A Cross-Sectional Study to Evaluate Work-Life Balance Among Indian Medical Students.

Introduction The concept of work-life balance is a complex, multidimensional intertwinement of the roles an individual plays in their professional and personal life. Work-life balance is crucial for every profession, and doctors have no exemption not exempted from it. Medical students and young graduates face numerous challenges that potentially impact their work (study)-life balance. Objectives of the study The aim is to assess the hours spent in study and the hours spent in non-study activities by medical students and graduates in India and to assess the study-life balance among them. Methodology A cross-sectional observational study employing a predefined web-based survey to investigate the study-life balance among medical students and graduates across India. A predesigned questionnaire was designed and made accessible through Google Forms, which was distributed among doctors across India via popular social media platforms. Data management was conducted using Microsoft Excel and Data analysis was done using SPSS (IBM Corp., Armonk, NY). Results A total of 416 responses were included in the study. The study participants were predominantly female (64.2%). Most of the study participants were from the State of Telangana (63.9%). The time spent studying was < 10 hours/week for 43.8% students and 10-25 hours/week for 27.2% students. Around 24% students reported spending 10-25 hours/week in hospital. While 47.4% reported spending less than one to two hours per day with their family, 26% of the participants answered "yes" to the question "Do you feel that your study-life is stressful?." Conclusions Self-care and study-life balance is a multi-factorial focal area that is based on balancing stress and happiness, with completing the tasks of the medical school. Medical students need to receive proper guidelines to transition into medical school for better study-life balance.

Readiness of Medical Students and Budding Doctors About the LGBTQ+ Community: A Cross-Sectional Study From India.

INTRODUCTION: The Lesbian, Gay, Bisexual, Transgender, and Queer or Questioning (LGBTQ) community has always faced discrimination across the globe. Due to a lack of information in medical curricula and no training or sensitization of doctors towards their health needs, there are numerous health disparities faced by this community. Negative attitudes and inadequate knowledge may also cause students to feel hesitant to treat patients in the community. The present study thus aims to evaluate the attitudes and knowledge of medical students and interns towards LGBTQ+. METHODOLOGY: The present study is a cross-sectional observational study where a self-administered questionnaire was shared with the medical students of India via an online platform. The collected data was then analyzed using Microsoft Excel STATA version 14.0 (StataCorp LLC, Texas, USA). RESULTS: A total of 790 responses were analyzed. 67.2% of respondents had an overall positive attitude, with students under the age of 20, female students, and medical students being more likely to have a positive attitude towards the community. 60.7% of the respondents had satisfactory knowledge, with interns being more likely to have more knowledge than students. The respondents with better knowledge were more likely to have a positive attitude. CONCLUSION: The study participants had satisfactory knowledge, and the majority had a positive attitude towards the LGBTQ+ community. However, to clear misconceptions regarding the LGBTQ+ community, the medical curriculum must be updated to include more information and provide proper training and sensitization in order to ensure optimum healthcare for all, regardless of sexual orientation and identity.

Bridging the Gaps: The Transformative Effect of Coronavirus Disease 2019 (COVID-19) on Preventive Measures Among Medical and Health Sciences College Students in Madinah, Saudi Arabia.

Background The global impact of coronavirus disease 2019 (COVID-19) has disrupted the activities of medical and health profession education institutions. This study aimed to determine the impact of COVID-19 on medical and health profession education students' knowledge, attitudes, and practices toward preventive measures and their commitment to precautionary measures before, during, and after the pandemic. Materials and methods A cross-sectional study was carried out from January to March 2023 using an online, structured, validated questionnaire survey to gather information from medical and health sciences students from three universities, encompassing five colleges in Madinah, Saudi Arabia. The minimum required sample size was estimated using the Epi Info software as 380. The data was analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States). Statistical tests including Student's t-test, chi-squared test, and analysis of variance (ANOVA) test were applied. Results The findings revealed that personal experiences with COVID-19 infection had a significant impact on students' attitudes and commitment to preventive measures (p<0.05). Among the participants, 172 students (45%) reported having contracted COVID-19. Students with clinical exposure showed a higher level of understanding and adherence to preventive measures (248 students, 68%), compared to pre-clinical students (198 students, 52%) (p<0.05). Positive attitudes were observed toward practices such as sneezing etiquette (289 students, 76%) and flu vaccination (314 students, 83%) (p<0.05). However, negative attitudes were observed toward mask-wearing (155 students, 41%) and social distancing (144 students, 38%), particularly among male students (p<0.05). Conclusion The study provided valuable insights into the impact of the COVID-19 pandemic on medical and health sciences students' knowledge, attitudes, and practices toward preventive measures and the importance of introducing COVID-19 prevention measures in the pre-clinical phase as well as mental health support to promote positive attitudes and enhance adherence to preventive measures.

