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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Sleep Quality and Daytime Sleepiness among Medical Undergraduate Students in Tamil Nadu: A Cross-sectional Study
Correspondence Address :
Dr. R Anuradha,
1041 (Old No 525/2), Periyar Evr High Road, Arumbakkam,
Chennai-600106, Tamil Nadu, India.
E-mail: dr.anuhems@gmail.com
Introduction: Sleep quality is strongly related to psychological and physical well-being. Medical students experience long duration of study period, academic over load, frequent exams, fear of failure and highly demanding lifestyle. They are vulnerable to poor sleep quality.
Aim: To find the prevalence of sleep quality and daytime sleepiness and their associated factors among medical undergraduate students in Tamil Nadu, India.
Materials and Methods: This was a cross-sectional study conducted among 367 undergraduate medical students from first year to final year of a Government Medical College, Chennai, Tamil Nadu, India. A self-administered questionnaire was used to collect data on socio-demographic characteristics, lifestyle behavioural factors, mobile phone usage and academic performance. Pittsburgh Sleep Quality Index (PSQI) and Epworth Daytime Sleepiness Scale (EDSS) were used to assess sleep quality and excessive daytime sleepiness, respectively. Descriptive statistics was used to express baseline characteristics. Chi-square test was applied to test associated factor. Pearson correlation coefficient was used to find correlation between continuous variables.
Results: Poor quality of sleep and excessive daytime sleepiness was found among 54.2% and 28.6% of students, respectively. Poor sleep quality and excessive daytime sleepiness was significantly associated with increased duration of mobile phone usage (p=0.030 and p=0.009 respectively). Significant association was found between sleep quality and academic performance (p=0.004). Statistically significant correlation was found between sleep quality and duration of mobile phone usage (r=0.18, p=0.0001) as well as sleep quality and excessive daytime sleepiness (r=0.14, p=0.005).
Conclusion: Prevalence of poor quality sleep and excessive daytime sleepiness was found to be high among medical students. Mobile phone overuse was significantly associated with poor sleep quality and excessive daytime sleepiness. Students with good quality of sleep had better academic performance when compared to poor sleepers. Excessive daytime sleepiness was found in increasing pattern among those with poor quality sleep.
Academic performance, Medicos, Mobile phone use, Quality of sleep
Sleep is a physiological process essential to life. Sleep quality is linked to psychological and physical well-being but has been found to deteriorate due to lifestyle changes, environmental disturbances, stress and modern technologies (1). Prevalence of poor sleep quality are increasing in both developing and modern societies (2),(3). Lack of good quality sleep may lead to diminution in immunity, psychological problems and metabolic disorders (4).
Medical students are considered a stressful group of students and this may be attributed to their long duration of study period, academic over load, frequent exams and the highly demanding lifestyle (5),(6). Medical students are susceptible to poor sleep quality. Sleep problems among medical students was found to range from 19-90% worldwide (2). Difficulty in concentration and attention along with poor academic performance are associated with poor sleep quality among students (7). Poor sleep quality and Excessive Daytime Sleepiness (EDS) may affect the performance of medical students (8) and their future work performance as practitioners which in turn can affect the healthcare system also.
Screening for poor quality of sleep among medicos helps in finding the magnitude of the problem and applying early intervention. This will enhance their academic performance and quality of care given by them in the future. There was only one study done in this part of the country to assess sleep quality and daytime sleepiness among medical students (9). Hence this study was conducted to find the prevalence of sleep quality and daytime sleepiness and their associated factors among medical undergraduate students in Tamil Nadu and plan appropriate managing strategies based on the findings of the study.
This was a cross-sectional study conducted among undergraduate medical students of a Government Medical College, Chennai, Tamil Nadu, India between June 2017 and October 2017. Institutional Ethical Clearance (IEC) was obtained (IEC No. 21-17/04/2017). All medical undergraduate students were invited to participate in the study.
Inclusion and Exclusion criteria: The students who were willing to participate were included and those who were not willing to participate were excluded from the study.
