence" group (47.4%). A multivariable regression model (χ2 (df = 5, N = 156) = 63.90, p < 0.001) revealed that the presence of depression diagnosis remains a significant risk factor, while a higher level of education, having a child, and being employed are protective factors from drug dependence. DISCUSSION: Findings support the importance of increasing academic competence and treating depression as prevention from the persistence of drug addiction in male high-risk populations.

Reliability of the Arabic Smartphone Addiction Scale and Smartphone Addiction Scale-Short Version in Two Different Moroccan Samples.

The extensive accessibility to smartphones in the last decade raises the concerns of addictive behavior patterns toward these technologies worldwide and in developing countries, and Arabic ones in particular. In an area of stigmatized behavior such as Internet and smartphone addiction, the hypothesis extends to whether there is a reliable instrument that can assess smartphone addiction. To our knowledge, no scale in Arabic language is available to assess maladaptive behavior associated with smartphone use. This study aims to assess the factorial validity and internal reliability of the Arabic Smartphone Addiction Scale (SAS) and Smartphone Addiction Scale-Short Version (SAS-SV) in a Moroccan surveyed population. Participants (N = 440 and N = 310) completed an online survey, including SAS, SAS-SV, and questions about sociodemographic status. Factor analysis results showed six factors with factor loading ranging from 0.25 to 0.99 for SAS. Reliability, based on Cronbach's alpha, was excellent (α = 0.94) for this instrument. The SAS-SV showed one factor (unidimensional construct), and internal reliability was in the good range with an alpha coefficient of (α = 0.87). The prevalence of excessive users was 55.8 percent with highest symptom prevalence reported for tolerance and preoccupation. This study proved factor validity of the Arabic SAS and SAS-SV instruments and confirmed their internal reliability.

Psychometric Properties of the Arabic Version of the Drug Use Disorders Identification Test (DUDIT) in Clinical, Prison Inmate, and Student Samples.

PURPOSE: The study aimed to validate the Arabic version of the Drug Use Disorders Identification Test (DUDIT) by (1) assessing its factor structure, (2) determining structural validity, (3) evaluating item-total and inter-item correlation, and (4) assessing its predictive validity. METHOD: The study population included 169 prison inmates, 51 patients with clinical diagnosis of substance used disorder, and 53 students (N = 273). All participants completed the self-report version of the Arabic DUDIT. After exploratory factor analysis, internal consistency of the Arabic DUDIT was determined and external validation was performed. RESULTS: Principal factor analysis showed that Arabic DUDIT exhibited only one factor, which explained 66.9% of the variance. Reliability based on Cronbach's alpha was .95. When compared to the DSM-IV substance use disorder diagnosis in a clinical sample, DUDIT had an area under the curve (AUC) of .98, with a sensitivity of .98 and a specificity of .90. CONCLUSION: The Arabic version of DUDIT is a valid and reliable tool for screening for drug use in Arabic-speaking countries.

Usefulness of fitness testing to establish metabolic syndrome in perimenopausal Moroccan women.

BACKGROUND: The use of fitness testing for the identification of women at high-risk of metabolic syndrome (MS), and therefore of cardiovascular disease, is clinically relevant. OBJECTIVE: The purpose of this study was to determine the ability of a set of physical fitness tests to establish the risk of MS in perimenopausal Moroccan women. METHODS: The study comprised 151 women (45-65 years) from the North of Morocco. We used standardized field-based fitness tests to assess cardiorespiratory fitness, muscular strength, flexibility and balance. Fatness was assessed by impedanciometry and anthropometry. We also measured resting heart rate, blood pressure and plasma fasting glucose, total cholesterol, low density lipoprotein (LDL)-cholesterol, high density lipoprotein (HDL)-cholesterol and triglycerides. RESULTS: Women with MS performed worse in most of the fitness tests studied. Among the fitness test studied, the six-minute walk test was the most associated to MS. Receiver operating characteristics curve analyses revealed that the six-minute walk test threshold that best discriminated between the presence and absence of MS was 480.5 m (area under curve (AUC): 0.719, 95% confidence interval (CI): 0.62-0.82; p<0.001). Logistic regression after adjustment for age and weight showed that a distance ≤480 m is associated with 2.9 times higher risk (95% CI: 1.56-7.65; p<0.05) for having MS. CONCLUSIONS: Including cardiorespiratory fitness as a MS risk factor may improve early identification of at-risk Moroccan women. Fitness testing provides useful information and is cheap, easy to perform, and not time-consuming, which makes its use in this specific clinical settings feasible.

[Health and quality of life: situation of the population of Tetouan (Morocco)]. / Santé et qualité de vie: situation pour la population de Tétouan (Maroc).

INTRODUCTION: The diagnosis of the health status of the population and its needs, especially from the population's view point, is a useful approach to the development of health policies. This approach is possible by Health-Related Quality of Life (HRQOL) studies. However, few studies of this type have been conducted in Morocco. The objective of this study was to evaluate the health-related quality of life as a function of gender and age in the population of Tetouan city in northern Morocco. METHODS: A survey was conducted on a sample of 385 subjects over the age of 16 years living in Tetouan by applying the Duke Health Profile. RESULTS: The results show that scores for perceive health dimensions were relatively high (physical health) to low (mental and social health). Dysfunction scores were also non-negligible. Women had a significantly more negative perception of their health at all levels except for the social health, perceived health, self-esteem and inability dimensions. CONCLUSION: Age did not influence the perception of health for the physical, social, and general health dimensions, or depression and pain. However, special attention should be paid to subjects over the age of 55 who presented significantly lower mean scores for several dimensions, and young people under 25 who presented the lowest social health scores.

