Lithuanian University of Health Science
Faculty of Medicine
Screen usage and health problems
among international students of LSMU
Author:
Yafit Shifrut
Supervisor: Prof. Ruta Ustinaviciene
Department of Environment & Occupational Medicine
TABLE OF CONTENTS
1. SUMMARY………..4
2. ACKNOWLEDGMENTS……….………..………. 5
3. CONFLICT OF INTEREST……….6
4. PERMISSION ISSUED BY ETHICS COMMITTEE………..7
5. ABBREVIATIONS AND TERMS………8
6. INTRODUCTION……….9
7. AIM AND OBJECTIVE………..………10
8. LITERATURE REVIEW.………11
8.1 Time devoted to screen use……….…….……….11
8.2 The effect of sleep quality……….………12
8.3 Computer vision syndrome………..……….…13
8.4 Musculoskeletal disorders……….14
8.5 Gender difference in complains.……..……….15
8.6 The effect of mental health………16
9. RESEARCH METHODOLOGY.………..……….17 9.1. Sampling ………..………17 9.2. Data collection ……..……….………..17 9.3. Questionnaires.. ………..……….………17 9.4. Statistical analysis…..……….……….18 10. RESULTS….……….19
10.1 Main preferable screen use………..…..………..19
10.2 Time devoted to screen use a day.……….……….……….20
10.3 Health disorders in a relation to screen use……….………21
10.3.1 Health symptoms during screen use………..…………21
10.3.2 Screen use and frequency of health symptoms ..………21
11. DISCUSSION OF THE RESULTS………..27
long term deterioration of vision associated to screen use.……….27
11.2.2 The frequency of neck pain, low back pain and shoulder pain associated to screen use.………..28
11.2.3 The frequency of headache associated to screen use ..……….29
11.2.4 The frequency of sleep disturbance and screen use………..29
12. CONCLUSION ..………..30
13. PRACTICAL RECOMMENDATION..………31
1. SUMMARY
The researcher :Yafit Shifrut.
Title: Screen usage and health problems among international students of LSMU.
This study aim to evaluate the adverse effect of screen usage among international student of LSMU, to evaluate the average amount of time devoted to screens a day, and type of screen that is preferably use, to assess the frequency of different type of health disorders; as musculoskeletal disorders, visual disturbances, headache and sleep disorders, and to detect an association between genders, age, year of degree and time devoted to screen a day to those symptoms. This study is a self-composed survey based study, in which the participants are randomly selected LSMU international students from all faculties and all years of degree. In total 73 students participated. The research contains 34 pages. The results show that students preferred type screen to use is mobile phone, follow by laptop, tablet, TV and desktop. The average student spends more than 3 hours a day using screens.
Students that use the screen more than 6 hours a day suffer more from eye strain [14]. Older age groups tend to suffer more frequently from “feeling of red tired eyes“, “visual disturbance” and “long term deterioration of vision”. Females suffer more frequently from ”headaches” and musculoskeletal disorders such as; “neck pain” and “shoulder pain” females are in higher risk of developing symptoms of eye redness, burning sensation, blurred vision, and dry eyes [25]. Screen use have also decrease quality of sleep by decrease melatonin levels, and interrupting at night by disturbing or stressful notifications [30].
Now-days screens are a part of our every day life and are in every aspect of them, avoiding screens is almost impossible, so prevention remains the main strategy in managing those symptoms. To avoid computer vision syndromes, it is recommended, during our daily use to take brief breaks from the screen, and by that to decrease eye strain. A proper ergonomic environment has shown to decrease frequency of musculoskeletal disorders, environment should be properly adapted to the person’s individual work opportunities. Proper ergonomic positioning of the computer device is important, screens are recommended to be 10-20° below eye level, as higher than this position requires a chin up posture with resulting muscular strain on the trapezius and neck muscles. Improve quality of sleep by giving yourself at least 30 minutes of screen-free transition time before going a sleep, keeping
2. ACKNOWLEDGMENTS
First and foremost, I thank God Almighty for the blessings He has bestowed upon me and for giving me the strength and wisdom to achieve this dream.
For my beloved parents for believing in me and making it all possible and supporting through hard times.