Creation and Administration of a Chiropractic Program Practical Classroom Preparticipation Screening Aimed to Prevent Student Injuries: A Descriptive Report.

Objective: The purpose of this descriptive report is to describe the development of a preparticipation risk assessment screening process for incoming students prior to participation in practical labs. Methods: A committee at the Palmer College of Chiropractic, Florida met to discuss a health history questionnaire, physical examination process, and course of action to have second-year students use their current knowledge to screen incoming students for possible clinical considerations of practice lab participation. The aim was to identify potential risk factors that may require application modification associated with performing and receiving adjustments and other hands-on lab activities within the curriculum. The preparticipation screening process, focused on general health and curriculum referenced chiropractic clinical considerations, and was created as an expansion of the existing informed consent procedures to screen incoming students prior to participating in palpation, technique, physical examination, and open adjusting labs in the chiropractic program. Any clinical considerations identified during the screening were referred to be fully evaluated by a third-year clinic intern and faculty-licensed chiropractor to maintain classroom safety standards for the students. Referred students were restricted from full classroom lab participation until recommendations from the clinic or outside licensed healthcare providers managing their concerns were received. Results: The program was implemented in April 2022. Eight out of the 48 students evaluated in the first group and 12 of the 81 in the second group had possible clinical considerations to participation and were referred appropriately for a full evaluation. In the third group, 35 out of 146 students with suspected clinical considerations to participation were identified. Of the 55 students referred out, all students are now actively participating in classroom activities. Fifteen have been cleared to return to classroom participation with no restrictions and the remaining 40 students have been released for participation with patient-specific restrictions as directed by their managing health care providers. Conclusion: The preparticipation screening process was implemented as all incoming students since the inception of the process have been screened, referred for evaluation when deemed appropriate, and cleared to participate in labs either with or without restrictions. This process has also demonstrated the possibility of identifying multiple clinical considerations for safe curricular participation while participating in doctor-patient simulated classroom activities. This process may be helpful for new students to recognize the patient history and examination procedures as an important aspect of a patient encounter prior to receiving treatment.

Sleep quality and associated factors among university students in Africa: a systematic review and meta-analysis study.

Background: Poor sleep quality significantly impacts academic performance in university students. However, inconsistent and inconclusive results were found in a study on sleep among university students in several African nations. Therefore, this study aimed to estimate the pooled prevalence and associated factors of poor sleep quality among university students in Africa. Methods: The databases PubMed, Scopus, Cochrane Library, Science Direct, African Journal Online, and Google Scholar were searched to identify articles. A total of 35 primary articles from 11 African countries were assessed and included in this systematic review and meta-analysis. Data were extracted by using a Microsoft Excel spreadsheet and exported to STATA version 14 for analysis. The I2 test was used to assess the statistical heterogeneity. A random effect meta-analysis model was employed with 95% confidence intervals. Funnel plots analysis and Egger regression tests were used to check the presence of publication bias. A subgroup analysis and a sensitivity analysis were done. Results: A total of 16,275 study participants from 35 studies were included in this meta-analysis and systematic review. The overall pooled prevalence of poor sleep quality among university students in Africa was 63.31% (95% CI: 56.91-65.71) I2 = 97.2. The subgroup analysis shows that the combined prevalence of poor sleep quality in East, North, West, and South Africa were 61.31 (95% CI: 56.91-65.71), 62.23 (95% CI: 54.07-70.39), 54.43 (95% CI: 47.39-61.48), and 69.59 (95% CI: 50.39-88.80) respectively. Being stressed (AOR= 2.39; 95% CI: 1.63 to 3.51), second academic year (AOR= 3.10; 95% CI: 2.30 to 4.19), use of the electronic device at bedtime (AOR= 3.97 95% CI: 2.38 to 6.61)) and having a comorbid chronic illness (AOR = 2.71; 95% CI: 1.08, 6.82) were factors significantly associated with poor sleep quality. Conclusion: This study shows that there is a high prevalence of poor sleep quality among university students in Africa. Being stressed, in the second year, using electronic devices at bedtime, and having chronic illness were factors associated with poor sleep quality. Therefore, addressing contributing factors and implementing routine screenings are essential to reduce the burden of poor sleep quality. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023493140.

