Background: Stress may affect students’ health and their academic performance. Coping strategies are specific efforts that individuals employ to manage stress. This study aimed to assess the perception of stress among medical students and their coping strategies. Methods: A cross-sectional study was conducted among 376 medical and medical sciences undergraduates in Management and Science University in Malaysia. Stress was assessed by a global rating of stress. Sources of stress were assessed using a 17-item questionnaire. The validated Brief COPE inventory was used to assess coping strategies. Results: The majority of respondents were females (64.4%), aged 21 years or older (63.0%), and were Malays (68.9%). Forty-six percent felt stress. The most common stressor was worries of the future (71.0%), followed by financial difficulties (68.6%). Significant predictors of stress were smoking (OR = 2.9 , 95% CI 1.3–6.8, P = 0.009), worries of the future (OR = 2.1 , 95% CI 1.3–3.4, P = 0.005), self-blame (OR = 1.3, 95% CI 1.1–1.5, P = 0.001), lack of emotional support (OR = 0.8, 95% CI 0.7–0.9, P = 0.017), and lack of acceptance (OR = 0.8, 95% CI 0.6–0.9, P = 0.010). Students used active coping, religious coping reframing, planning, and acceptance to cope with stress. Conclusion: Stressors reported by the students were mainly financial and academic issues. Students adopted active coping strategies rather than avoidance. Students should receive consultation on how to manage and cope with stress.

Background: Stress is a common work-related problem worldwide. Railway workers are predominantly stressed due to their rigid protocols and limited rest opportunities. This study aimed to determine the level of, and factors associated with, stress among railway workers in Malaysia. Methods: A cross-sectional study was conducted among all 729 railway workers employed at Keretapi Tanah Melayu Berhad (KTMB) in eight states in Malaysia via a postal survey. The selfadministered questionnaire consisted of socio-demographic characteristics and the validated Malay version of Perceived Stress Scale-10 (PSS-10). Response rate was 70.4% (513/729). Results: Mean (SD) age of workers was 41.4 (10.7), with the majority aged 30 years or older (79.3%). Mean (SD) perceived stress was 18.8 (4.3). In multiple linear regression analysis, the significant predictors of high stress were high school versus tertiary education (β = 0.10, 95% CI 0.11, 1.73, P = 0.027) and being a white collar worker versus blue collar (β = 0.113, 95% CI 0.10, 1.74, P = 0.010). Conclusions: Education level and type of work were significantly associated with perceived stress among railway workers in this study.

Background: The Perceived Stress Scale 10 (PSS-10) is a validated and reliable instrument to measure global levels of perceived stress. This study aims to assess the internal consistency, reliability, and factor structure of the Malay version of the PSS-10 for use among medical students. Methods: The original English version of the PSS-10 was translated and back-translated into Malay language. The Malay version was distributed to 242 Bachelor of Medical Science students in a private university in Malaysia. Test–retest reliability was assessed in 70 students. An exploratory principal component factor analysis with varimax rotation was performed. Reliability was tested using the intraclass correlation coefficient (ICC). Results: All 242 students participated in the initial questionnaire study (validity and factor structure), and 70 students participated in the test–retest reliability of the study. Exploratory factor analysis yielded 2 factors that accounted for 57.8% of the variance. Cronbach’s alpha coefficients for the 2 factors were 0.85 and 0.70, respectively. The reliability test showed an ICC of 0.82 (95% CI: 0.70, 0.89). Conclusion: The Malay version of the PSS-10 showed adequate psychometric properties. It is a useful instrument for measuring stress among medical students in Malaysia.

There is high expectation from the population on part of the healthcare providers. These include; skilful and timely medication administration; and knowledge, honesty, listening skills, availability and professional attitude. The aim of this paper is to evaluate the expectation of population with regards to the healthcare providers in Turkey. A cross- sectional study was conducted in Turkey, including both rural and urban population, carried out from October 2011 till January 2012. A total of 540 household heads were selected using multistage random sampling technique. Data was collected using modified self-administered 16-items QUOTE (Quality of Care Through the Patients’ Eyes) questionnaire. The questionnaire measures communication/ accessibility, organizational skills and professional skills. The response rate was (77.1%) and data was analyzed by using SPSS version 16.0. All the aspects measured using QUOTE questionnaire were found to be important by the majority of respondents, but with varying degrees of priority. The quality aspects related to the professional skills of physicians was ranked first followed by communication/ accessibility and last but not the least is the organizational skills of health care providers. This study explored the Turkish people priorities and expectations regarding healthcare providers. The public priorities and expectation were different across population. This may reflect the need to understand people’s expectations before providing the services to avoid complaints that may occur after the services have been rendered.

