Sleep Disturbances Rate among Medical and Allied Health Professions Students in Iran: Implications from a Systematic Review and Meta-Analysis of the Literature.

Medicine and healthcare professions are prestigious and valued careers and, at the same time, demanding, challenging, and arduous jobs. Medical and allied health professions students, experiencing a stressful academic and clinical workload, may suffer from sleep disturbances. In Iran, several studies have been conducted to explore the prevalence rate among medical and healthcare professions students. The aim of this systematic review and meta-analysis was to quantitatively and rigorously summarize the existing scholarly literature, providing the decision- and policy-makers and educators with an updated, evidence-based synthesis. Only studies utilizing a reliable psychometric instrument, such as the Pittsburgh sleep quality index (PSQI), were included, in order to have comparable measurements and estimates. Seventeen investigations were retained in the present systematic review and meta-analysis, totaling a sample of 3586 students. Studies were conducted between 2008 and 2018 and reported an overall rate of sleep disturbances of 58% (95% confidence interval or CI 45-70). No evidence of publication bias could be found, but formal analyses on determinants of sleep disturbances could not be run due to the dearth of information that could be extracted from studies. Poor sleep is highly prevalent among Iranian medical and healthcare professions students. Based on the limitations of the present study, high-quality investigations are urgently needed to better capture the determinants of poor sleep quality among medical and healthcare professions students, given the importance and the implications of such a topic.

Trans-Cultural Validation of the "Academic Flow Scale" (Flow 4D 16) in Arabic Language: Insights for Occupational and Educational Psychology From an Exploratory Study.

Background: As an optimal psychological state, flow represents those moments when everything comes together for the performer. Flow is often associated with high levels of performance and is a positive psychological experience. Aim: Our study aimed to validate the "Academic Flow Scale" (Flow 4D 16) in Arabic language across Tunisian population, and to test its factor structure, in terms of internal consistency/reliability, predictive validity, and sensitivity. Methods: The population is composed of 320 students (139 men and 181 women) belonging to the University of Sfax, with a mean age of 22.26 years. The students voluntarily responded to the scale of academic flow (Flow 4D 16). Both exploratory (EFA) and confirmatory (CFA) factor analyses were performed. Results: The four-dimensional alpha coefficients of the Flow 4D 16 indicate an excellent internal consistency, respectively, of 0.902 (Cognitive), 0.959 (Time), 0.974 (Ego) and 0.960 (Well-being). The CFA fit indices were satisfactory. Conclusion: In summary, the 16-items model (original version) showed for all the indices an excellent fit to the theoretical model, confirming the four-dimensional factor structure among Tunisian student population.

Trans-cultural Adaptation and Validation of the "Teacher Job Satisfaction Scale" in Arabic Language Among Sports and Physical Education Teachers ("Teacher of Physical Education Job Satisfaction Inventory"-TPEJSI): Insights for Sports, Educational, and Occupational Psychology.

Background: Job satisfaction is largely associated with organizational aspects, including improved working environments, worker's well-being and more effective performance. There are many definitions regarding job satisfaction in the existing scholarly literature: it can be expressed as a positive emotional state, a positive impact of job-related experiences on individuals, and employees' perceptions regarding their jobs. Aims: No reliable scales in Arabic language to assess job satisfaction in the sports and physical education field exist.This study aimed to trans-culturally adapt and validate the Pepe's "Teacher Job Satisfaction Scale" 9 items (TJSS-9), creating the "Teacher of Physical Education Job Satisfaction Inventory" (TPEJSI) in Arabic language. This scale was administered to a Tunisian population of sports and physical education teachers and analyzed according to the Pepe's theoretical model. More in detail, this investigation systematically tested its factor structure, in terms of internal consistency/reliability, predictive validity, sensitivity and convergent validity. Methods: A total of 417 Tunisian teachers of sports and physical education participated voluntarily in this study. The sample comprised of 258 males and of 159 females. More in detail, 189 were teachers teaching in primary schools of physical education, 105 teaching in secondary schools, and 123 were university teachers. Both exploratory (EFA) and confirmatory (CFA) factor analyses were performed on random-split halves of the sample. Results: The three-dimensional alpha coefficients of the TPEJSI were all >0.80: for satisfaction with colleagues, alpha was 0.865; for satisfaction with parents, alpha was 0.856 and for satisfaction with students alpha was 0.860. The CFA fit indices were satisfactory. Conclusions: Given the good EFA factor loadings, the CFA fit indices, the correlation matrix, the sensitivity analysis, the convergent validity and the excellent internal consistency, it can be concluded that the TPEJSI is a good psychometric tool that can be used to quantitatively assess the job satisfaction level among teachers of sports and physical education in the Arabic-speaking world.

