European Journal of Molecular & Clinical Medicine

Background: Studying medicine is stressful. Stressors of medical students have been described in many studies. “Stress is a body’s non-specific response to demands made upon it, or to disturbing events in the environment”. It is a course by which we feel and cope with environmental threats and challenges. Events which cause stress are referred to as stressors. Stress is nothing but the emotional disturbances or changes caused by stressors. Stress is of two types Favourable Stress – facilitates learning and Unfavourable stresses-suppress learning. Medical students may perceive the same stressors differently based on their inbuilt talents. Excessive amount of stress affect students’ self-esteem, achievement and development in their field. Aim & Objective: Prevalence of stress and its association with Resilience, and coping strategies adopted   among Medical Students. Method: Study design:  A cross‑sectional study. Study setting:  Department of Community medicine at tertiary care centre .Study duration: Aug to Nov 2022 Study population: The study population included all MBBS students and interns studding in a tertiary care center. Sample size: Using purposive sampling, a total of 425 medical students from 1st year to internship were included by Using the Cochran formula. Results:  Majority of study participants belongs to the age group 18-22 years e.g 139 (32.70%) followed by 23-27 years age group 127 (29.88%) 98 in 28-32 and 61 students in >33 years age group. majority of study Participants were Females contributing 247 (58.11%) and males 178 (41.89%). Maximum of study participants belongs to the Hindu religion 237 (55.76%) followed by Muslim 81 (19.05%) Buddhist 47 (11.05%) Christian 31 (7.29%) and 29 study participants in other religion. maximum of study participants Duration of Sleep less than 8 hours 297 (69.88%) and 122 participants reported duration of sleep more than 8 hours. maximum of study participants reported that the worried about future 217 (51.05%) followed by academic related 197 (46.35%) 59 participants reported family problems and 33 participants reported other cases of stress. Prevalence of stress among medical students was 57.64%.majority of 1^st year students reported stress 97 (39.59%) followed by final year students 53 (21.63%) 2^nd year 42 (17.14%), Third year 29 (11.83%) and 24 interns reported stress. Association of coping habits with stress among medical students was statistically Significant at p<0.5. Conclusions: Academic factors are greater perceived cause of stress in medical students in this study. Interventions must be developed to target the particular stressors to reduce the burden on students. The students should be taught various stress management techniques to improve their ability to cope with the demanding professional course. Various programs should be implemented to reduce the stress burden right from the 1st year itself. Teaching stress management and self‑care skills to medical students become essential.

The purpose of this study is to investigate the prevalence and relationships between stress, anxiety, and depression and daytime sleepiness among medical students in the Erode area of Tamil Nadu. Methods: Using a stratified random sample technique, a cross-sectional research of 288 Government Erode Medical College medical students was conducted. The survey was self-administered electronically. The daytime sleepiness, sleep quality, and stress, depression, and anxiety were evaluated by the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), and DASS 42, respectively. Results: Overall, 22.6% of students reported excessive daytime sleepiness. Depression, anxiety, and stress all had prevalence rates of 40.6%, 39.9%, and 29.9%, respectively. 78.5% of people reported having undesirable or poor sleep quality (total PSQI score 5). Epworth Sleepiness Scale Grade and DASS Levels are not correlated (P>0.05). The findings show that women are substantially more stressed than women are (P< 0.05). Stress and poor sleep quality were substantially correlated (P <0.05), indicating that stress level is a significant predictor of poor sleep quality. The study's findings show that students have a high level of stress and poor sleep quality, and they are strongly correlated. We advise creating classes that instruct students on good sleeping habits and coping mechanisms for stressful situations.
Medical students were reported to have a significant prevalence of night-time sleepiness and excessive daytime sleepiness. Overuse of mobile devices was found to be causally related to both excessive daytime sleepiness and poor sleep quality. When compared to students who get low quality sleep, the former performed better academically. Those who had low quality sleep showed an escalating pattern of excessive daytime drowsiness. There was a high prevalence of sleep problems, anxiety, stress, and depression among pre-clinical medical students. Those medical students who struggled with their academic performances, poor lifestyle factors, and poor Social and COVID management had significantly higher levels of sleeping disorders, anxiety, stress, and depression.

COVID-19-causing SARS-CoV-2 is global. respiratory distress. COVID-19 exhausts oxygen in the lungs. COVID-19 patients worry about their own and their family's health, being alone, losing their job, feeling helpless, and dying, which causes anxiety, depression, physiological stress, decreased physical performance, and decreased physical activity. Respiratory rehabilitation helps chronic pulmonary disease patients breathe. Rehabilitating COVID-19 patients is rare. Thus, this study compares the male and female effects of physiotherapy management on performance, anxiety, and stress in hospitalized COVID-19 pneumonia patients

Background and Aim: Screw loosening is one of the most common clinical dilemmas seen in the post operative phases of implant therapy. Screw loosening can lead to ultimate failure of the prosthesis thus entire treatment. Several factors are discussed by different researchers which are responsible for screw loosening. Therefore, this in vitro study was conducted to comprehensively assess the effect of different types of implant abutment with varying loading stresses on early screw loosening.  
Materials & Methods: This study was conducted in the department of Prosthodontics wherein total sixty implant abutment samples were included. Group 1 consisted of twenty standard types abutment. Group 2 consisted castable abutment. Group 3 consisted of CAD-CAM assisted implant abutment. A customized rectangular metal jig was fabricated in which implant fixture fits comfortably. Abutments were tightened over the implants with maximum of 30 Ncm. Dynamic stresses were applied independently on each sample assembly and unscrewing torques was noted carefully. P value less than 0.05 was considered significant (p< 0.05).
Statistical Analysis and Results: Statistical analysis was completed by using statistical software Mean torque value (Unscrewing Torques before Cyclic Loading) for group 1, 2 and 3 was 19.37, 17.82 and 17.43 respectively. Mean torque value (Unscrewing Torques after Cyclic Loading) for group 1, 2 and 3 was 18.17, 16.92 and 16.55 respectively. The measured standard deviation was 0.381, 0.637 and 0.032 for group 1, 2 and 3 respectively. P value was highly significant for group 1. The comparison among the 3 study groups using one-way ANOVA showed highly significant level of significance. Two sample t- test assessments of mean score and standard deviation in three groups showed highly imperative values.
Conclusion: Within the limitations of the study authors confirmed that there was not any significant different in the initial screw loosening stresses with various abutment systems. All the three experienced implant abutment systems showed insignificant change in screw loosening stresses after undergoing cyclic loading.