[Sociodemographic variables and lifestyle as predictors of self-perceived health in immigrants in the Basque Country [Spain]]. / Variables sociodemográficas y estilos de vida como predictores de la autovaloración de la salud de los inmigrantes en el País Vasco.

OBJECTIVE: To explore the importance of socio-demographic factors as well as life-style and their influence in self-rated health of Maghribian, Sub-Saharian, Latin-American and non-Communitarian European immigrant groups living in the Basque Country (Spain). METHODS: Descriptive cross-study with a convenience sample of 689 persons, consisting of 219 Maghribians (31.8%), 152 Sub-Saharians (22.1%), 167 Latino(a)s (24.2%) and 151 non-Communitarian Europeans (21.9%). Data base have been completed with data collected using the 2002 Regional Basque Health Interview Survey (ESCAV 2002). The multivariate analysis was performed by using the dicotomic logistic regression (software SPSS 13). RESULTS: We found that 64.2% of Maghribian, 78.7% of Sub-Saharian, 66.1% of Latin-American and 67.1% of non-Communitarian European assessed their health as very good or good. The significantly associated variables (p<0.05 and p<0.01) with self-rated health were collective membership, sex and age. Persons belonging to the Sub-Saharian collective showed a stronger advantage of positively self-assessed health (OR=2.08; 95%CI: 1.29-3.36). This advantage was also found among men of all four collectives (OR=2.16, 95%CI: 1.54-3.02) and in persons in the age of 33-38 years (OR=3.13, 95%CI: 1.71-5.73). Those variables remained significant in the multivariate analysis. CONCLUSIONS: Our results demonstrated the importance of considering differences in the health status and in self-rated health among immigrant groups, as well as the variables associated with those differences, when developing community-based health strategies.

Variables sociodemográficas y estilos de vida como predictores de la autovaloración de la salud de los inmigrantes en el País Vasco / Sociodemographic variables and lifestyle as predictors of self-perceived health in immigrants in the Basque Country [Spain

Objetivo: Investigar la importancia de los factores sociodemográficosy de los estilos de vida en la autovaloración de lasalud en los inmigrantes de origen magrebí, subsahariano, latinoamericanoy europeo no comunitario del País Vasco.Métodos: Estudio descriptivo transversal con una muestraformada por 219 magrebíes (31,8%), 152 subsaharianos(22,1%), 167 latinoamericanos (24,2%) y 151 europeos no comunitarios(21,9%). La herramienta para la recopilación dedatos fue la Encuesta de Salud de la Comunidad Autónomadel País Vasco (ESCAV’2002). El análisis multivariante se realizócon regresión logística dicotómica (soporte SPSS 13).Resultados: Para la autovaloración de la salud, el 64,2% delos magrebíes, el 78,7% de los subsaharianos, el 66,1% de loslatinoamericanos y el 67,1% de los europeos declararon teneruna salud muy buena o buena. Las variables asociadas significativamente(p < 0,05 y p < 0,01) a la autovaloración de lasalud fueron la procedencia, el sexo y la edad. Ser subsaharianomostró mayor ventaja para una mejor valoración de la salud(odds ratio [OR] = 2,08; intervalo de confianza del 95% (IC95%):1,29-3,36). La ventaja también se observó para los hombres(OR = 2,16; IC95%: 1,54-3,02) y la edad, especialmente en losde 33-38 años (OR = 3,13; IC95%: 1,71-5,73). En el análisismultivariante, dichas variables mantuvieron su significación.Conclusiones: Los resultados muestran la importancia de considerarel estado de salud percibida en los diferentes colectivosde inmigrantes e identificar las diferencias, así como lasvariables asociadas, para poder desarrollar actuacionesorientadas a mejorar la salud en estos grupos(AU)

Objective: To explore the importance of socio-demographicfactors as well as life-style and their influence in self-rated healthof Maghribian, Sub-Saharian, Latin-American and non-Communitarian European immigrant groups living in the BasqueCountry (Spain).Methods: Descriptive cross-study with a convenience sampleof 689 persons, consisting of 219 Maghribians (31.8%),152 Sub-Saharians (22.1%), 167 Latino(a)s (24.2%) and 151non-Communitarian Europeans (21.9%). Data base have beencompleted with data collected using the 2002 Regional BasqueHealth Interview Survey (ESCAV 2002). The multivariateanalysis was performed by using the dicotomic logistic regression(software SPSS 13).Results: We found that 64.2% of Maghribian, 78.7% of Sub-Saharian, 66.1% of Latin-American and 67.1% of non-CommunitarianEuropean assessed their health as very good orgood. The significantly associated variables (p < 0.05 and p< 0.01) with self-rated health were collective membership, sexand age. Persons belonging to the Sub-Saharian collective showeda stronger advantage of positively self-assessed health(OR = 2.08; 95%CI: 1.29-3.36). This advantage was also foundamong men of all four collectives (OR = 2.16, 95%CI: 1.54-3.02) and in persons in the age of 33-38 years (OR = 3.13,95%CI: 1.71-5.73). Those variables remained significant in themultivariate analysis.Conclusions: Our results demonstrated the importance of consideringdifferences in the health status and in self-rated healthamong immigrant groups, as well as the variables associatedwith those differences, when developing community-basedhealth strategies(AU)