The Effects of the COVID-19 Confinement on Screen Time, Headaches, Stress and Sleep Disorders among Adolescents: A Cross Sectional Study

Computer vision syndrome: a comprehensive literature review

Computer Vision Syndrome is a growing health concern in the digital age, with a reported prevalence of 69.0%. It is caused by screen-related, environmental, ergonomic, and physiological factors, affecting diverse demographics. The COVID-19 pandemic significantly amplified CVS due to increased screen time for remote work, online learning, and social media use, with studies reporting symptoms in up to 74% of individuals. Unique visual challenges from digital screens, including reduced clarity and glare, exacerbate symptoms like dry eyes and discomfort, especially in those with uncorrected vision. Understanding CVS is crucial for mitigating its impact through effective prevention and management strategies. This study explores the causes, diagnosis, management, and prevention strategies of CVS by synthesizing recent findings from optometry, occupational health, digital health, and ergonomics. It also highlights emerging trends such as AI, wearables, and augmented reality while providing practical management strategies. A narrative review of literature from 2014 to 2024 was conducted, focusing on PubMed-indexed, peer-reviewed articles, including meta-analyses and systematic reviews, with priority given to recent, highly cited studies.

Pre-sleep screen time and screen time addiction as shared determinants of poor sleep and obesity in adolescents aged 11-14 years in Scotland

BACKGROUND

The overall quantity of screen time has been associated with short sleep duration and increasingly sedentary lifestyles, leading to adiposity. The aim of this research was to explore which components of screen time usage are shared determinants of poor sleep and higher adiposity in adolescents, using data from the Teen Sleep Well Study.

METHODS

A cross-sectional study of adolescents aged 11-14 years in Fife, Scotland was conducted. Sleep was measured objectively using the Actigraph GT3X-BT and subjectively using validated questionnaires. Adiposity was assessed using body fat percentage (BF%) and obesity was measured using body mass index percentile (BMIp). Four components of screen time were addressed using questionnaires: the timing of screen time, quantity of screen time, location of screen time, and screen time addiction. Descriptive statistics and statistical tests such as Pearson correlation tables, and adjusted regression analyses were used. Mediation analyses explored wellbeing as a factor in the association between screen time and sleep and obesity.

RESULTS

Sixty-two participants (33 female/29 male, mean age 12.2 ± 1.1 years, mean BMIp 60.3 ± 32.1) completed the study. Excessive screen time pre-sleep (30 min before sleep) and post-sleep (first 30 min after waking), excessive screen time on a weekend, and screen time addiction were shared determinants of higher adiposity, a later chronotype (evening-preference) and poor sleep outcomes: poor sleep habits, increased insomnia symptoms (IS) and increased sleep onset variability. Mediation analyses confirmed that adolescent wellbeing mediated the association between pre-sleep screen time and IS (36.3%) and BF% (21.9%), post-sleep screen time and IS (37.7%) and BF% (30.4%), videogaming addiction and IS (31.9%) and BF% (34.6%), social media addiction and IS (35.0%) and BF% (17.4%), mobile phone addiction and IS (34.0%) and BF% (10.6%), weekday screen time and IS (58.1%) and BF% (39.8%), and weekend screen time and IS (51.4%) and BF% (38.0%).

CONCLUSIONS

These screen time behaviours, alongside wellbeing should be considered in multi-component health-promoting interventions aimed at improving adolescent sleep and reducing obesity risk. Future research should employ longitudinal designs to clarify the directionality of these associations and determine the effectiveness of interventions that target both screen time behaviours and wellbeing.

A School Nurse's Guide to Migraine

Migraine is a common neurologic disorder associated with considerable pain and disruption of daily function among school children. Given the impact of migraine on academics and social engagement, ensuring robust support in the school setting is vital to the well-being and development of students affected by migraine. School nurses have an active role in providing and coordinating care, acting as the critical link between care providers, families, and educators to promote health among students with migraine. We aim to equip school nurses and educational staff with practical tools for helping students manage migraine pain in the school setting. We suggest a comprehensive approach, including the use of medications, psychological and complementary interventions, and school accommodation plans, with a focus on both prevention and management.

Sleep disturbances in Healthcare Workers During the COVID-19 Pandemic

Background

Many studies have reported the negative impact of the COVID-19 pandemic on the rhythms and sleep in various populations. Particularly in frontline healthcare workers, which are highly susceptible to developing sleep disturbances. Therefore, the present study was conducted to determine the prevalence and determinants of sleep disturbances in healthcare workers at the regional Hospital Hassan II in Agadir, Morocco.

Methodology

A cross-sectional study among frontline healthcare workers was conducted at the Regional Hospital in Agadir, by administering an online questionnaire using the Google Forms platform distributed through social media. The questionnaire was anonymous, and data confidentiality was assured. Data analysis was performed using SPSS version 21.