Worldwide 284+ million people suffer from stress, anxiety and depression disorders and modern lifestyle, environments and unhealthy diets are causing an epidemic of stress, anxiety & depression (SAD) disorders. Other risk factors which contribute to SAD disorder are compromised genetics, weak immune system, low response to stress & brain neuroplasticity. Several studies had investigated genes, single nucleotide variation, Indels, large deletions, inversions & triple repeat polymorphism involved in various molecular and biological mechanisms underlying the disease initiation & progression. Recent genome-wide association studies (GWAS) have identified 150+ genes and genetic association of 44 risk variants ^{[1, 2]} for detection of SAD disorders. Nowadays At-home DNA tests (direct-to-consumer DNA tests) are gaining popularity for wellness and healthy longevity. These tests predict risk for micronutrient & vitamin deficiency, antioxidant activity, neuro-muscular functionality, risk for SAD disorders, efficacy of pharmacologically active herbal formulations for prevention & cure. On the basis of genetic outcome, medicinal plants/ herbs have been greatly employed to combat and reduce stress, anxiety & depression and thereby enhance general wellbeing in recent years. Ashwagandha (Withania somnifera, fam. Solanaceae) is a most versatile and potential herb of the Indian Ayurvedic system of medicine as a Rasayana. It is also accredited as a ‘royal herb’ having potential therapeutic applications. There are more than 33,787 publications for genetic markers for SAD & due to health awareness Ashwagandha research has gained scientific importance as evidenced by 77 publications documented since 2010 in NCBI PubMed ^[3]. The present review concludes with a discussion of prospects for clinical translation of genetic findings based on DNA testing, mode of action & personalized dosage of Ashwagandha as potent anti-SAD medicinal supplement

INTRODUCTION: The Covid- 19 pandemic has caused many drastic changes in the lines of the general population. Moreover, the people with physical disabilities were affected more, as they commonly encounter day to day life challenges in their life, such as barriers to mobility, reduced access to healthcare services, and high depression.
AIM: The study aims to create awareness and survey the problems faced by the physically disabled people during the Covid- 19 pandemic.
MATERIALS AND METHODS: The present study was conducted survey through online mode with the help of google forms through an e-questionnaire.The survey was conducted among the general population with a second of 101 responses. The obtained results were statistically analysed using SPSS software version 23.
RESULTS: Most of the general population have an awareness of the problems faced by the physically challenged people during the corona pandemic. Most of the population found this survey was useful.
CONCLUSION: Because of the lack of access to hospitals, drastic changes in lifestyle and social  habits, no physical activity were all noted. From the present study, it is evident that most of the people are aware of the various problems faced by physically challenged people during COVID.

INTRODUCTION: Coping with stress is the process by which a person consciously attempts to master, minimize, tolerate, stressors, problems in life.  Stress and coping are branch medicine, anthropology, management, etc. Nowadays many instruments for measuring coping are found. One of the most dominant in literature is the coping styles questionnaire. One of the most dominant in literature is the coping styles questionnaire. To reduce the stress as positive reappraisal, social support. Academic related stress is due to high academic work, high frequency of exams, lack of learning materials. Stress does not have an equal effect on people but can definitely need for its abatement coping was also seen as conscious and volitional.

With the rise of covid-19 world saw what was unprecedented, and just when we thought we got things under control second wave of covid-19 virus hit us. No one was left unaffected, either directly or indirectly covid caused disruptions in everyone’s lives and thus left with psychological problems in unforeseen majority. Aim of this study was to measure the psychological impact it had on health care workers and general public. Results showed significant differences between the socio demographic profiles of the two groups. Significant difference was found in scores of stress, anxiety, insomnia and depression. This study highlights the need for specialist guided assistance and action towards betterment of mental health of health care workers as well as general public in post covid era.

Aim: The purpose of the present research was to assess the co-relation between stress and hypertension.
Methodology: In this correlation study 30 individuals were selected. Basic demographic data was collected and were asked to fill up the Perceived stress scale. Blood pressure was measured at the brachial artery three times and average of the three was taken. To study the relation between stress score and BP, correlation was done. As data were not normally distributed, Spearman correlation test was done (P < 0.001).
Results: According to the analysis done, PSS shows moderate correlation with SBP while DBP shows weak correlation with r values 0.47 and 0.202 respectively and p values 0.806 and 0.283 respectively.
Conclusion: Stress is significantly related to hypertension and is an independent risk factor for hypertension.

Study of examination related anxiety levels in first year medical students during university examination

Background: Healthcare workers (HCWs) are the frontline warriors in dealing with the COVID-19 pandemic and similar health crises. In developing countries, HCWs face high stress because they have to deal with the increased patient load and limited infrastructure. Long-term exposure to stress, anxiety, and depression may lead to impaired mental health in HCWs. It is, therefore, essential to assess the mental health of HCWs as a part of their annual health check-up. Objective: The present cross-sectional observational study was aimed to assess the mental health of HCWs by analysing the stress, anxiety and depression during their annual health check-up at a tertiary care hospital in North India. Methods: Total 200 participants, including the consultants, and junior and senior resident doctors, were included in the study. The stress level was analyzed using PSS-10, and anxiety and depression were analyzed using GAD-7 and PHQ-9 respectively. Results: The mean PSS-10 score was 9.39 ± 8.53, indicating low stress among HCWs; the mean GAD-7 score was 5.20 ± 4.19, indicating mild anxiety in HCWs and the mean PHQ-9 score was 3.41 ± 3.59, indicating minimal depression among HCWs. Conclusion: The present study revealed that the HCWs faced minimal to mild stress, anxiety, and depression. It is therefore recommended that the mental health check-up should be made a regular part of the annual health check-up in HCWs so that adequate, timely steps are taken to address the same.