Assessment of knowledge and attitude of cervical cancer among the youths in the Rayalaseema region of Andhra Pradesh - India.

BACKGROUND: India suffers a quarter of the global burden of cervical cancer (CC) but is controllable by taking some precautions. The major issue is the low amount of participation among women in screening and vaccination for disease. The objective of the research is to evaluate knowledge, attitude, and practice (KAP) regarding CC among college going students residing in the Rayalaseema region of Andhra Pradesh-India. MATERIAL AND METHODS: A cross-sectional study was conducted on a total of 380 subjects whose ages ranged from 15 to 25 and older. The questionnaires were circulated through google forms. The socio-demographic variables and KAP levels are represented by descriptive statistics. The Chi-square test is used to determine the relationship between sociodemographic factors and KAP levels. RESULTS: Among 380 subjects, 172 (54.7%) are aware of CC, 71% have poor knowledge, and 20% have good knowledge about CC. More than three-fourths of women 374 (98.4%) are not having regular practice towards CC. CONCLUSION: The awareness about CC is very low in the population, so prevention of CC relies on routine screening, proper vaccination, and treatment. Awareness programs and promoting knowledge about cervical health in social media are required.

Concept and methodology of the Health Behaviour in School-aged Children (HBSC) study - Insights into the current 2022 survey and trends in Germany.

Background: Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18. Method: 174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347). Discussion: The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.

College students' satisfaction with online teaching during the COVID-19 pandemic: Evidence from Hubei Province, China.

To evaluate the performance of online teaching during the COVID-19 period, we collected 1886 survey data from college students in Hubei Province, China. The scoring rules of the Framework for Teaching were used to measure college students' satisfaction with online teaching, and an econometric model was constructed to empirically validate its dynamic influences. We found that college students' satisfaction with online teaching during the COVID-19 pandemic was lower than that with offline teaching. Online teaching satisfaction was significantly affected by variables of class size, proportion of online teaching, epidemic severity, college grade, network, course classification, major classification, and the teacher's age and skills. It was further found that as COVID-19 gradually dissipated, offline teaching should be resumed as soon as possible. These findings objectively evaluate the teaching performance of college students during the COVID-19 pandemic and can provide suggestions for optimizing online teaching during future emergencies.

Exploring students' perception of subjective food literacy: A model of educational practice.

Introduction: Latest research showed that lower levels of food literacy led to poorer health outcomes and highlighted the importance of nutrition education to improve food literacy for the population. Although evidence at the global level exists, the scientific literature on food literacy in Romania is scarce; therefore, this article aims to explore the perception of subjective food literacy as an outcome of an educational model in a sample of university students from Romania. Methods: The present study used a qualitative inductive approach using focus groups to explore the results from an educational "learning-by-doing" model regarding the perception of subjective food literacy. The sample consisted of 64 second-year students who participated in a class taught by one of the authors between October 2019 and February 2020 and later agreed to participate in the focus groups. All focus groups were audiotaped following participants' permission and transcribed verbatim. Data was analyzed with the QSR Nvivo 12 Pro software package using an inductive thematic analysis. Results: Several themes and sub-themes emerged from the focus groups discussing prior information of participants regarding nutrition, change in nutrition knowledge (information about plant protein, information about soy and soy products, information about sugar and its effects on health, and additional nutrition information), modified perception of nutrition and food, dietary habits, short-term behavior changes, and aspects that helped them to have more information about nutrition (construction of the health campaign, pre-testing materials, and support offered by the professors). All participants reported acquiring new information about food and nutrition, modified perceptions about nutritional habits, and even reported short-term behavioral change as an outcome of the educational model. Conclusions: Educational models using a learning-by-doing approach and combining formal and non-formal education can potentially affect students' subjective food literacy. Future research should explore university students' food literacy using evidence-based educational models.