To Prof. Ruta Ustinaviciene the head of the Department of Environmental and Occupational Medicine Faculty of public health and Prof. Renata Šimoliūnienė from the department of physics, mathematics and biophysics for the guidance and the patients and all of the good advices.
Last but not list for you A.S.M for the endless love understanding and support.
3.CONFLICT OF INTEREST
The author reports no conflict of interest.
5. ABBREVIATION AND TERMS
1. CVD- Computer Vision Syndrome 2. H- Hour
3. LSMU- Lietuvos Sveikatos Mokslų Universitetas 4. MS- MusculoSkeletal
5. NHANES- National Health and Nutrition Examination Survey 6. NSF- National science foundation international
7. PIU- Problematic Internet Use 8. Prof- Professor
9. REM- Rapid Eye Movement 10. SD - Standard Deviation 11. T- Table
6. INTRODUCTION
The prolong computers or screen use and association with health disorders, has been shown a great interest over the last years. The changes and progress in informative technology now-days has let modern society to change behaviour in almost all everyday aspect of life, including; studying, working sleeping and spending leisure time. Recently, in the last years, it was noticed that there is increase in the amount of time people devote to screens use a day [11],[3]. Many studies associated a prolong computer use to; Musculoskeletal (MS) disorders, the effect on quality of sleep, and visual disturbances [7],[9],[10][12-16],[17],[18]. MS disorders are the most common work-related health problems reported in Europe, affecting millions of workers [21]. Shoulder and low back pain are mostly reported [17],[21]. The quality of sleep was effected among students using computer, and Physiological changes in sleep cycles (e.g.: Increase REM stage duration) has been reported [8],[7], [31]. Visual disturbances-computer vision syndrome is well establish diagnosis of symptoms related to prolong uninterruptible focusing the eye on a digital screen, associated symptoms are eye strain, headaches, blurred vision dry, eye neck and shoulder pain [13]. As a student that spend enormous time using computer I found it extremely important to asses the computer/screen hazards among my colleagues, to understand the magnitude of the phenomena, and aim to prevent these outcomes. This study is a self composed survey based study, in which the participant are randomly selected student of LSMU, from all faculties, and all years. In total 73 students participated.
7. AIM AND OBJECTIVES
Screen usage and health problems among international students of LSMU.
This study is a survey based study, in which randomly selected students of LSMU from all faculties and all years, in total 73 students participated.
The aim of this study is to evaluate the adverse effect of computer usage among international student s of LSMU, to evaluate the average amount of time, and type of screen that is preferably use, to assess different type of disorders as; musculoskeletal disorders, visual disturbances, headaches and sleep disorders, their frequency and the association between genders, age time spent using screen a day and year of the degree to various type of symptoms.
Objectives:
1. To assess the health disorders among international students of LSMU. 2. To assess the relation between screen usage and health disorders.
3. To evaluate the time spent using screens a day and the type of screen use.
4. To assess relation with prolong screen use and frequency of symptoms appearance.
5. To evaluate the relation between gender, age and year of study to a specific health problem and the frequency in which it appears.
8. LITERATURE REVIEW
Nowadays, Internet is a primary resource to help students in completing their assignments, doing research, and even as a media to release their stress. Internet helps the students in beneficial aspects, but it also helps to destroy student’s life if the students misuse or overuse it [24].
8.1 Time devoted to screen use:
A new Nielsen Company audience report reveals that adults in the United States devoted about
10 hours and 39 minutes each day to consuming media [3]. A study done among U.S collage student show that Three-quarters (74%) of college students use the Internet four or more hours per week, while about one-fifth (19%) uses it 12 or more hours per week. Nearly two-thirds (62%) reported studying for classes no more than 7 hours per week, while only 14% reported studying 12 or more hours per week[23]. Respondents who used the Internet more than 5 hours considered as excessive Internet user (Subramaniam et.al, 2008). Supporting that, a study conducted among Malaysian university student
conclude that, 93% of the respondents are excessive Internet user and they have a big chance to be addicted Internet user [24],(Fig.1.).
When comparing faculties engineering and medicine, a significantly higher proportion of medical students 85% (171/201) were using computers for less than 4 h/day as compared with engineering students 46% (99/215) (P < 0.001) [25].