Results

A total of 54 healthcare professionals filled in the questionnaire. The mean age was 28.81±05.35, The two-thirds were female participants (59.3%), and the mean Epworth score was 07.53±04.05, High prevalence rates of sleep disorders were reported as follows; sleep onset insomnia (27.4), excessive daytime sleepiness (24.1), snoring (24.1).We found that morning headaches and concentration difficulties are factors associated with sleep disorders among healthcare workers.

Conclusion

COVID-19 has a high risk of poor sleep quality, with many consequences. Measures to improve the sleep and well-being of healthcare workers are needed.

Is There a Long-Term Link Between Digital Media Use and Adolescent Headaches? A Longitudinal School-Based Study

BACKGROUND/OBJECTIVES

The use of digital media, and especially social media, has been increasing over recent years. Previous research has reported a negative impact of media use on headaches; however, most of these studies are cross-sectional. Therefore, we conducted a longitudinal study to explore the relationship between different types of media usage (watching videos, gaming, and social media) and headache frequency and headache intensity over time.

METHODS

School-aged children from five German schools completed five assessments between 2017 and 2018. In total, N = 575 (72.9% female; Mage = 13.3, SDage = 1.86) children and adolescents reporting consistent headaches across all assessments were analyzed. Multilevel linear modeling was used to assess the relationships between media use and headache frequency and intensity over time.

RESULTS

There were only minor associations between media use and headache intensity or frequency. Notably, only high social media usage was linked with worse headache intensity (t(1989) = 4.109, p < 0.001).

CONCLUSIONS

The impact of media use on headaches seems to be less harmful than previous research might suggest. We believe that increased time spent consuming media should not be considered a risk factor for pain conditions but rather a helpful resource for pain management.

Gut microbiome and metabolic pathways linked to sleep quality

Sleep quality is a vital determinant of human health as sleep disorders are associated with cognitive deficits, and chronic sleep deprivation is associated with a broad range of health complications. Previous studies on the association between the gut microbiome and sleep quality have been constrained by small sample sizes or have focused on specific sleep disorders, thus yielding inconsistent results. Herein, we investigated the relationship between microbial composition and sleep quality in a cohort of 159 Koreans. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), determined through a self-administered questionnaire. Gut microbiome analyses were performed using 16S rRNA amplicons. We found no direct correlation between microbial alpha diversity metrics and sleep; however, we identified differences in beta diversity among sleep quality groups (with a PSQI score > 5 indicating poor sleep quality and PSQI ≤5 indicating good sleep quality). We also found differential microbial signatures (Bacteroides, Prevotella 9, and Faecalibacterium) among the groups. Furthermore, functional metabolic pathway profiles revealed significant linear correlations of the L-arginine and L-tryptophan biosynthetic pathways as well as 4-aminobutanoate degradation with sleep status. In particular, Faecalibacterium prausnitzii, which harbors these metabolic pathways, showed differences between sleep quality groups and a linear association with sleep quality scores and was thus identified as the species most strongly associated with sleep status. This study provides a significant advance in our understanding of the relationship between gut microbiota and sleep regulation. The current findings provide a basis for further research into potential therapeutic strategies for sleep disorders targeting the gut microbiome.

Migraine self-management at work: a qualitative study

BACKGROUND

Migraine is common and can be highly disabling. Adequate migraine self-management (SM) can mitigate the potentially adverse health effects of migraine. However, adequate SM can be challenging to implement in everyday life, for instance, at the workplace. We aimed to explore how migraine SM is carried out at work and which occupational factors may determine effective implementation according to employees with migraine. We also explored the potential impact of the COVID-19 pandemic and the associated re-arrangement of working conditions on migraine SM at work.

METHODS

We conducted semi-structured qualitative interviews (08/2020-01/2021). Participants were eligible if they have worked for at least six months with a minimum of twenty hours per week and with a migraine diagnosis. The interviews were transcribed and content-analyzed using MAXQDA.

RESULTS

Migraine SM was perceived to be influenced by social interactions at work (e.g., in terms of understanding vs. stigmatization), the level of job decision latitude (JDL, i.e., the extent to which one is able to influence work processes, e.g., when working from home), and workplace design (e.g., in terms of opportunities to withdraw from work). During the COVID-19 pandemic, especially increased JDL appeared to favorably influence migraine SM.

CONCLUSIONS

Migraine SM at work is fostered or complicated by various psychosocial working conditions. By considering these facilitators and barriers, more migraine-friendly workplaces can be created.

Screen time and pediatric headache: A scoping review of the literature

OBJECTIVE

The aim of this study was to summarize the evidence regarding screen use as a contributing factor in pediatric headache and migraine.