A reliability and content analysis of Italian language anorexia nervosa-related websites.

OBJECTIVE: Internet represents a major source of information related to health issues, increasingly used by providers. Indeed, there are numerous websites concerning eating and weight disorders, such as anorexia nervosa. The aim of the current investigation was to systematically perform a reliability and content analysis of Italian language anorexia nervosa-related websites. METHODS: Reliability of the anorexia nervosa website pages was assessed using the Health on the Net Foundation Code of Conduct Standards (HonCode®) certification mark. A comprehensive content analysis (thematic cluster analysis, correspondence analysis of emerging themes and topics, density and degree-centrality analysis, and co-word analysis) was performed using the commercial software T-Lab. RESULTS: 402 unique website pages were included and analyzed in the current study. Statistically significant differences related to the accomplishment or less to the items of the HonCode® certificate mark were found for all items, except for confidentiality and webmaster/additional contact. From the thematic cluster analysis, four clusters were identified: namely, treatment (26.6%), vomiting (24.7%), weight (24.4%) and onset-age (24.3%). Treatment (in particular, cognitive-behavioral psychotherapy) was the most represented theme (with a frequency of 97.76%, recurring in 393 websites). Pro-ana content characterized 147 website pages (with a frequency of 36.57%). CONCLUSION: The quality of Italian language anorexia nervosa-related websites was rather moderate-poor, being generally inconsistent with the principles of the HonCode® certification mark. Therefore, physicians and health authorities should be aware of such findings to provide their patients with proper answers and education.

The efficacy of Crocus sativus (Saffron) versus placebo and Fluoxetine in treating depression: a systematic review and meta-analysis.

Background: Depression represents a serious public health concern, imposing a high burden, both in epidemiological and clinical terms. Crocus sativus (Saffron) is a herbal remedy that has anti-cancer, anti-oxidant, anti-inflammatory and anti-platelet properties. However, the exact mechanisms of Saffron in treating depression are not yet clear. This study was conducted to evaluate the effectiveness of Saffron versus placebo and Fluoxetine in the treatment of depressed patients. Methods: Different bibliographic thesauri, namely the Cochrane Library, Scopus, PubMed/MEDLINE, Centre for Reviews and Dissemination (CRD), EMBASE, and ISI/Web of Science (WoS) were searched up to May 2018. Effect sizes were computed as Standardized Mean Differences (SMD) with their 95% confidence interval (CI). To evaluate the heterogeneity among the studies, I2 test was carried out. Results: Eight studies were included. The SMD was -0.86 (95% CI: -1.73 to 0.00) concerning the comparison of Saffron with placebo. The SMD was found to be 0.11 (95% CI: -0.20 to 0.43) concerning the comparison of Saffron with Fluoxetine. In both sensitivity analyses, the results did not statistically change, confirming the stability of the findings. Conclusion: The findings of this study showed that Saffron administration was well comparable with Fluoxetine and placebo.

Development and Preliminary Validation of the "Teacher of Physical Education Burnout Inventory" (TPEBI) in Arabic Language: Insights for Sports and Occupational Psychology.

Background: Burnout is an inappropriate response to chronic work stress, leading to emotional exhaustion (EE), depersonalization (D), and low personal accomplishment (PA). Burnout can affect workers in the helping professions. To quantitatively assess the burnout level among teachers, Maslach has adapted the "Maslach Burnout Inventory" (MBI) to the educational environment (the so-called MBI Educators Survey version or MBI-ES). Among teachers, sports and physical education teachers may suffer from burnout due to high workload. Aims: No reliable psychometric tool in Arabic language exists that can be used to measure the burnout level among sports and physical education teachers. The objective of the present study was to develop a burnout measurement scale according to the Maslach's three-dimensional theoretical model for physical education teachers in Tunisia and to test its factor structure, in terms of internal consistency/reliability, predictive validity, and sensitivity. Methods: A total of 525 Tunisian teachers teaching in secondary schools from different Tunisian governorates volunteered to participate in this study. The sample comprised of 285 males (54.3%) and of 240 females (45.7%). More in detail, 327 were teachers of primary school of physical education (62.3%) and 198 teachers of secondary school (37.7%). Teachers were administered both the ad hoc developed "Teacher of Physical Education Burnout Inventory" (TPEBI) and the MBI-ES. Both exploratory [principal component analysis (PCA)] and confirmatory factor analyses (CFAs) were performed. Results: The Cronbach's alpha coefficients were excellent (0.93, 0.94, and 0.91 for EE, D, and PA, respectively). The correlation matrix indicated significant correlations between the TPEBI and MBI-ED dimensions. However, CFA fit indices were not completely satisfactory. Conclusion: Given the good PCA factor loadings, the correlation matrix, the sensitivity analysis, and the excellent internal consistency, it can be concluded that the TPEBI is a reliable psychometric tool that can be used to quantitatively assess the burnout level among teachers of physical education in the Arabic-speaking world. However, considering the CFA fit indices, further modifications to fully support the model are warranted.