Despite growing options, radio and television continue to reach the most users in the U.S. each month. Of new technologies, smartphones have the largest reach [4]. According to comScore's 2017 Cross Platform Future in Focus report, the average American adult (18+) spends 2 hours, 51 minutes on their smartphone every day and the time increases with years [22].
Spending excessive time using a computer and watching TV has been linked to higher blood pressure, higher cholesterol, and being overweight or obese. We also know how bad sitting is for your health, and most screen time happens in people who aren't moving around. That's why adolescent groups recommend a two-hour time limit [5]. The risk of developing problematic internet use (PIU) in those who spent more than 8 hours a day online is higher than those who spent less than 2 hours a day on-line [6]. Data from the National Health and Nutrition Examination Survey (NHANES) and the NHANES National Youth Fitness Survey, 2012 show that:
• Nearly all (98.5%) youth aged 12–15 reported watching TV daily.
• More than 9 in 10 (91.1%) youth aged 12–15 reported using the computer daily outside of school. • Among youth aged 12–15, girls (80.4%) were more likely to use the computer 2 hours or less daily
when compared with boys (69.4%) [11].
8.2 The effect of sleep quality:
According to a study conducted in the Department of Public Health, Akita University School of
Medicine, Akita, Japan, it has been found that playing an exciting computer game increased heart rate and decreased sleepiness before going to bed, it increased sleep latency and decreased REM sleep. A bright display did not affect physiological sleep variables, although a combination of playing a computer game and a bright display decreased subjective sleep quality [7]. In another cross-sectional study conducted State University of Campinas (UNICAMP), Campinas SP, Brazil and the University
of São Paulo Medical School, collected data on computer use between 19:00 and 21:00 or between 19:00 to 24:00 increases the risk of poor sleep among university students. However, perceptions of sleep relating to TV viewing during the same periods did not present the same risk [8]. Cross-sectional, school-based survey of school children (Grades 4–8) living in Shanghai, China, found that prolonged time spent on homework and mobile phone playing, was related to shorter sleep duration, and later bedtime. Habitual activities had small but significant associations with sleep hygiene outcomes. Intervention strategies such as limiting children’s use of electronic screen devices after school are implicated [9]. The National science foundation international (NSF) 2006 in America sleep poll indicates that the adolescents interviewed were asked how often they had experienced the following difficulties when sleeping in the past two weeks: difficulty falling asleep, difficulty staying asleep, and/ or waking up before they have to and trying to fall back asleep but being unable to do so. Almost one-half of the adolescents surveyed (45%) experienced at least one of these difficulties at least a few nights a week within the past two weeks [10]. The possible ways screens disturb our sleep: 1.Suppress Melatonin. 2.Keep the brain alert (keeping the mind engaged, technology can trick the brain into thinking that it needs to stay awake, and if one is surfing the web, seeing something exciting on Facebook, or reading a negative email, those experiences can make it hard to relax and settle into slumber) 3.Wake up keeping a mobile within reach can still disturb slumber, thanks to the chimes of late night texts, emails, calls, or calendar reminders [30].
8.3 Computer vision syndrome:
With the increase use of electronic devices with visual displays, computer vision syndrome is becoming a major public health issue [12].
Computer Vision Syndrome (CVS), also referred to as Digital Eye Strain, describes a group of eye and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use. Many individuals experience eye discomfort and vision problems when viewing digital screens for extended periods. The level of discomfort appears to increase with the amount of digital screen use. The most common symptoms associated with Computer Vision Syndrome (CVS) or Digital Eye Strain is:
• eyestrain • headaches
• blurred vision • dry eyes
• neck and shoulder pain
The extent to which individuals experience visual symptoms often depends on the level of their visual abilities and the amount of time spent looking at a digital screen [13]. In A cross-sectional study done, involving students from the six undergraduate programs in the Faculty of Medical Sciences (FMS) UWI, concluded that CVS was not well-known among undergraduate students in this sample, where there was a high prevalence of neck pain, eye strain and burning. Eye strain is the most common eye complaint for computer users spending >6 hours per day on their devices, which was reflected in their study, where 40.3% of students used the computer >6 hours per day. Students with computer use of 4-6 hours a day were at a higher risk of redness, burning in the eyes (OR 2.1, P < .01) compared to those with <4 hours. Females were more likely to have mild (34.1%) and moderate (20.4%) headache compared with males [14]. In another study Among 500 University Students In Ajman, United Arab Emirate, More than half of the students included in the study had mentioned to have some computer-related eye problems. Headache, burning sensation in eyes and dry/tires/sore eyes were the most common visual related problems associated with usage of computers. Females preponderance was observed for developing the problems [15]. A study done Among Medical and Engineering Students in Chennai, revealed that more than three fourth of the students complained of any one of the symptoms of CVS while working on computers. Engineering students (computer science and information technology) were at higher risk of developing CVS compared with medical students. Those students who were using computer continuously for more hours were at higher risk developing CVS syndrome compared to students who spend less hours and took frequent breaks [25].