Better understanding and early recognition of hypertrophy in hypertensive patient helps with effective treatment and prevention of cardiovascular events and morbidity.
It has been established that anti-hypertensive therapy may diminish LVH and hence lessen the risk of serious cardiovascular events in individuals with hypertension. Left ventricular hypertrophy (LVH) is an adaptation of the heart, specifically the left ventricle, to increasing ventricular stress.
Subjects with borderline isolated systolic hypertension in the Framingham Heart study also had modestly elevated left ventricular (LV) layer thickness.¹ It's widely recognized that left ventricular hypertrophy is linked to high blood pressure and the cardiovascular complications that come with it..

Background: Preoperative counseling is one for pregnant women help to improve the surgical outcome and also reduce the number of analgesics used. Though it is known that preoperative counseling is effective, there are limited studies to testify to its importance.
Objective: The present study was undertaken to observe the preoperative knowledge about spinal anesthesia on anxiety and pain in patients undergoing cesarean section.
Materials and methods: A total of 60 patients who were elected under CS anesthesia were part of the study after obtaining informed consent. After recording the baseline pain scores, depression, anxiety and stress scores, the participants were randomly grouped into control and intervention groups with 30 participants in each group. Preoperative counseling was offered to the participants of the intervention group. No counseling was offered to the participants of the control group. Post-surgical pain and depression, anxiety and stress scores were recorded in both groups. A visual analog scale was used to record the pain scores. Depression, anxiety and stress scores were recorded using DASS 42.
Results: There was no significant difference in the scores of depressions, anxiety and stress among the control and intervention group participants before the counseling. There was a significant decrease in the depression, anxiety and stress scores in the intervention group participants. Further, a significant decrease was observed in the pain scores also in the participants of the intervention group.
Conclusion: There was a significant decrease in the pain scores, depression, anxiety and stress scores after the surgery in the intervention group participants who underwent the preoperative counseling. The study recommends further detailed study in this area to recommend the implementation of preoperative counseling for the women undergoing cesarean section.

Background: Since March-April 2020, India and its overburdened health care services have faced a new challenge of COVID-19 pandemic. HCWs, along with stress of rigorous duties and long work hours have faced additional stress like fear of infection, transmission, alienation and rejection.Burden not only undermines the quality of life of HCWs but also impacts the quality of health services provided by them, increase practice errors, leading to worse outcomes and additional costs. As our hospital was one of the busiest tertiary care centers of central India with maximum patient load, during this pandemic, we initiated this study to assess how mental health of the HCWs is being affected.To measure the level of Depression, Anxiety & Stress in Health care workers (Resident doctors & Consultants) working in a tertiary care centre in central India. To compare the depression, anxiety & stress scores between various factors related to the work profile.
Material and Methods: It was a Cross sectional study carried out in a tertiary care center in central India. 145 HCWs (resident doctors and consultants) working in COVID wards and ICUs were included in the study. After taking an informed consent, socio-demographic details were obtained and DASS-21 (Depression, anxiety and stress scale) was applied.
Results: 78 (53.7%) of HCWs were males and 67 (46.2%) were females. Majority 97 (66.8%) were from medicine allied branches and 48 (33.1%) from surgery allied branches. Majority [110 (7.6%)] were 1^st and 2^nd year residents. 72 (49.6%) had more than 4 months of duty. 84 (57.9%) had 1-60 hours of ICU duty. The prevalence rates of depression, anxiety and stress were 62%, 66%, and 56% respectively.  Out of these extremely severe grades of depressive, anxiety and stress symptoms were seen in 30%, 18% and 10% respectively. Significantly higher scores were observed in residents of surgery allied branches (54 +/- 32.5), HCWs who had no previous experience (52.18 +/- 31.8), 1^st (56.6+/-34.6) and 2^nd (43.2+/-27.6) year residents, total duration of duty upto 2 months (59.12+/-36.4) and ICU duty of 100 hours (62.1+/- 33.2). However the scores decreased in HCWs who had duties of more than 2 months and ICU duty of more than 100 hours.
Conclusion: More than half of HCWs had depression, anxiety & stress. Significantly higher scores were seen in junior residents, more number of ICU work hours and total duration of duties, and the HCWs with no prior experience. Reducing the duty hours, adequate training in intensive care settings and sensitization about various methods to regulate emotions might help to reduce the stress in HCWs in such difficult times.

Preterm laboris defined as the occurrence of regular uterine contractions after the age of viability and
before 37 completed weeks of gestations with intact membranes [1] . It is the leading cause of neonatal
mortality and a substantial portion of all birth-related morbidity. Preterm delivery accounts for 65% of
neonatal deaths and 50% of neurological disability in childhood. Prematurity rates have not changed in
recent decades [2]

Background: shifting of the school classes to online format owing to social distancing
norms led to amplification of academic stress, independent learning pressure, dropouts,
everyday life abandonment, less study chance made researchers focus on assessing the
impact of coronavirus on the mental condition of the students. This requires prompt
intervention as stress can further increase in subjects adopting conventional coping
strategies and in subjects with pre-existing stressors.
Aim: The present study was conducted to assess stress, anxiety, and depression in subjects
at a defined geographical area to assess psychological needs in subjects dealing with
causal factors and the pandemic.
Methods: In 156 subjects, DASS 21 scale was used having 21 questionnaires that were
answered by the subjects themselves and were concerned about stress, anxiety, and
depression. The responses were recorded on a scale of 0 to 4 where 0 meant little time/none
and 3 meant most of the time. The responses were recorded based on symptoms severity in
the last week before answering the questionnaire. The interpretation of the DASS 21 scale
was divided into categories of normal, mild, moderate, severe, or very severe. The collected
data were subjected to statistical evaluation.
Results: For gender, only anxiety was statistically significant (p=0.01) which was higher in
females with the value of 1.72±0.993 compared to males with the value of 1.47±0.881. For
the age anxiety levels were significantly higher in subjects of age ≤ 20 years with 1.76±1.01
compared to ≥ 21 years with the value of 1.52±0.883 (p=0.02). For familial history also
significantly correlated to anxiety with p=0.004, whereas for depression and stress the pvalues
were 0.758 and 0.238 respectively and were non-significant. For family history, it
was significantly related to anxiety with a p-value of 0.12, whereas, it was non-significantly
related to depression and stress with respective p-values of 0.753 and 0.297. The
socioeconomic status was also significantly associated with anxiety with the low
socioeconomic group having a strong association having a p-value of 0.25.
Conclusion: The present study concludes that the depression, anxiety, and stress in
students during COVID-19 was seen ranging from mild to severe levels, whereas, majority
European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 08, Issue 04, 2021
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of the students showed normal levels of DASS. Also, positive family history of COVID-19
and family income was associated with increased depression, anxiety, and stress in the
students.