BACKGROUND

Screen exposure is often reported as a headache trigger, though there is no current consensus in terms of how screen type, duration, or frequency influences pediatric headache and the associated burden of disease.

METHODS

A systematic search in PubMed, Scopus, Cochrane Library, ProQuest Health and Medical Database, and Google Scholar was performed through November 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All English-language articles of pediatric patients aged ≤18 years evaluating screen use in relation to headache were included.

RESULTS

A total of 48 studies were included. Nearly all studies were cross-sectional and represented international samples. The strongest association between screen use and headache found was for duration of use, and computer use emerged as the most common device type related to headache. While there were mixed findings related to screen use and specific headache diagnosis, migraine appeared to confer a higher risk. Across studies, there were insufficient data to assess the impact of screen use on headache frequency or headache-related disability. Several studies demonstrated changes in screen use and headache patterns related to the COVID-19 pandemic and computer vision syndrome was commonly reported.

CONCLUSIONS

While there is preliminary evidence supporting possible associations between screen use and pediatric headache, there are several limitations in the present review including a lack of prospective and randomized controlled trials to better demonstrate causal relationships as well as methodological limitations with significant variability in how both headache and screen use are defined and measured. Future studies including real-time screen use and device monitoring are needed to better understand the influence of screen use behaviors on pediatric headache and to help further define best-use guidelines around these technologies.

Association between maternal pre-pregnancy body mass index and offspring's outcomes at 9 to 15 years of age

OBJECTIVE

Maternal pre-pregnancy underweight, overweight and obesity might increase the risk for worse short- and long-term outcome in the offspring. There is a need for further study into the relationship between maternal pre-pregnancy body mass index (BMI) and the combined outcome of physical development, state of health and social behavior in children.

QUESTION

Is maternal pre-pregnancy BMI associated with the child outcome in terms of physical development, state of health and social behavior (school and leisure time behavior) at the age of 9 to 15 years?

METHODS

In the population-based birth cohort study Survey of Neonates in Pomerania (SNIP) children at the age 9-15 years and their families were re-examined by questionnaire-based follow-up. 5725 mother-child pairs were invited to SNiP-follow-up. This analysis is based on the recall fraction of 24.1% (n = 1379). Based on the maternal pre-pregnancy BMI (ppBMI), 4 groups were formed: underweight (ppBMI < 19 kg/m2, n = 117), normal weight (ppBMI 19-24.99 kg/m2, n = 913, reference), overweight (ppBMI 25-30 kg). /m2, n = 237) and obesity (ppBMI > 30 kg/m2, n = 109).

RESULTS

In the multiple regression model, the BMI-z-score for children of mothers in the underweight group was -0.50 lower, and 0.50/1.07 higher in the overweight/obese group (p < 0.001) compared to reference at median age of 12 years. No differences were found in children of underweight mothers with regard to social behavior (interaction with friends and family), school and sports performance (coded from "very good" to "poor"), other leisure activities (watching television, using mobile phones, gaming), and health (occurrence of illnesses) compared to children of normal weight mothers. In contrast, maternal pre-pregnancy overweight and obesity were associated with lower school and sports performance, and higher screen time (smart phone, gaming, television) compared to children of normal weight mothers.

CONCLUSION

Maternal pre-pregnancy overweight and obesity but not underweight was negatively associated with school performance and leisure time behavior in the offspring at 9-15 years of age.

The impact of the COVID-19 pandemic era on children with primary headache: a questionnaire survey study and literature review

Background

The coronavirus disease (COVID-19) pandemic has resulted in individual isolation and secondary problems, especially in children. Research on the effect of the social isolation on children with primary headache is limited. This study aimed at exploring the effects of environmental changes caused by COVID-19 on headache in children.

Methods

This cross-sectional survey study enrolled school-aged children (age, 8-16 years) with headache who were able to complete the questionnaire from a Pediatric Headache Clinic between January 2021 and December 2022. Headache diaries for all patients were in their medical records and two questionnaire responses were requested at a 3-month interval. The questionnaires included headache type, frequency, previous medical conditions, family history, Pediatric Migraine Disability Assessment scores (PedMIDAS) scores, changes in daily life after COVID-19, and factors that aggravated headaches associated with social distancing.

Results

We identified 35 patients who were diagnosed with primary headache and continued to visit our outpatient clinic for at least 3 months. Among them, 33 (15 males and 18 females) patients responded to the first survey. The average age (±SD) of patients was 12.5 ± 1.9 years. PedMIDAS scores were not affected by the COVID-19 infection history. Prolonged use of masks and increased use of digital devices were reported as the most common factors that aggravated headache during the pandemic era.