Measuring the psychosocial impact of COVID-19 by means of the "international student well-being study questionnaire": Evidence on Italian university students.

Background: The COVID-19 pandemic appeared as an unpredictable disruption of daily activities. This situation produced a unique mental health impact for the general population, youth, and vulnerable groups. A documented consequence has been alcohol abuse and impaired mental health. To our knowledge, no published study has yet evaluated the rates of depressive symptoms, academic frustration, and substance abuse in the Italian student population in the COVID era linking them to sociodemographic variables. Aims: To investigate the incidence of depressive symptoms, academic frustration, and substance abuse students developed in one university in Northern Italy during the first COVID-19 outbreak, using a student wellbeing framework borrowed from Allardt's and Bronfenbrenner's theories. Methods: Descriptive statistics, correlations, Wilcoxon test and factorial ANOVA were performed on data gathered through an online questionnaire sent to a convenience sample of university students. Data collection occurred between 18 May and June 21, 2020. Results: According to the framework used, Being was the dimension of sociodemographic variables, Having was economic support and Loving was social support. Students experienced academic frustration and related depressive symptoms. Male gender seemed to be less affected by the depressive syndrome. With regard to economic support and related repercussions on depressive symptoms, students who reported that they could not obtain a loan showed significantly higher depressive symptoms. Students benefiting from greater financial support showed less academic frustration. Age appeared to be a predictor of academic frustration since young students proved to be the most frustrated. The examined students' population showed a significant decrease in alcohol and cigarettes consumption. Conclusions: Having and Being dimensions influenced depression and academic frustration. Having and Loving dimensions were related with use of substances. The study findings support the implementation of interventions to help students, at a psychological, social, financial level aiming at fostering the quality of students' educational life.

Acceptance of Students with Physical Disabilities in Medical Schools in Saudi Arabia: Perception, Experience, and Recommendation.

Introduction: Physical disability is seen as a burden in many countries, and it has been a challenge to create a healthy environment and a fair living experience for all people with physical disability. For a long time, the number of students accepted to medical school has been limited, and the number of successful experiences for doctors with disabilities is inadequate worldwide. This study aims to investigate the perception of the public, medical educators, and medical students about the acceptance of students with physical disabilities in medical schools in Saudi Arabia. Methods: The study uses two methodological strategies: a quantitative cross-sectional survey and a qualitative interview with a young female doctor with a physical disability to discuss her educational experience and work journey in Saudi Arabia and abroad. The study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Results: The perception survey results showed a broad acceptance of the public, medical educators, and medical students regarding the enrollment of students with physical disabilities in medical schools and regarding being treated by doctors with physical disabilities. The participants also believed that students with physical disabilities are compatible with most doctors' jobs. Conclusion: Students with physical disabilities should be able to study and practice medicine. Educational and health institutions should apply more effort and commitment to provide the necessary accommodations to accept students and doctors with physical disabilities based on their cognitive ability but not their physical disability.

PTSD prevalence and factors in intern nursing students after COVID-19 full liberalization in China: a cross-sectional study.

Objective: This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) and its influencing factors among intern nursing students after the full liberalization of the COVID-19 prevention and control policy in China. Methods: Participants completed the online survey from January 14 to January 19, 2023. A demographic questionnaire, COVID-19 and internship-related questionnaire, the Fear of COVID-19 scale, the Primary Care PTSD Screen, and the Connor-Davidson Resilience Scale were used to conduct the online survey. Results: Of 438 participants, 88.4% tested positive for COVID-19 in the last 6 months. The prevalence of fear, resilience, and PTSD was 16.9, 15.5, and 11.2%, respectively. Direct care of COVID patients in hospital (OR = 2.084, 95%CI 1.034 ~ 4.202), the experience of occupational exposure (OR = 2.856, 95%CI 1.436 ~ 5.681), working with an experienced team (OR = 2.120, 95%CI 1.070 ~ 4.198), and fear COVID-19 (OR = 8.269, 95%CI 4.150 ~ 16.479) were significantly and positively associated with PTSD in nursing internship students. Conclusion: After COVID-19 full liberalization in China, intern nursing students still experienced pandemic-related mental distress, which can bring PTSD. Adequate support and counseling should be provided, as needed, to intern nursing students who are about to enter the workforce and have experienced severe PTSD symptoms related to COVID-19. Our findings indicated that should understand the importance of screening, formulate intervention strategies and preventive measures to address psychosocial problems, and provide coping skills training to intern nursing students.