8.4 Musculoskeletal disorders:
In the EU Labour Forced Survey 2007 ad hoc module about 60% of the respondents with work-related health problems identified musculoskeletal (MS) problems as their most serious work-work-related health problem, mostly back pain [21]. The prevalence of MS pain among computer users was high, with shoulders and low back being the most affected anatomical areas [17]. A longitudinal study
shoulder complaints [18]. There is significant associations between individual factors, work ergonomics (inappropriate posture and movements) and MS pain. Work-related psychosocial factors had a significant impact on experiencing pain as well, high quantitative demands were associated with MS complaints in almost all anatomical areas [17]. Moderate evidence for an association between the duration of mouse use and the incidence of hand–arm symptoms [19]. Cross-sectional studies of Visual Display Units (VDU) users have reported a prevalence of 10–62% of musculoskeletal symptoms in the neck/shoulder region among VDU workers. A model of musculoskeletal disorders and computer work is proposed (Fig. 2.), the model is modified from Sauter and Swanson [26],[28].
Figure-2 A model of musculoskeletal disorder and computer work modified from Suter
and Swanson [28].
The results of Kaliniene et al. research in the population of employees working with computers, the prevalence rate of neck MS disorders was very high – 65.7% [20]. On the other hand Diepenmaat et al. research strengthens the findings that musculoskeletal pain is common among adolescents not associated with computer use [27].
8.5 Gender difference in complains:
at higher risk than men, regardless of the kind of work or occupation involved [26]. In the study by Ekman et al. in which the aim was to investigate possible differences between women and men in the reporting of musculoskeletal symptoms among VDU users in the Swedish workforce, the estimated odds ratio for sex (women/men) was 11.9 (95% confidence interval [95% CI] 2.9 – 50.0). Two explanations for this increased risk for women discussed by the authors were that sex could be a confounder of non work-related factors, and that there could be a difference in the occupational exposure among men and women [29].According to M.Logaraj et al. males were at a higher risk of developing symptoms of redness, burning sensation, blurred vision and dry eyes. Females were at a significantly higher risk of developing headache and neck and shoulder pain as compared to males [25]. In a study among undergraduate university students, females have a 2.6 odds ratio (95% CI 1.6-4.1) of having CVS.In that study females were more likely to have mild to moderate headaches (P
= 0.001) and shoulder pain than males (P = 0.004) [14]. Headache, burning sensation in eyes and dry/
tired/sore eyes were the most common visual problems associated with usage of computers among students studying in Gulf Medical University, Ajman .A females preponderance observed for developing the problems [15].
8.6 The effect of mental health
Internet addiction appears to be a common disorder that merits inclusion in DSM-V. Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and consists of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging [1]. There is considerable controversy with respect to so-called Internet addiction and whether it ought to be reified as a diagnosis in the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition. The relationship between “addiction” and
various compulsive or impulsive behaviours is also a source of confusion. Some psychiatrists have argued that internet addiction shows the features of excessive use, withdrawal phenomena, tolerance, and negative repercussions that characterize many substance use disorders; however, there are few physiological data bearing on these claims [2].
9. RESEARCH METHODOLOGY
The study design as a self composed, survey based research. The study approved by the Department of Environment & occupational Medicine, by the dean of LSMU medical faculty and by LSMU bioethics canter.