Conclusion

COVID-19 did not affect in worsening primary headache in children. However, the pandemic can introduce various changes in daily life, which in turn can affect the management of headache. By gathering feedback regarding the thoughts of the patients on the impact of the current pandemic environment, patient counseling on the precautions and management can be conducted in advance in the case of repeated lockdown in the future.

Electronic device and social network use and sleep outcomes among adolescents: the EHDLA study

BACKGROUND

Considering the evident risk in the literature between the use of screen devices and sleep, there are still few studies on the relationship between each electronic screen device, media programs and sleep duration and sleep-related problems among adolescents and which variables interfere in these relationships. Therefore, this study has the following objectives: (1) to determine which are the most common electronic display devices related to sleep time and outcomes and (2) to determine which are the most common social network applications, such as Instagram and WhatsApp, associated with sleep outcomes.

METHODS

This was a cross-sectional study with 1101 Spanish adolescents between 12 and 17 years old. Age, sex, sleep, psychosocial health, adherence to the Mediterranean diet (MD), sport practice, and time spent on screen devices were assessed by an ad hoc questionnaire. Linear regression analyses were applied, adjusting for several covariables. Poisson regression was applied between the sexes. A p value < 0.05 was considered statistically significant.

RESULTS

Cell phone use was more associated with sleep time (13%). In boys, time spent on cell phones (prevalence ratio [PR] = 1.09; p < 0.001) and videogames (PR = 1.08; p = 0.005) had a higher prevalence ratio. When psychosocial health was included in the models, we found the greatest association (Model 2: PR = 1.15; p = 0.007). For girls, time spent on the cell phone was significantly associated with sleep-related problems (PR = 1.12; p < 0.001), and adherence to the MD became the second most important in the model (PR = 1.35; p < 0.001), followed by psychosocial health and cell phone use (PR = 1.24; p = 0.007). Time spent on WhatsApp was associated with sleep-related problems only among girls (PR = 1.31; p = 0.001) and was the most important variable in the model along with MD (PR = 1.26; p = 0.005) and psychosocial health (PR = 1.41; p < 0.001).

CONCLUSIONS

Our results suggest a relationship between cell phones, video games, and social networks with sleep-related problems and time.

Associations between sedentary behavior and negative emotions in adolescents during home confinement: Mediating role of social support and sleep quality

BACKGROUND

Prolonged periods of sedentary behaviour, for instance, engendered by home confinement in Shenzhen city, has led to negative mental health consequences, especially in adolescents. Previous research suggests, in general, that sedentary behavior can increase negative emotions. However, the specific mechanism driving the relationship between sedentary behavior and negative emotions is still relatively unclear. Social support and sleep quality might partly explain the effect of sedentary behavior on negative emotions. Thus, the current study aimed to examine the associations between sedentary behavior and negative emotions, and to investigate if social support and sleep quality mediate such a relationship.

METHOD

During home confinement due to the COVID-19 Omicron variant outbreak, 1179 middle and high school students in Shenzhen were invited to voluntarily complete an e-questionnaire, including the 21-item Depression Anxiety Stress Scale (DASS-21), the short form of the International Physical Activity Questionnaire (IPAQ-SF), the Social Support Rating Scale (SSRS) and the Pittsburgh Sleep Quality Index (PSQI). Data from 1065 participants were included in the analysis.

RESULTS

We observed significant sex-related and demografic-related differences in emotional (e.g., anxiety, stress and social support) and other outcome variables (e.g., sitting duration and PSQI score). Furthermore, sedentary behavior, social support, and sleep quality were associated with negative emotions (p < .01), even after controlling for sex, age, only-child case, body mass index, and metabolic equivalent level. In addition, social support and sleep quality partially mediated the association between sedentary behavior and negative emotions.

CONCLUSION

The findings of the current study suggest that social support and sleep quality partially mediate the relationship between sedentary behavior and negative emotions in middle and high school students during home confinement in Shenzhen city.

Raising the Child-Do Screen Media Help or Hinder? The Quality over Quantity Hypothesis

Screen media are ubiquitous in human life across all age, cultural and socioeconomic groups. The ceaseless and dynamic growth of technological possibilities has given rise to questions regarding their effect on the well-being of children. Research in this area largely consists of cross-sectional studies; experimental and randomized studies are rare, which makes drawing causative conclusions difficult. However, the prevailing approach towards the use of screen media by children has focused on time limitations. The emerging evidence supports a more nuanced perspective. It appears that the older the child, the more important how the screen media are used becomes. Concentrating on the quality of the screen, time has become increasingly relevant in the recent COVID-19 pandemic, which necessitated a transfer of educational and social functioning from real-life to the digital world. With this review, we aimed at gathering current knowledge on the correlations of different screen media use and development outcomes, as well as providing an overview of potential benefits that new technologies may provide to the pediatric population. To summarize, if one cannot evade screen time in children, how can we use it for children's maximum advantage?