Study on the outdoor thermal comfort of college students under different activity intensities in a high-altitude climate zone.

Introduction: Research on the outdoor thermal comfort (OTC) of a university campus is beneficial to the physical and mental health of college students. Methods: In this study, the OTC of students attending Tibet University in Lhasa, which experiences high-altitude cold climate conditions, under different activity intensities was studied using field measurements and a questionnaire survey. Results: With the increase in activity intensity, the comfort physiologically equivalent temperature (PET) value gradually increased in summer, while the comfortable PET value gradually decreased in winter. The most comfortable PET value is 17.6°C in summer and 11.5°C in winter. The neutral PET of Tibetan college students during outdoor activities in summer was 16.3°C, and the neutral PET of outdoor activities in winter was 12.1°C. Gender and ethnicity had different effects on thermal sensation under different activity intensities. Under vigorous-intensity activities, PET in winter and summer had the greatest influence on thermal sensation. The situation was different under moderate-intensity activity. PET had the greatest influence on thermal sensation in summer, and Tmrt had the greatest influence on thermal sensation in winter. Discussion: These findings provide a basis for an improved design of the outdoor environment under different outdoor activity intensities in high-altitude areas.

Unhealthy diets increase the likelihood of being overweight or obese among African migrant students in China, but not among African non-migrant students: a cross-sectional study.

Background: The impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data. Methods: The researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries. Results: Approximately 678 responses were received, mainly between 18-25 years (46.7%) and 26-36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students. Conclusion: Controlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.

Multicultural personality traits of Chinese university students and their effects on the psychological adjustment in the aftermath of COVID-19 in Shanghai: a scale validation.

Objective: This study aims to explore Chinese university students' multicultural personalities and examine how they predict the psychological adjustment of students in Shanghai. In addition, the validation of Multicultural Personality Questionnaire Short Form (MPQ-SF) scale developed to assess the multicultural personality traits of individuals is also aimed in Chinese context. Data were collected after the psychological stresses from restrictions imposed by COVID-19 in China that influenced life adjustments for nearly three years. Method: A total of 1,099 university students participated in this multi-stage study. First, the Chinese version of MPQ-SF (MPQ-SF-C) was developed and validated. The impact of MPQ-SF-C dimensions was then tested through path analysis to establish the effects of Chinese university students' multicultural personality traits on their psychological adjustment using the Schwartz Outcome Scale (SOS-10). Results: The MPQ-SF-C yielded a five-factor solution which accounted for 60.14% of the common variance. The findings indicated that cultural empathy (ß = 0.23, p < 0.05), certainty seeking (ß = 0.13, p < 0.05), open-mindedness (ß = 0.48, p < 0.05), and emotional stability (ß = 0.24, p < 0.05) had significant influences on adjustment. Only flexibility was found to have a statistically insignificant impact on adjustment at this time in this context. MPQ-SF-C and SOS-10 scales represented very good psychometric properties in terms of their reliability and validity. Conclusion: The MPQ-SF-C shows good psychometric properties and appropriateness for evaluating multicultural personalities in Chinese contexts. The multicultural personality characteristics of university students using this scale well predicted their psychological adjustment.

The effect of perceived stress on binge eating behavior among Chinese university students: a moderated mediation model.

Introduction: Previous studies have demonstrated a strong link between perceived stress and binge eating behavior, but the psychological mechanisms underlying such phenomenon are not fully understood. The present study further addressed this issue in a life history framework, focusing on life history strategy and distress tolerance. Methods: Firstly, we investigated the mediation role of life history strategy on the relationship between perceived stress and binge eating behavior. Secondly, we examined the moderation role of distress tolerance on the effect of perceived stress on life history strategy, as well as on the direct effect of perceived stress on binge eating behavior. We analyzed data from 1342 Chinese university students. Results: Results indicated that life history strategy mediates the relationship between perceived stress and binge eating behavior; distress tolerance has significant moderating effects on the direct effect of perceived stress on binge eating behavior and their indirect effect via life history strategy. Discussion: Therefore, distress tolerance skills training and life history-based interventions might be potentially effective ways to reduce binge eating behavior triggered by perceived stress.