Background: Vitiligo has a significant effect on patients’ quality of life; they feel stigmatized and disturbed by their condition. A lot of vitiligo patients, according to reports, suffer from psychological disturbances. The aim of the study is to find the relation between vitiligo and stress, anxiety, and depression and to measure how vitiligo affects the quality-of-life index. Methods of study is a case-control involving fifty patients of both sexes with the diagnosis of vitiligo and fifty healthy volunteers as a control group matched in age, gender, and academic level. Patients were selected from patients who visiting dermatology clinic at King Abdul-Aziz hospital in Makkah Al-Mokarramah. All patients were assessed by the Depression Anxiety Stress Scale (DASS) to determine the severity of anxiety, depression, and stress symptoms and the Dermatology Life Quality Index (DLQI) scale to evaluate their quality of life while the control group underwent only the Depression Anxiety Stress Scale. Results: The prevalence of stress was 76%, anxiety was 78%, and depression was 80%; the difference was statistically significant between patient group and control group regarding stress, anxiety, and depression. Gender had a significant relationship with stress, anxiety, and depression (p < 0.05) (female affected more than male). Also, there was a statistically significant relation between the degree of vitiligo and anxiety (p < 0.05). Vitiligo has a moderate to very severe effect on the quality of life index. There was a statistically significant positive correlation between stress and feeling of embarrassment from vitiligo and clothes choice. Conclusion: Vitiligo is a psych cutaneous disease that does not only affect the patient’s physical status, but also his mental and psychological status.

Objective: Stress is a feeling of emotional or physical tension. It has now become a part of modern lifestyle. At some point in life, everyone must have encountered with some degrees of stress. It has negative impact of life and certain complications associated which includes increased risk of cardiovascular disease, elevating certain medical conditions like asthma, diabetes, hypertension, etc. Considering the increasing prevalence of stress and anxiety through multiple factors, there is a great need to find a solution to the existing problem. The current research depicts the safety and efficacy of HFSM-02 in reducing stress and anxiety in subjects with chronic medical condition and perceived stress. Material and methods: 120 subjects were enrolled in the study. Subjects were undergoing clinical examination. Vitals were recorded. Blood samples were collected for biochemical tests like change in serum cortisol levels. Subjective questionnaire scores evaluation were performed like POMS-2, and GHQ-28, questionnaire. Changes in symptoms severity were noted like disturbed sleep, and day time mood swings.

The term suicide refers to the experience that one’s life is undeserved that starts with a thought and advances to the actual action to kill oneself or an obsession with self-destruction. This study aimed to construct a structural equation model of factors that affect suicidal ideation among undergraduate students. This study was conducted at 14 colleges at state universities in Jakarta, Indonesia. Method: A cross-sectional design was used in this study. A sample of 504 students was selected using a stratified random sampling method at 14 colleges. Data was analyzed with structural equation modelling testing. Results: Depression, anxiety, stress, and social support were significant factors that affected students’ suicidal ideation. Low social support was associated with increased suicidal ideation in college students. Depression, anxiety, and stress triggered suicidal ideation in students. Conclusion: Universities need to plan activities that can raise awareness and prevent students from experiencing depression, anxiety, and stress so that students can avoid suicidal ideation

Burnout Syndrome or burn syndrome is a disease caused by exhaustion or work
overload, this has a high impact due to the consequences occurring in different
situations. This document presents a systematic review of the literature on the
impact of information technologies to measure the level of burnout syndrome.
We reviewed 65 articles from the period 2015-2020 on Burnout syndrome with
indicators like causes, consequences and treatments from the databases IEEE
Xplore, Sciencedirect, SpringerLink and Proquest

Objective of the study: The purpose of the study was to compare stress level, basketball performance and menstrual distress in during and post menstrual phases among the university level female basketball players. The relationship between stress level, basketball performance and menstrual distress was also ascertained. Method: A total 80 girls were purposively selected as subjects from different colleges of Punjabi University, Patiala. All the subjects were assessed for stress, basketball performance and menstrual distress in during and post menstruation phases of menstrual cycle. The stress level of subjects was measured with the help of Perceived Stress Scale
(PSS) developed by Sheldon Cohen (1988). Menstrual distress was assessed by using the Menstrual Distress Questionnaire (MDQ) developed by Rudolf. H. Moos (1969).Basketball performance was assessed with the help of Johnson Basketball Test Battery design by L. William Johnson (1934).
Results: Paired sample t-test revealed that the basketball players had significantly (p<0.05) higher mean value on perceived stress scale in during menstruation phase as compared to post menstruation phase. Menstrual distress, pain and concentration were found to have significantly higher mean values (p<0.05) in during menstruation phase among basketball players. Behaviour and arousal were significantly (p<0.05) associated with perceived stress and control significantly associated (p<0.05) with basketball performancein post menstrual phase.
Conclusion: The performance of basketball players was not affected during the menstrual phase. Behaviour and arousal showed significantassociation with stress level and control was observed to be significantly associated with basketball performance in the post menstrual phase.