9.1 Sampling:
The research conducted among international student of LSMU, Kaunas, in a multilevel sampling (faculties, course, age). To achieve significant statistics a sample of more than 30 students is needed, in my survey the sample size is 73 (n=73). The participants are students that randomly selected from all faculties and years of degree. The student population include 50.7% males and 49.3% females, ages of participants are between 18-29 with a mean age of 24 years (SD 3.1). The study include 50 (68.5%) participants of Medical faculty, 6 (8.2%) participants of Odontology faculty, 1 (1.4%) participant of Pharmacy faculty, 1 (1.4%) participant of Physiotherapy faculty, 2 (3.3%) participants of Veterinary faculty. The mean of year of study is 2.9 (SD 1.73) in which 1st year are 32.8% of the poll, 4th year are 20.7% and 5th year are 17.2%.
9.2 Data collection:
The questionnaire was distributed by the researcher in LSMU facilities. The students had the option to refuse participation in the survey. The researcher did not attempt to persuade any potential respondent to participate.
Respondents conducted the survey with voluntary and anonymous participation.
9.3 Questionnaire
A self-report questionnaire was used in this study. The questionnaire consisted of four questions
regarding sociodemographic data (gender, age, faculty, and year of study); 1 question regarding individual screen types use preference (more than one answer was allowed) the most popular screens
regarding self-rated, health related issues to screen use. To determine the amount of time students devote to screens a day student were asked “on average, How many hours per day do you spend on internet or using the screen?’’, to identify heavy use, the following response options were provided: less than 1h a day, 1-2h a day, 2-3h a day, 3-4h a day, >4h a day. The participants were asked to identify the most related symptoms for them during screen use (more than one answer was allowed), such as: visual disturbances, MS disorders, skin rash, stress, headache.
The frequency of red eye, blurry vision, neck pain, low back pain, shoulder pain, headache, long term visual deterioration, sleep disturbances, were measured as a scale of choices, the choices vary from never (0 time per month), rarely (<3 times/month), sometimes (1-2 times/month), often (3-4 times/ month) to almost every day (5 or more time per week). The participants had the opportunity to answer that they do not relate to any of the symptoms and “feel absolutely fine” in the same scale as describe above.
9.4 Statistical analysis:
Statistical analysis of the data performed using SPSS 13.0 software package for Mac.
The data analysed by assessing the frequencies of general sociodemographic information, analysing general screen type preferences, time devoted to screen use a day and comparing differences frequencies of symptoms in relation to gender, age the amount of time devoted to screen use a day and year of degree.
To better analyse the results the answers regarding time use was divided as follow: participant who spent less than 3 hours a day using the computer, and participant how spent more than 3 hours a day; the frequency of the symptoms appearance was also divided in to; symptoms reported to appear less than 3 time a month, and symptoms appear more than once a week. Except when assessing age with frequency of symptoms (see section 10.3.2.4), than the whole scale was measured [never (0 time per month), rarely (<3 times/month), sometimes (1-2 times/month), often (3-4 times/month) to almost every day (5 or more time per week)]. The age scale was divided in to age groups twice; once to three groups: 18-21, 22-24, 25-29 to asses frequencies, and the other into two groups 18-24, 25-29 years of age, in order to increase sample size when using Man-Whitney U test.
10. RESULTS
Characteristics of the participants are demonstrated in Table-1 (T-1).
10.1 Main preferable screen use:
As seen in Table-2 the preferred screen to use among students is the mobile phone (76.6%) follow by laptop (64.4%), tablet TV and desktop are less use among them.
With different age groups vary screen type preference to particular kind of screen (Table-1), in older age group (26-29), 88% prefer to use mobile phone as compare to laptop in the same age group. In the middle age group (22-25), the main screens preferred to use was almost the same between mobile phone and laptop, 68% and 65% respectively. In the youngest age group (18-21), we see much greater difference between main screen use in which mobile phone is used mostly 42% as compare to laptop only 17%.
10.2 Time devoted to screen use a day.
Almost 40% percent of the participants declared using screen more than 4h a day (Fig.3.), 23.3% reported using screen 3-4h a day, 24.7% use the screen 2-3h a day, 11% use the screen 1-2h a day and only 1% use the screen less than hour a day. In Table-1, we can see that over all 63% students reported daily screen use of more than 3 hours a day and 37% use less
than 3 hors a day. Difference between genders in time devoted to screen a day show no statistical significant (female:n-36, mean rank-39.88, male:n=37, mean rank-34.20) p=0.231. Age groups (18-21, 22-24, 25-29) have not show statistical significant in time spent using screen a day (! =0.089,
df=2, p=0.957). Year of study and difference in screen time usage a day has not shown any statistical
significant (! =4.124, df=5, p=0.532).