Demographic, substance use, and mental well-being correlates of high-intensity drinking among college students and non-college young adults: implications for intervention.

OBJECTIVE: To assess demographic, substance use, and mental wellbeing factors associated with high-intensity drinking (HID; 10+ drinks on one occasion) among college- and non-college young adults, to inform prevention and intervention efforts. PARTICIPANTS: A total of 1,430 young adults (819 in college and 611 not attending college) in a Midwestern state who reported trying alcohol at least once. METHODS: Participants were recruited via social media between November 2019 and February 2020 to complete a web-based survey assessing demographics, substance use, and mental well-being. Logistic regression was conducted to assess relationships between these measures and HID among (1) college students and (2) non-college young adults. RESULTS: About 14.0% of participants reported past-month HID. Among both college- and non-college young adults, men, those who perceived slight or no risk of harm from binge drinking, and those who used alcohol and marijuana simultaneously in the past year had greater odds of reporting past-month HID. Among students, past-year prescription drug misuse was also associated with HID. CONCLUSIONS: High intensity-drinking is concerning given potential adverse consequences. Campus programming should address norms that may promote such drinking and other high-risk substance use associated with HID.

Hippocrates, the first aphorism, and decorum: A personal view of caution and guidance regarding Generation Z students.

Generation Z students can be challenging. The Internet, the Covid-19 epidemic, its political aftermath, and the substantial online educational content they have been required to endure, has left them with a perspective towards a work-life balance to which we older, more experienced faculty are not accustomed. Here, I give caution and guidance to my colleagues regarding their interactions with this cohort through my reading of the Hippocratic corpus.

Spiritual care for clients with mental illness from an Islamic background: Nursing students' perspectives.

WHAT IS KNOWN ON THE SUBJECT?: Spirituality is an important aspect for clients with mental illness. Spirituality is essential to holistic care in mental health nursing. Nurses found an apparent disconnection between the theory and practice of spiritual care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Nurses acknowledged that attitudes that allocate blame towards clients with mental illness have the most negative impact on clients' spiritual wellbeing. The conflicting worldviews between spiritual healing and a biomedical approach impact the provision of care as relationships among the mental health team are disrupted. The non-assessment of the client's spirituality hindered nurses from providing spiritual care. Language differences between nurses and clients impede nurses from providing spiritual care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The use of spiritual therapy as an element of nursing care works if clients and nurses are both aware of the importance of spirituality. Nursing staff must also be aware of several issues that may make it difficult for nurses to provide such therapy, including specific symptoms of mental illness. Nurses can apply spiritual care effectively when they have significant spirituality. Nurses with good competency in mental health nursing skills are more likely to provide efficient spiritual care as part of holistic care. ABSTRACT: INTRODUCTION: Spiritual care is essential to clients with mental illness. AIM: To explore mental health nursing students' perspectives on spirituality and spiritual care and how this impacts clients with mental illness in an Islamic context (Saudi Arabia). METHOD: Thematic analysis is used to analyse data from two focus groups of mental health nursing students (one comprising eight, the other six). RESULTS: Six themes emerged: factors affecting spirituality in mental illness, the impact of mental illness on spirituality, the use of spiritual healing in mental illness, nurses' use of spiritual healing; challenges in providing spiritual care and recommendations for improving spiritual care. DISCUSSION: Clients being blamed for having mental illness by health professionals and the community harmed their spirituality. The religious support of peers was a practical approach to spiritual therapy, asserted as a beneficial element of nursing care. However, nurses found providing such therapy challenging because of the language barrier and the lack of any assessment of clients' spirituality. It was also challenging when dealing with specific symptoms of mental illness. IMPLICATIONS FOR PRACTICE: The study asserts that spiritual therapy in nursing care will work if the client knows its importance. Nurses who have significant spirituality can apply it effectively.