Objective: This study aimed to compare the efficacy of the Contasure-Needleless (C-NDL) technique with the Transvaginal Tension Free Vaginal Tape-Obturator (TVT-O) technique in the surgical management of stress urinary incontinence (SUI).
Methods: This prospective observational study was performed on adult women with urodynamic proved SUI who failed or declined conservative treatment between August 2017 to October 2019. The cough Stress test was performed for all patients, and they underwent urodynamic evaluation preoperatively. Follow-up visits were performed at one month, six months, and 12 months after surgery. For statistical analysis, we used the Statistical Packages for Software Sciences (SPSS) version 21.
Results: Forty patients were divided equally into two groups (TVT-O subgroup and C-NDL subgroup). Regarding the operative time and pain scale, there were no significant differences between both groups (p= 0.078 and 0.054). A higher blood loss was observed in the TVT-O group than the C-NDL group (p= 0.001). At three, six, and 12 months of follow-up, no significant difference was observed in terms of the cough test (p= 0.4708, 0.7256, and 0.6644). Moreover, there was no significant difference in terms of complications (all p>0.05). Regarding the relationship between Valsalva leak-point pressure and cough stress reflex at the last follow-up visit, we detected a significant difference among the studied patients (p= 0.001).
Conclusions: C-NDL is a promising technique for treating SUI cases, with low complication rates and a good patient satisfaction level. Furthermore, the procedure's efficacy holds encouraging results that need to be affirmed and tested by long-term outcomes.

The goal of the random group experimental research was to figure out the impact of yoga therapy on the peak expiratory flow rate (PEFR) of asthmatic adult women and stress. For the purposes of the study, 30 adult asthmatic women were randomly selected using the Chennai random group sampling method between the ages of 45 and 55 and were divided into two groups, A and B, each with 15 subjects. It was speculated that substantial discrepancies within the control group on selected physiological and psychological variables among asthmatic adult women would occur due to Yoga Therapy. The pre-test on the chosen physiological variable such as Peak Expiratory Flow Rate (PEFR) and psychological variable such as Stress before the start of the training program was conducted for both groups (A and B).Yoga Therapy was given to Group A; Group B (Control Group) received no specific treatment, but were in active rest after the trial duration of eight weeks, all groups were retested on the selected dependent variables. The dependent variables tested were measured and compared using the Study of Co-variance (ANCOVA) approach to figure out the essential variations between the classes. The importance test has been set at a confidence level of 0.05. There was a major increase in the peak expiratory flow rate (PEFR) and depression after eight weeks of yoga therapy. Group A remained significantly relevant relative to Group B at the conclusion of the intervention; it is concluded that yoga therapy had a significant impact among asthmatic adult women on physiological and psychological variables. Yoga therapy is therefore useful in increasing the Peak Expiratory Flow Rate (PEFR) and overcoming stress for asthmatic adult women.
 

High levels of depression, anxiety, and stress (DAS) can adversely influence the academic and clinical performance of nursing students, psychological well-being, and physical health. Large numbers of studies have recognized the factors that related by depression, anxiety, and stress. The purpose of the study is to determine the prevalence of depression, anxiety, and stress and their levels among undergraduate nursing students in the Mosul University /Mosul/ Iraq. A confidential questionnaire was done in this cross-sectional survey study which is carried out using a depression anxiety stress scale DASS reported by Lovibond and Lovibond (1995a) carried out from 22th of January- 20th of March 2020. Among 800 nursing students analyzed, the age distribution shows that (83%) and (67%) respectively in the third class in morning and evening courses are between age group 22-25 years, 84% and 87% are female in the third class with significant p values. About the prevalence of moderate stress (26%) of third and 25% of second class respectively of morning and evening courses and mild anxiety 26% and 28% respectively of morning and evening courses. Finally, moderate depression was seen among 24% of the fourth class of morning and 35% of second class evening courses. The DAS and their levels among learner nursing students in the Mosul University, Mosul, Iraq had a high prevalence in comparison with others. Prospect research can localize on the need to set up social and mental health screening and hold up services, such as psychotherapy centers in nursing colleges.

The aim of the random group experimental research was to figure out the impact of yogic practices on teenage stressed girls' body mass index (BMI) and stress. For the purpose of the study, 30 stressed adolescent girls were chosen randomly using random sampling group method They came from Chennai between the ages of 14 and 18, and were split into two classes, I and II, each with 15 subjects. It was hypothesized that there will be substantial variations in physiological and psychological factors such as Body Mass Index (BMI) and Depression in the teenage depressed girls than in the control group. Preliminary test was conducted for two Groups on Body Mass Index (BMI) and Stress before the start of the training program. Group I subjects were given Yogic practices for 60 minutes, 6 days a week  for a total period of eight weeks. Group II (Control Group) were in active rest. After the experimental period, the two groups were retested again on the same dependent variables. Co-variance analysis (ANCOVA) was used to assess the relevant distinctions between the experimental group and the control group. The significance test was set at a degree of trust of 0.05. The results of the study proved that the Experimental Group showed significant differences on selected physiological and psychological variables such as Body Mass Index (BMI) and Stress than the Control Group due to Yogic practices among adolescent stressed girls. The theory was agreed at a confidence level of 0.05. Therefore it is concluded that teenage girls benefit from Yogic activities to sustain a balanced Body Mass Index (BMI) and to overcome stress.

Technology has now served as a means of cyberbullying. Cyberbullying represents harassment done at any time and in any place. A victim of cyberbullying may undergo a sequence of emotional effects such as anxiety, stress, depression, or even suicidal intention. The present study aimed to confirm the effectiveness of cognitive behavior group counseling with cognitive restructuring and self- instruction technique in reducing university students’ stress due to cyberbullying. To this end, factorial experimental design was implemented. The participants of the study were 20 private university students in Yogyakarta, Indonesia. The data were collected using Social Anxiety Scale. In analyzing the data, repeated measure ANAVA was applied. The result of the study indicated that cognitive behavior group counseling with cognitive restructuring and self-instruction technique was effective in reducing the stress of cyberbullying victims. The study also revealed that self-instruction was more effective in reducing stress, compared to cognitive structuring. Regarding gender, female students exhibited a more significant decrease in stress than male students did.