Study Procedure
After obtaining informed consent students were asked to complete a self-administered questionnaire. A total of 388 questionnaires were distributed of which 367 were completed and returned. Questionnaire was prepared based on review of literature (10). PSQI (11) and EDSS (12) are validated scales which were used in this study to assess the sleep quality and daytime sleepiness. The questionnaire consisted of following sections:
a) Socio-demographic profile
b) Information regarding exercise, smoking, alcohol intake, bedtime intake of coffee, duration of mobile phone usage per day and academic performance.
c) PSQI (11) -It is a self-reported instrument to assess the quality of sleep. It consists of 19 individual items, creating seven components that produce one global score. The seven components are subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and sleep disturbance, use of sleep medication and daytime dysfunction. Each item is weighted on a 0-3 interval scale. The global PSQI score is then calculated by totaling the seven component scores, providing an overall score ranging from 0-21. A total score of 5 or greater is indicative of poor sleep quality.
d) EDSS (12)- It is a self-administered questionnaire which consists of eight-items to assess the chance of falling asleep or dozing off during different daily life situations on an ordinary day. The study participant rates his or her probability of falling asleep on a scale of increasing probability from 0-3 for eight different situations. The scores for the eight questions are added together to obtain a single number which ranges from 0-24. A score ranging from 0-10 is defined as normal, while a score of 11-24 is considered abnormal and indicates excessive daytime sleepiness.
Statistical Analysis
The data was coded and entered in Microsoft excel sheet. Statistical Package for Social Science (SPSS) software version 21.0 was used for analysis of the data. Descriptive statistics such as frequency and percentages were used to express socio-demographic profile, lifestyle factors, sleep quality and daytime sleepiness. Chi-square test was used to find factors associated with sleep quality and daytime sleepiness. Pearson correlation coefficient was used to find correlations between continuous variables. A p-value of <0.05 was considered statistically significant.
A total of 388 questionnaires were distributed of which 367 questionnaires were completed and returned. The mean age of the study participants was 19.75±1.27 years. Out of the 367 study participants, 221 (60.2%) were females and 146 were males (39.8%). The mean weight of the study participants was 59.8±13.3 kgs. The mean height of the study participants was 1.64±0.09 m. The mean Body Mass Index (BMI) of the study participants was 22.13±4.06 kg/m2. There were 210 (57.2%) hostellers and 157 (42.8%) day scholars (Table/Fig 1). Smoking was noted in 4 (1.1%) and alcohol intake in 8 (2.2%) students. Intake of coffee at bedtime was noted among 18 (4.9%) student’s. The habit of exercising was reported among 63 (17.2%) students. Academic score of >70% was found in 97 (26.4%) students (Table/Fig 2). Laptop usage of more than 2 hours per day was noted among 18 (4.9%) students. Environmental factors such as mosquitoes and loud noise were reported by 292 (79.6%) and 98 (26.7%) students’ respectively as major reasons for the sleep disturbance. Other environmental factors such as hot weather and poor ventilation were reported by 6 (1.6%) and 5 (1.3%) students respectively. Poor quality of sleep was reported in 199 (54.2%) study participants (Table/Fig 3). Proportion of poor sleep quality was reported higher among males (58.2%) compared to females (51.6%), hostellers (55.7%) compared to day scholars (52.2%) and prefinal year (61.1%) students compared to other academic year students. There was a statistically significant association between alcohol consumption and sleep quality (p=0.009). The proportion of students with poor sleeps quality increased with an increase in the duration of mobile usage. A statistically significant association was found between mobile phone usage and sleep quality (p=0.030) (Table/Fig 4). Academic performance >70% was noted in 59 (35.1%) and 38 (19.1%) among those with good quality sleep and poor-quality sleep, respectively. There was a statistically significant association between sleep quality and academic performance (p=0.004) (Table/Fig 5).
Excessive daytime sleepiness was found in 105 students (28.6%) (Table/Fig 6). The proportion of excessive daytime sleepiness was higher among prefinal (38.9%) year and second-year students (37.2%) when compared to first (23.0%) and final year (14.3%) students and was found to be statistically significant (p<0.0001). The proportion of excessive daytime sleepiness increased with an increase in the duration of mobile phone usage and was found to be statistically significant (p=0.009) (Table/Fig 7). No significant association was found between daytime sleepiness and academic performance (Table/Fig 8). Poor but highly significant correlation was noted between sleep quality and duration of mobile phone usage (hours) per day (r=0.18, p=0.0001) (Table/Fig 9). However, no statistically significant correlation was found between excessive daytime sleepiness and duration of mobile phone usage (hours) per day (r=0.09, p=0.069) (Table/Fig 10). Correlation between sleep quality and excessive daytime sleepiness was poor but statistically significant (r=0.14, p=0.005) (Table/Fig 11).