Psychometric properties of the Brief Symptom Inventory in nomophobic subjects: insights from preliminary confirmatory factor, exploratory factor, and clustering analyses in a sample of healthy Italian volunteers.

BACKGROUND: The Brief Symptom Inventory (BSI), developed by Derogatis in 1975, represents an important standardized screening instrument that enables one to quantitatively assess psychological distress and psychiatric disorders. The BSI is a 53-item self-report scale, measuring nine dimensions that can be summed up to reflect three global indices, including the General Severity Index (GSI). In the era of new information and communication technologies, nomophobia ("no mobile phobia") is an emerging disorder, characterized by the fear of being out of mobile phone contact. Nothing is known, however, about the factor structure and reliability of the BSI in a population of nomophobic subjects. This study aimed at addressing this gap in knowledge. METHODS: A sample of 403 subjects aged 27.91±8.63 years (160 males, 39.7% of the entire sample, and 243 females, 60.3%), recruited via snowball sampling, volunteered to take part in the study. The Italian versions of the Nomophobia questionnaire and the BSI were administered. Exploratory factor analyses, confirmatory factor analyses, and clustering analysis were carried out together with correlation analysis, analysis of variance, and multivariate regression analysis. RESULTS: For each BSI subscale, scores were significantly higher than the norms. The nine subscales exhibited acceptable-to-good Cronbach's alpha coefficients, varying from 0.733 for psychoticism to 0.875 for depression. Overall, the reliability of the entire instrument proved to be excellent (alpha coefficient=0.972). Furthermore, all BSI subscales as well as BSI synthetic indexes correlated with nomophobia in a significant way. Stratifying the population according to the severity of nomophobia (mild, 206 individuals, 51.1% of the sample; moderate, 167 subjects, 41.4%; and severe, 30 individuals, 7.4%), the GSI score could distinguish (P<0.001) between mild and moderate (0.99±0.71 vs 1.32±0.81) and between mild and severe (0.99±0.71 vs 1.54±0.79) nomophobia, although not between moderate and severe nomophobia (P>0.05). Similar patterns could be found for the other subscales of the BSI. Finally, looking at the fit indexes, the second-order 9-factor model best fit the data compared with the Derogatis 1-factor model. CONCLUSION: The findings of our study show that the BSI is a reliable and valid instrument with acceptable psychometric properties, and can be administered to populations of nomophobic subjects.

The Relationship Between Nomophobia and Maladaptive Coping Styles in a Sample of Italian Young Adults: Insights and Implications From a Cross-Sectional Study.

BACKGROUND: Information technologies have become an integral part of the modern society; however, it is speculated that their overuse would result in addiction. Nomophobia refers to the irrational fear of being out of contact with virtual communication platforms. Generally, upon exposure to stress, humans adjust by employing cognitive mechanisms and behavioral efforts known as coping strategies. OBJECTIVE: The goal of the research was to explore coping styles implemented in subjects with nomophobia. METHODS: This was a cross-sectional study involving young adult participants (undergraduate students and younger subjects) who were recruited via an online survey using a snowball approach. The Italian version of the Nomophobia Questionnaire was administered to subjects. The measurement of coping styles was done using the 28-item Brief COPE questionnaire. Continuous data were computed as means and standard deviations, whereas categorical data were expressed as percentages, where appropriate. Correlation analysis was performed between the Nomophobia Questionnaire and Brief COPE scores. Multivariate regression analyses were conducted in order to shed light on the determinants of each coping style and its association with nomophobia. RESULTS: A total of 403 subjects took part in the study. Subjects with higher nomophobia scores responded when confronted with stress with behavioral disengagement (r=.16, P<.001), denial (r=.19, P<.001), self-blame (r=.12, P=.02), self-distraction (r=.22, P<.001), venting (r=.28, P<.001), use of emotional (r=.25, P<.001), and instrumental support (r=.16, P=.001). CONCLUSION: Nomophobia subjects adopt maladaptive coping strategies when confronted with stress. The acknowledgment of how nomophobia subjects react provides insight and introduces a focus for preventative and interventional measures in this population.

Psychometric evaluation of the Arabic version of the nomophobia questionnaire: confirmatory and exploratory factor analysis - implications from a pilot study in Kuwait among university students.