10.3 Health disorders in a relation to screen use :
10.3.1. Health symptoms during screen use:
The leading symptom reported during screen use is visual disturbances 60.3% (Table-3) follow
by headache 47.9%, musculoskeletal disorders 35.6%, stress 9.6% and skin rash 2.7%. Only 12.3% have reposted no symptoms during long screen use.
10.3.2 Screen use and frequency of health symptoms.
To asses the relation between different factors to frequency of health symptoms and complains, symptoms divided into two groups according to frequency in which they appear: symptoms appeared less than 3 times a month (rarely) and symptoms appeared more than 1-2 a week (often).
x2
Time devoted to screens use a day compare to frequency of health symptoms:
To asses the relation between the amount of time devoted to screen a day and the frequency in
which symptoms appear, the time spent using screen a day was divided into two groups: students who use the screen less than 3h a day, and students how use the screen more than 3h a day. The results are demonstrated in Table-4. When comparing the frequency of “felling red tired eyes” after screen use to
the hours spent using, less than 3h a day and more than 3h a day, there was no statistical significant (p=0.838). When comparing the frequency of “visual disturbance” after
screen use to the hours spent using, less than 3h a day and more then 3h a day, there was no statistical significant found (p=0.592). When comparing the frequency of “neck pain” after screen use to the hours spent using, less than 3h a day and more then 3h, a day there was no statistical significant (p=0.230). When comparing the frequency of “low back pain” after screen use to the hours spent using, less than 3h a day and more then 3h a day, there was no statistical significant (p=0.155). When comparing the frequency of “headache” after screen use to the hours spent using, less than 3h a day and more then 3h a day, there was no statistical significant (p=0.389). When comparing the frequency of “shoulder pain” after screen use to the hours spent using, less than 3h a day and more then 3h a day, there was no statistical significant ( p=0.106). When comparing the frequency of “feeling tired
and easily fall a sleep” after screen use to the hour spent using, less than 3h and more then 3h a day,
there was no statistical significant (p=0.742). When comparing the frequency of “feeling tired and
hardly fall a sleep” after screen use to the hours spent using, less than 3h a day and more then 3h a
day, there was no statistical significant (p=0.821). When comparing symptom of “long term
deterioration of vision” due to screen use and the hours spent using, less than 3h a day and more then
3h a day, there was no statistical significant (p=0.265). When comparing the statement frequency of
“feeling absolutely fine and has no symptoms” after screen use to the hours spent using less than 3h a
day and more then 3h a day there was no statistical significant found (p=0.396).
Gender difference compare to frequency of symptoms, associate to screen use:
Table-5 represent the Gender difference in frequency of symptoms associate with screen use.
When comparing the frequency of “feeling red and tired eyes” with responders gender there was no statistical significant (p=0.197). When comparing the frequency of “visual disturbance” with responders genders there was no statistical significant (p=0.130). When comparing the frequency of
“neck pain” with responders gender, females complains significantly more frequent than males on
neck pain with associate to prolong screen use (p=0.007). When comparing the frequency of “low
back pain” with responders gender there was no statistical significant (p=0.569). When comparing the
frequency of “headache” with responders gender, females complains significantly more frequent than males on headaches associate to prolong screen use (p=0.013). When comparing the frequency of “shoulder pain” with responders gender, females complain significantly more frequent than males on
When comparing the frequency of “feeling tired and easily fall a sleep” with responders gender, there was no statistical significant (p=0.200). When comparing the frequency of “feeling tired and hardly
fall a sleep” with responders gender there was no statistical significant (p=0.122). When comparing
the frequency of “long term deterioration of vision” with responders gender there was no statistical significant(p=0.131). When comparing the statement frequency of “feeling fine and has no
complains“ with responders gender there was no statistical significant (p=0.117).