Health system reform has been a major concern for different countries. The aim of this research was to develop a reliable and valid questionnaire suitable to assess the consequences of health reform process from people’s perspective. An extensive literature review used to extract a set of statements as possible indicators for health system reform. Expert panel used to determine the content validity rate (CVR) and the content validity index (CVI). The first version produced in Turkish language and pre-piloted with 20 heads of household. Qualified committee used to translate the Turkish version to English version. Group of eighteen academics and graduate students recruited to tests both versions for parallel test validity. The construct validity of the questionnaire was determined using principal components analysis with Varimax rotation method (PCA). Internal consistency and questionnaire’s reliability were calculated by Cronbach’s alpha and the test–retest reliability test. A 17- items questionnaire was developed through the qualitative phase. The Bartlett’s test was significant (p < 0.001), and the KMO value (0.842) showed that using principal component analysis (PCA) was suitable. Eigenvalues equal or higher than 1 were considered significant and chosen for interpretation. By PCA, 4 factors were extracted (accessibility, attitude and preference, quality of care and availability of resources) that jointly accounted for 85.2% of observed variance. The Cronbach’s alpha coefficient showed excellent internal consistency (alpha=0.97), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (Intra-class coefficient = 0.96). The findings showed that the designed questionnaire was valid and reliable and can be used easily to assess the consequences of health reform process by comparing the situation before and after the reform from people’s perspective.

Musculoskeletal disorders (MSDs) represent a significant occupational problem. Only limited research is available about the impact of MSD on the active Calligraphers. Uncertainty remains about MSD prevalence and associated factors among Arabic calligraphers in Saudi Arabia. A cross-sectional study was conducted among 124 Arabic calligraphers in Saudi Arabia. Data were collected by telephonic interviews using a structured questionnaire that consisted of the validated Standardized Nordic Questionnaire, socio-demographics and working characteristics. A total of 124 completed questionnaires were analyzed. The majority were men (96.8 %), worked for less than 10 hours/week (63.7%). The majority had musculoskeletal pain (59.7%) and about half of them worked for less than 15 years. The most commonly reported MSD was back pain (26.6%) followed by neck pain (21.0%) and shoulder pain (12.1%). In multiple logistic regression the significant predictors in the model were: not exercising (OR=7.1, 95% CI 2.6-19.2), age ≤40 (OR=2.8, 95% CI 1.1- 7.3), worked for ≤20 years (OR=3.4, 95% CI 1.3 -9.1) and being a professional calligrapher (OR=2.3, 95% CI 1.1 – 6.2). The total model is significant (p<0.001) and the adjusted r square= 0.37.MSDs among Arabic calligraphers in Saudi Arabia is relatively high; further clinical assessment is needed. We recommend that health authority in Saudi Arabia should increase the awareness among calligraphers about MSDs and its prevention.
Musculoskeletal disorders ; calligraphers ; Saudi Arabia

Background: Burnout has become a problem that is increasing among doctors. Burnout syndrome consists of emotional exhaustion, depersonalization, and reduced personal accomplishment, which results from the accumulation of stress in a workplace. Objectives: This study aimed to determine the prevalence and associated factors of burnout among resident doctors in Tabuk, Saudi Arabia. Methods: A cross-sectional study was conducted among 230 resident doctors at King Salman Armed Forces Hospital in Northwestern Region in Tabuk City, Saudi Arabia between September 2020 and January 2021. Data were collected by using a self-administered questionnaire. The Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS (MP)) was used to measure burnout. Sources of stress were assessed by 20 items. Univariate and multivariate analysis were used to examine the factors associated with burnout. Results: The overall prevalence of burnout was 89.1%. This study found that 32.2% of participants scored high on all the subscales. Burnout was associated with gender (p=0.012), chronic disease (p=0.018), level of training (p<0.05), dissatisfaction with work-life balance (p<0.001), work overload (p<0.001), and sources of stress in the workplace (p<0.05). Conclusion: The prevalence of burnout among medical residents in Tabuk was high. Burnout was mainly associated with work-related sources of stress. There is a need for a comprehensive assessment of burnout and stress among medical residents at different levels and specialties. Thus, these findings may help diagnose such problems earlier and trace them to find better solutions,

Stress and depression among physicians are recognized as important problems because of the potential risks they impose on individual health and medical care. This study aims to assess level of stress and depression and associated factors among family medicine residents in Al-Madinah, Saudi Arabia. Methods: This cross-sectional study was conducted among 75 residents in the family medicine residency programs in Al-Madinah. Stress and depression were assessed by using the stress and depression subscales of the validated Depression, Anxiety and Stress Scale-21 item (DASS-21). Sources of stress were assessed by 22 items. Results: Most participants had stress (57.3%) and depression (53.3%). Stress was associated with work overload (P=0.032), work demands affect personal/home life (P<0.001), inability to participate in decision making (P=0.026) and inability to make full use of skills and abilities (P=0.019). Depression was associated with ‘work demands affect personal/home life’ (P<0.001). Conclusion: The prevalence of stress and depression among family resident doctors was high. Establishing a residency counseling office is suggested to deal with the resident's problems in a way that supports their needs and leads to the best working environment.