In the present study, 54.2% of undergraduate medical students had poor sleep quality as per the PSQI scale which was higher than the findings of a study conducted in Nepal (13). A higher prevalence of poor quality of sleep among medicos was reported by other studies (Table/Fig 12) (14),(15),(16),(17),(18). Students in the age group >20 years were found to be poor sleepers (59.3%) in present study. The increase in academic burden might be a reason. However, many studies reported a higher proportion of poor quality of sleep among younger students <20 years (14),(16),(19),(20). This may have been due to the reason the younger students may have not adapted to a higher academic load after their higher secondary education. Anxiety and the pressure of passing the first professional exams may also play a role. Male students (58.2%) had a higher proportion of poor sleep quality when compared to females (51.6%) in the present study. Madhusudan M et al., also revealed males (41.7%) had poor quality of sleep compared to females (36.4%) (19). In a study conducted among medicos in Maharashtra females had a better quality of sleep than males. attributing drug abuse among males (10). In contrast, females were poorer sleepers compared to males, as reported by many previous studies (3),(14),(18). Attributing to more psychological problems like anxiety and depression among females. Prefinal year (61.1%) students followed by first-year (57.5%) students were having poor sleep quality in present study. A study conducted in Kerala found poor sleep quality among first MBBS students (19). Transition from schooling to professional course may be the reason for poor sleep quality among first year students. Basu M et al., reported sleep quality improves as students advance in academic years (14). The reason may be that over a period of time students become accustomed to their academic schedule and learn to improve their sleep habits. Hostellers had poor quality of sleep when compared to day scholars in the present study which was similarly reported in other studies also (16),(20). Poor sleep quality was found more among single when compared to those married. Ibrahim N et al., reported similar findings in their study (6). Students who had a smoking habit had a higher proportion of poor quality of sleep in present study however no significant association was found. Similar findings were reported in other studies (10),(16). Alcohol consumption was significantly associated with sleep quality which was also found in other studies (14). No significant association between bedtime coffee intake and sleep quality was found in the current study. Excessive consumption of caffeine was associated with poor sleep as reported by Ibrahim NK et al., (16) and Sanchez SE et al., (21). No significant association between exercise and sleep quality was found in the present study. However, a significant association between exercise and sleep quality was reported in a study conducted in Kolkata (14). Giri PA et al., found that those who exercise daily showed less sleep disturbance (10). In present study, increased duration of mobile phone usage was associated with poor sleep quality. Studies revealed long-time use of mobile phones/laptops was associated with poor quality of sleep (10),(14). However a study conducted in Saudi Arabia revealed that there was no association between social media usage at night and sleep quality (16). Poor sleep quality was associated with low academic performance in this study which was consistent with the findings by Seun-Fadipe CT and Mosaku KS (22). Few studies reported no significant association between sleep quality and academic performance (19),(23). Excessive daytime sleepiness was found in 28.6% of students in the present study. Studies have shown the prevalence of excessive daytime sleepiness in medical students to be 24.9-36.6% (14),(24),(25),(26). No gender difference was observed in the prevalence of excessive daytime sleepiness in this study which was similarly reported in a study conducted in Kerala (27). However few studies found that females had a higher prevalence of excessive daytime sleepiness (24),(28). Excessive daytime sleepiness was higher among prefinal year (38.9%) students and second year (37.2%) in present study and was found to be statistically significant. However, no significant difference was found between excessive daytime sleepiness and the year of study in a study conducted among medical students in Morocco (26). The proportion of excessive daytime sleepiness increased with an increase in the duration of mobile phone usage in present study and was found to be statistically significant. Other studies also reported excessive daytime sleepiness among medicos due to excessive use of smartphones and the internet (29),(30). No significant association was found between daytime sleepiness and academic performance in the present study. Similar findings were reported in a study conducted in Morocco and Saudi Arabia (26),(31). Excessive daytime sleepiness was significantly correlated with poor quality sleep in the present study which was similarly reported by Sathe HS et al., (29).
Limitation(s)
This was a cross-sectional study conducted only in one medical college which may limit the generalisability of the findings. Since the responses were collected using a self-administered questionnaire, there may be an information bias.
The poor quality of sleep and excessive daytime sleepiness was found to be highly prevalent (54.2%) among medical undergraduate students in this study. Mobile phone overuse was significantly associated with poor sleep quality and excessive daytime sleepiness. Students with good quality of sleep had better academic performance when compared to poor sleepers. Excessive daytime sleepiness was found in increasing pattern among those with poor quality sleep.
Study on sleep quality is very important for the monitoring of sleep in students and helps in the planning of interventions aimed at increasing awareness of this issue. Awareness about the adverse impact of sleep disturbances on academic performance should be raised. Avoidance of overuse of mobile phones is strongly recommended. Sleep quality can be improved through counselling, providing a positive environment and practicing a healthy lifestyle. This can be achieved by establishing counselling facilities, conducting sleep educational programs, stress management courses and promoting good sleep hygiene that can enhance the quality of life of the medicos and cope with their stressful environment.
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DOI: 10.7860/JCDR/2022/57499.16552
Date of Submission: May 02, 2022
Date of Peer Review: May 26, 2022
Date of Acceptance: Jun 17, 2022
Date of Publishing: Jul 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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