BACKGROUND: In the past decades, thanks to the widespread use of the new information and communication technologies, nomophobia has emerged as a contemporary psychological disorder. More in detail, it has been defined as the modern fear of feeling disconnected, being out of mobile phone contact, and being unable to access information and/or communicate with others. Few authors have used an Arabic version of the Nomophobia Questionnaire, even though its psychometric properties are not well known and have been poorly investigated from a formal rigorous standpoint. MATERIALS AND METHODS: Our research objective was to develop and validate the Arabic version, administering it to a sample of adolescents and young adults in a country characterized by a high mobile network coverage. A total of 512 subjects (aged 21.62±4.33 years, median 20 years), equally distributed between males and females, and based in Kuwait, volunteered to take part in the study. RESULTS: The confirmatory factor analysis did not show a completely satisfactory fitting with the original factor structure. The exploratory factor analysis showed that four factors had 57.24% variance. Overall Cronbach's alpha coefficient was 0.879. However, the coefficient increased from 0.645 to 0.849 with respect to the original factor structure. Scores (and mean scores) were 4.25±1.59 (21.23±7.95), 2.95±1.33 (17.68±7.97), 4.48±1.78 (8.96±3.56), and 4.98±1.52 (34.84±10.67) for factors I, II, III, and IV, respectively, whereas the overall score (and mean overall score) was 4.14±1.13 (82.71±22.68). CONCLUSION: In our sample, no subject (0.0%) was without nomophobia, with 92 (18.0%) and 288 individuals (56.2%) reporting mild and moderate nomophobia levels, respectively. Approximately a quarter of the recruited sample (132 subjects, 25.8%) had severe nomophobia level.

Effects of acculturation, coping strategies, locus of control, and self-efficacy on chronic pain: study of Chinese immigrant women in Italy - insights from a thematic field analysis.

Chronic pain represents a common public health concern worldwide. It is a complex phenomenon, owing to the interaction of different factors, including biological, physiological, psychological, environmental, and social variables. Some groups, such as women and immigrants, are particularly vulnerable. However, little is known about how Chinese women in Italy live with and face chronic pain. The present study aimed at filling this knowledge gap by examining the burden of chronic pain in Chinese immigrants in Italy in terms of acculturation processes, perceived control over disease, social networks, and coping strategies. A qualitative approach was used, performing a thematic field analysis. We interviewed 82 Chinese women from different Italian towns (Genoa, Milan, Turin, Bologna, Florence, and Prato) in depth. The sense of belonging to the host culture was strong in our sample. However, this did not simply reflect or translate into a linear engagement with medical systems, as health care pathways were more complex and dual (both Chinese and Western). Chinese women who felt deeply rooted in the Italian environment did not discontinue the use of traditional Chinese medicine. Chronic pain extensively and adversely affected daily life, particularly interfering with work. Coping strategies were mainly adaptive behaviors, being problem focused or maladaptive, relying upon "cope and avoid" mechanisms. Chinese women preferred to use traditional Chinese remedies rather than conventional medicine, while using the Italian system in emergencies. Perceived control over chronic pain was usually external. Finally, Chinese women with chronic pain benefit from social networks and support, which were mainly composed of Chinese peers. In conclusion, our findings underline the tremendous burden of chronic pain affecting all aspects of Chinese women's lives. Health care workers and providers should be aware of the complexity of chronic pain Therefore, a holistic approach, involving different stakeholders, should be adopted when managing chronic pain and approaching immigrant patients.

Data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of immigrants in Genoa (Italy).

This article reports the data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of 143 immigrants accessing an outpatient clinic or the general practitioners offices in Genoa (Italy) compared with 186 Italian patients. For further details and for the interpretation of the data, the reader is referred to the original publication "Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants" by Bragazzi et al. (2014) [1].

Ramadan Fasting and Patients with Cancer: State-of-the-Art and Future Prospects.

Ramadan fasting represents one of the five pillars of the Islam creed. Even though some subjects (among which patients) are exempted from observing this religious duty, they may be eager to share this particular moment of the year with their family and peers. However, there are no guidelines or standardized protocols that can help physicians to properly address the issue of patients with cancer fasting in Ramadan and correctly advising them. Moreover, in a more interconnected and globalized society, in which more and more Muslim patients live in the Western countries, this topic is of high interest also for the general practitioner. For this purpose, we carried out a systematic review on the subject. Our main findings are that (1) very few studies have been carried out, addressing this issue, (2) evidence concerning quality of life and compliance to treatment is contrasting and scarce, and (3) generally speaking, few patients ask their physicians whether they can safely fast or not. For these reasons, further research should be performed, given the relevance and importance of this topic.