The study is based on investigating the work life balance of the resident doctors during COVID-19.
Design: Focus group interviews with doctors, resident doctors and interns were conducted who were assigned duties in COVID 19 wards of the hospitals of Northern India.
Participants: The study was carried out on 97 doctors (Psychiatrists, radiologists, pediatricians, gynecologists and Medicine) who were posted in COVID 19 wards in some or the other shift. The doctors were assigned duties in the two COVID- 19 hospitals of Northern India where the study was carried out. The long and tedious working hours in the hospital came with additional responsibility of maintaining and recording the data of COVID patients. After the 15 day long duty in the hospital these doctors were required to stay alone in a separate accommodation where they were quarantined for fourteen days. This long separation from family and friends disturbed their lives leading to immense stress. Their morale went down drastically. The issue of balancing work life was especially challenging for female doctors having young children.
Conclusion: poor work-lie balance adversely affected the wellbeing of the doctors.

This article is based on a review of the literature and recent clinical studies on changes in plasma cortisol hormone concentrations in cognitive impairment in Parkinson's disease. The article presents the reasons for the relationship between cognitive impairment in Parkinson's disease, in particular vascular Parkinsonism and neurodegenerative diseases, as well as the results of neuropsychological tests.
Methods: We studied the level of morning plasma cortisol in 68 patients with Vascular Parkinsonism (VP) who were hospitalized in 1st neurology department of TMA in the period from 2015 to the present.The relationship between increased morning plasma cortisol and cognitive impairment was determined.The results of the study were statistically analyzed.Cortisol was determined in all blood samples of patients of the Main and Control groups.The control group consisted of 47 volunteers.
Results: Normal levels of cortisol were observed in 20 patients (29%) with vascular parkinsonism,, moderate increases in cortisol were observed in 37 patients (54.4%), and elevations in cortisol were observed in 11 patients (16.1%). Was determined the relationship between the value of cortisol and the assessment of cognitive impairment.In the main group, a statistically significant moderate inverse correlation was determined between plasma cortisol level and cognitive impairment in VP. When studying cortisol levels in VP, its significant increase is noted than in the control (p <0.05).
Conclusion: Increased levels of the hormone cortisol in Parkinson's disease play an important role in cognitive impairment and during the course of the disease and affect the effectiveness of VP therapy.

Background: Healthassociated with Quality of life is most important for people with diabetes but this aspect is given less attention.
Objectives: To assess quality of lifeamong type 2 diabetes mellituspatientsand its socio-demographic determinants
Methods:A hospital based cross sectionalstudywasconductedin a tertiary care hospital from June 2014 to September 2016.130 diagnosed patients of Type 2 diabetes mellituswereincluded.Apre-structuredquestionnairewasusedand data related to demographic profile, history of diabetes, quality of life, stress etc. were collected. Datawere analysedusing SPSS version 20.
Results: Out of 130 study subjects selected for the study, 58.5% were males. The mean age 53.68 years ±10.48. The averageperiod of diabetes of participants was 5.88 ±4.70 years. Among participants, 11.5% were suffering from neuropathy. The sleeping hours was less than 7 hours in 27.7% participants. The mean stress scores of the participants was 14.61 ± 2.90 and 6.9% were having stress score 20 and above. The suggested score of the health related excellence of life study participants was 122.42 ± 14.37. The mean HRQoL score was 72.43 and found that 24.6% of the patients showed good score, 56.9% moderate score and 18.5% of the patients showed poor HRQoL score. Conclusion: Steps should be taken in individual and community level to get better the quality of life like counselling for reduction of psychological distress, practice of Yoga and meditation, diabetic diet at diabetic clinics and hospitals.

Background: The The purpose of this study was to identify the effects of the education of
using structured multimedia on self-efficacy, stress, and performance confidence in future
nursing professionals. Methods: A quasi-experimental study with a non-equivalent control
group pretest-posttest design was used. Participant were recruited from two nursing
colleges. The sample consisted of an intervention group (n=29) that participated in the
educational program and a control group (n=30). The data were collected using selfadministered
questionnaires. Data analyses utilized x2-test, fisher's exact probability & ttest
with the SPSS 21.0 program. Results: As a result of research, the experimental group
showed significantly increases in self-efficacy (t=2.694, p=.027) and performance
confidence (t=1.825, p=.031) than the control group. Also, the experimental group showed
significantly decreases in stress (t=-4.026, p=.031) than the control group. The findings
indicate that the education of using structured multimedia on self-efficacy, stress, and
performance confidence in future nursing professionals is an effective teaching method for
nursing students. Conclusions: It is important to manage the psychological well-being to
prepare successful professionals. In addition, it will be necessary to consider teachinglearning
method strategies for applying structured multimedia learning in the nursing
education.

The article reflects the results of an experimental study of the specifics of coping behavior of university students. Considering coping behavior as a special purposeful socially-oriented behavior of a person that ensures his productivity, health and, both psychological and social, well-being, we believe that the formation of the experience of coping behavior is a prolonged process and is carried out throughout a person's life. We determined the study of the specifics of coping behavior among students of a higher educational institution as the target guidelines of our research. Relying on theoretical and methodological provisions in the field of personality psychology, psychology of coping behavior, as well as the theory of stress, we have designed a diagnostic program that included the method of scientific observation, as well as a system of test methods. Our pilot study showed that the complex application of the diagnostic program developed by us makes it possible not only to study the specifics of coping behavior of students within the framework of their educational activities, but also to determine the type of behavioral activity of respondents, the characteristics of their behavior in emotionally stressful situations, and also to determine the main reasons stimulating the onset of stress.

Aim: Aim of our research was to evaluate the amount of stress as well as performance pressure on the oral hygiene in our study participants.
Methodology: Survey was conducted in 200 patients who had reported to various private clinics over a period of 6 months. Questionnaire was given having 12 questions, which helped us assess their stress levels related to their oral hygiene status. Descriptive analysis was carried out with the data received from the study participants.
Results: Maximum participants had moderate stress levels (47%), whereas around 34 % experienced oral health problems. 67% were conscious about their appearance, and their smile. Only 14 % went for regular dental check-ups, which further shows less awareness for preventive care.
Conclusion: Our findings suggest that individuals with greater perceived stress also report poorer oral health. These findings may warrant greater attention be paid to the role of psychological stress in the development of oral disease.

INTRODUCTION- Doctor’s stress has an impact for health and doctor’s satisfactory level involved which ultimately has an effect on care quality for the patients. Stress induced sleep disturbance is prominent.
AIM-This study was designed with aim of assessing the influence of work characteristics on the association between doctor’s stress and sleep quality METHOD- This cross-sectional study was conducted on doctors of Tertiary Care Hospitals of Wardha city using questionnaire, containing 24 questions. The stress was evaluated using 10 items “Global perceived stress scale” and for sleep quality “Pittsburgh Sleep Quality Index” of 
total 14 items was used. The variables were compared in unpaired t test and Pearson correlation test to know the level of significant of determinacy which was set at less than 0.05.
RESULTS –The Positive PSS Score for post-graduates was 14.03 ± 4.55 and staff was 15.69 ± 4.44, the Negative PSS score was 13.57 ± 5.15 and 11.37 ± 4.39, respectively which was statistically significant (p<0.05). Negative PSS scores of females were higher (13.92 ± 5.36) as compared to males (11.96 ± 4.54) but the difference was also statistically insignificant (p <0.05). The total PSS and Total PSQI scores were almost equals in post-graduates and staff, males and females, day and night shift duty doctors.
CONCLUSION- Certain characteristic of work shift among doctors can directly affects the stress and sleep quality and indirectly affect the patient care and treatment. The study indicates that work characteristic may influence sleep quality and stress among doctors. We need to improve work shift schedule in order to provide good health and well-being of doctor which will further improve the quality of patient care.

Background: Schizophrenia is characterized by disordered thoughts, emotions, perceptions, language, sense of self and behavior. Primary caregivers of individuals with Schizophrenia encounter comprehensive care giving challenges that causes physical as well as mental stress and can deteriorate the family functioning. However, if primary caregivers are resilient enough with strong and positive mindset, they can overcome burden associated with patient care and preserve own health and health of family as well.
Aim: To assess the relationship between depression, anxiety, stress and resilience perceived by primary caregivers of persons with Schizophrenia 
Materials and Methods: Primary caregivers of person diagnosed with Schizophrenia disease reporting to OPD and IPD of Department of Psychiatry of Medical College as per DSM-5 diagnostic criteria will be assessed for depression, anxiety, stress and resilience after taking informed consent for the study by applying inclusion and exclusion criteria. Then psychological scales will be applied on these primary caregivers. The Depression Anxiety and Stress (DASS-21) and Brief Resilience Scale (BRS) scales will be applied and accordingly the points will be given.
Conclusion: We expect to find significant relationship between depression, anxiety, stress and resilience perceived by caregivers of persons with Schizophrenia.

The recent pandemic disease called “COVID-19 or Corona Virus”, which is prevalent the whole world is also spread in every state of our own country India. It has a wide range impact on every aspect of the life of the people everywhere. The people are sure to undergo vast variety of COVID-19 impacts like stress, anxiety, tensions, fear, remorse, disinterestedness, physical problems like pressure and heart problems, various other discomforts, frustrations, irritation, anger, etc. It is said by the psychologists that a like 'COVID-19’ will have a significant impact on the mental health of the people who live any part of the world. This impact will be multifaceted: immediate effect, short-time impact, effect which could be long lasting, different types of impacts, etc. One great impact of this COVID-19 situation is felt in the educational field-education process is in a standstill. Lot stress is experienced by the teachers which has affected their psychological well-being and has reduced the degree of their employment-related experience or the total quality of their work life at the school. Teachers must remain calm so as to look after their own well-being. In this way, through different ways,they should navigate through this time and must their own psychological well-being and higher degree of quality of work life.

Disseminating information on psychological health for university students is critical to university adjustment, interpersonal relationships, academic issues, and others. Using smartphones as the mean of conveying information is vital as it become devices of choice for the millennials. On this basis, the study aims in developing DeStressMeNow app that acts as early preventative tool in managing stress: to identify stressors, to understand its negative consequences, and to cope with stress. There are three main parts; online activities, offline activities and a podcast; along with detailed definition, self-assessment, techniques and strategies, and stress management success stories revealing the app novelty and uniqueness. The results from Usability Testing show that Relax Your Mind is the favorite segment of the app and is effective in managing stress. Further, the results of the effectiveness study of the app showed its significance in decreasing the stress level among university students. It extends the Emotional Intelligence principle in stress management and improve students’ health. We are proposing a mobile app, a technical version of stress management module, as an accessible instrument to prevent the high occurrence of stress among university students

Background: Korean nursing students experience higher levels of academic stress than
those of other disciplines. Academic stress leads to psychological distress and has
detrimental effects on well-being. The aim of this study was to identify the levels of stress,
self-perception and resilience of undergraduate nursing students and to recognize the
correlations between them. Methods: The research design is a descriptive correlational
study design. The participants in the study 198 nursing students in South Korea. The used
research measures were tools which measure stress, self-perception and resilience. Data
collection was conducted from May 13, 2019 to May 24, 2019 using SPSS 21.0 for data
analysis.Results: The results show that stress is affected by health status, and clinical
practice satisfaction. Meanwhile, resilience is affected by health status, interpersonal
relationships, personality trait and major satisfaction. Stress and resilience are negatively
correlated while self-perception and resilience are positively correlated. Furthermore, an
increase in self-perception correlates with an increase in resilience and a decrease in selfperception
correlates with a decrease in resilience. Conclusions: It is important for nursing
leaders of education and practice to find out the sources of stress and coping strategies used
by the students so that such leaders can help students effectively manage upcoming
problems and situations. In addition, if the social support system that protects nursing
students is systemically formed and utilized, it can not only help increase self-perception
and resilience of nursing students but also improve their happiness.

The existing pandemic of COVID-19 has developed an unimaginable, socially hostile climate for citizens. Against the context of this exogenous shock, we analysed the relationship between risk-taking, trait resilience and state anxiety, under which the relationship between trait resilience and risk-taking moderates with state anxiety during the pandemic, and using the principle of combined prospects. In a survey of 515 people in the U.S. we test risk taking by means of a comportment assessed and evaluate trait anxiety, five main characteristics and other demographics. Study of a regression showed that age moderates the correlation between risk and anxiety and that highly resilient, risk-tolerant people have lower anxiety than less resilient people. In the other hand, older people with a higher longevity, are less prone to threats than their younger and least resilient opposites. Studies are minimal and further research is proposed.

Background: During the last century, there has been a high increase in health problems in the world, including Indonesia, one of it is mental health. The actual prevalence of mental health disorders worldwide remains poorly understood. Mental health is very much underreported, and under-diagnosed.
Aims
The purpose of this study was to identify factors associated with schizophrenia relapse of patients at the Islamic Mental Hospital in Jakarta, Indonesia.
Settings and Design
The research method with a quantitative approach was performed with a total sample comprisedof 150 respondents using primary data.
Material and Methods
The data collection method used was library research, field research (observation), and questionnaire research design through a cross-sectional approach.
Statistical Analysis
Univariate analysis process (frequency distribution) and Bivariate analysis with the Chi-square test and multi-variate with path analysis was used in this study
Results
Based on the results of the validity of the instrument, the variable of compliance for taking medication (X1), Stress variable (X2), Drug Abuse variable (X3), the Psychology variable (X4), the variable of Emotional Expression (X5), Relapse among schizophrenic patients (Y) was considered. The results revealed that the correlation of the adherence to the antipsychotic drugs consumption (X1), stress level (X2), and psychological response (X4) to the relapse in schizophrenia patients (Z) is acceptable, whereas the strongest or dominant correlation is the stress factor (X2).
Conclusions
The results of this study can provide a plan for schizophrenic patients in the country. Since schizophrenic patients need medication and treatment for a long time, the researchers recommend for the government to provide medical assistance.

The study of the adrenaline content in the blood and the manifestation of a stress state in patients using psychoactive substances (PAS) with HIV infection is one of the key indicators in the provision of medical and psychological assistance and the development of appropriate psychotherapeutic measures. When carrying out these activities, it is necessary to take into account the level of adrenaline and the severity of stressful conditions, in order to be able to overcome stress and adapt to the diagnosis.

The purpose of this research is to know the psychological disorder in the incidence of hypertension among liquefaction refugees in Petobo Shelter. A cross-sectional design was performed. The total number of patients who visit the health post at a Petobo shelter is 3,079 people taken in accidental sampling. The analysis uses the univariate and bivariate analyses at a degree of confidence of 95% (α = 0.05). The chi-square test results show that anxiety (ρ = 0,031), depression (ρ = 0,008), and stress (ρ = 0,000) are associated with the incidence of hypertension. It is expected that hypertension sufferers should do breathing exercises, perform physical activity and meditation relaxation to avoid anxiety, negative thoughts, also avoiding depression, stress and do interact with someone else so that the mind is not saturated and easy to forget the negative thoughts.

Homesickness is the mental and physical distress caused by the anticipated separation of students from their families. This homesickness may lead to depression, stress, and other psychological problems. The objective of this study is to observe the post-vacation mental state of the students who have been suffering from homesickness in the hostel. In this study, a standardized tool that measures the level of anxiety of the students was used. A questionnaire DASS-21 (Depression Anxiety Stress Scale), containing 21 questions was used which was circulated among 100 -1st-year dental students of Saveetha Dental College who were affected by homesickness. Data collection was done through the administration of Google forms and the data were analyzed in SPSS version-15 using cumulative frequency and percentage analysis. The results of the study showed that the post-vacation period had considerable changes in the student population. The students developed a feeling of positivity, had good energy levels and they were not stressed and anxious and felt enthusiastic during the post-vacation period. Thus the present study concludes that physical and mental stress disorders can only be reduced by spending time with family and home place.

Depression occurrence is found to be three times higher in people with diabetes mellitus. Sometimes the majority of the cases with depression are under diagnosed. According to the International diabetes federation, diabetes is the largest global health emergency of the 21st century. A questionnaire was created with a set of ten questions related to diabetic patients and depression. 100 random participants of the age 25- 50 years took the survey and a random sampling method was done. More than half the participants are well aware that depression is common in adults with diabetes (57.5%). 71.3% think that diabetic patients are more anxious than a normal person, 54.5% are aware that using antidepressants in diabetic adults can be risky, 51% think that diabetes can be under diagnosed during treatment and 70% are aware that glucose metabolism will be altered if the doabetic patient is under depression or stress. Awareness about diabetic patients who could possibly be dealing with stress and depression was created.

Background
Obesity is emerging as a serious problem throughout the world, not only among adults, but also health care worker and children, teenagers and young adults. Of the factors contributing to obesity, stress seems to be particularly important as stressful condition leads to irregularity in worker in work, lack of exercise and addiction also considered independent and factors leading to stress. Workers in the health care is stressful throughout the whole work time. The amount of material to be absorbed, social isolation, pressure of examination, discrepancies between expectation and reality all can be anticipated to bring psychological stress. Prevalence of Stress and its Association with Body Weight Among health care worker,
Prevalence of stress and its Association with Body Weight Among health care worker fears related to stress have affected a considerable number of health care worker, especially the nursing category,studies have shown that healthcare workers managing patients have been experiencing worse psychological issues such as stress than the public because they are more likely to get infected and transmit the infection to their relatives and friends.
Aim of the study: To assessment of the prevalence of stress and its association with Body Weight Among health care workerin Primary Health Care Centers in makkah 2019
Method:Cross-sectional analytical study has been conducted health care workers at Primary Health Care Centers in Makkah city, that included all health care worker during data collection period 2019 the perceived stress scale-10 questionnaire used to measure the stress score. Weight and height were collected based on self-reported value.  the total sample has been (400) nurses, physicians and other
Result:the majority of the respondents were married status were (75.0%) while other were (14.0%).  The association between the stress and stress score most of the participant moderate Stress were constitutes (47.75%) followed by low stress the were constitutes (44.75%) while a statistically significant (P-value =0.001) and Chi-square (120.665), the Range (5-45) (Mean ± SD (25.441±6.125).
 Conclusion:Stress is prevalent among health care worker at Primary Health Care Centers, Makkah we found a positive correlation between BMI and stress but no statistically significant association between gender and stress level. Preventive measures should be implanted to reduce the level of stress and interventional studies are needed among health care worker at Primary Health Care Centers.