responders is divided into two groups, according to year of study: first group1st -3rd years of study, second group 4th-6th years. The sample size was less than 30 (n=26)
As demonstrated in Table-6. When comparing the frequency of “feeling red and tired eyes” with the year of study 1st-3rd year to 4th-6th there was no statistical significant (p=0.597). When comparing the frequency of “visual disturbance” with the year of study, 1st-3rd year to 4th-6th, there was no statistical significant (p=0.384). When comparing the frequency of “neck pain” with the year of study, 1st-3rd year to 4th-6th, there was no statistical significant found (p=0.868). When comparing the frequency of “low back pain” with the years of study, 1st-3rd year to 4th-6th, there was no
statistical significant (p=0.868). When comparing the frequency of “headache” with the year of study, 1st-3rd year to 4th-6th, there was no statistical significant (p=0.483). When comparing the frequency of “shoulder pain” with the year of study, 1st-3rd year to 4th-6th, there was no statistical significant
(p=0.285). When comparing the frequency of “feeling tired and easily fall a sleep” with the year of
study, 1st-3rd year to 4th-6th, there was no statistical significant (p=0.162). When comparing the frequency of “feeling tired and hardly fall a sleep” with the year of study, 1st-3rd year to 4th-6th, there was no statistical significant (p=0.913). When comparing the frequency of “long term
deterioration of vision” with the year of study, 1st-3rd year to 4th-6th, there was no statistical
significant (p=0.957).When comparing the statement frequency of “feel fine and has no symptoms” with the year of study, 1st-3rd year to 4th-6th, there was no statistical significant found (p=0.315).
Age of the responders compare to frequency of symptoms, associate to screen use:
To properly compare the ages of the responders to the symptoms, the responders is divided into two age groups first group, 18-24 years of age and the second, 24-29 years of age. The symptoms is calculated as a scale according to appearance as follow; never (0 time a month), rarely (<3 time a month), sometimes (1-2 times a week), often (3-4 times per week), almost every day (>5time a week). Table-7 demonstrate the results as describe below; When comparing the frequency of “feeling red and
tired eyes” with ages 18-24 to 24-29, there was significant difference between them, the older age
group complain feeling red tired eye more frequent after long screen use than the younger group
(p=0.015). When comparing the frequency of “visual disturbance” with ages 18-24 to 24-29, there
pain” with ages 18-24 to 24-29, there was no statistical significant (p=0.524). When comparing the
frequency of “low back pain” with ages 18-24 to 24-29, there was no statistical significant
(p=0.541).When comparing the frequency of ”headache“ with ages 18-24 to 24-29, there was no
statistical significant (p=0.273).When comparing the frequency of ”shoulder pain“ with ages 18-24 to 24-29, there was no statistical significant (p=0.534). When comparing the frequency of ”feeling tired
and easily fall a sleep“ with ages 18-24 to 24-29, there was no statistical significant (p=0.102).When
comparing the frequency of ”feeling tired and hardly fall a sleep“ with ages 18-24 to 24-29, there was no statistical significant (p=0.057). When comparing ”long term deterioration of vision“ with ages 18-24 to 24-29, there was significant difference, the older age group complaint on feeling long term deterioration of vision more frequently after long screen use (p=0.001).When comparing the respond to the statement “I feel fine and have no complains” with ages 18-24 to 24-29, there was no statistical significant (p=0.061).
11. DISCUSSION OF THE RESULTS
11.1 Time devoted to screens a day and preferred type of screen:
It has been shown that the preferred screen to use is mobile phone follow by laptop, tablet, TV
and desktop [4],[T-2]. An average American adult (+18) spends 2 hours, 51 minutes on their smartphone every day and the time increase with years [22]. A great different in type of screen use is seen in younger age groups among LSMU students, in which they highly preferred phone use over laptop [T-1]. Over 63% reported using screens more than 3 hours a day, and almost 40% reported excessive screens use of more than 4 hours a day [Fig-3], prolong screen use is reported in other university students as well, they reported that 54% use the internet 5-8 hours a day [24],[Fig-1]. Difference in time devoted to screens a day has been related to different faculties [25]. Based on the above students are considered to be excessive screen users and by that they have increase risk of developing problematic internet use and internet addiction, most commonly using mobile phone.
11.2 Health disorders in a relation to screen use:
The leading symptom reported during screen use is visual disturbances 60.3% follow by
headache 47.9%, musculoskeletal disorders 35.6%, stress 9.6% and skin rash 2.7% [T-3]. Only 12.3% have reposted no symptoms during long screen use. In some factors that were assessed the sample size was less than 30, it might explain why there was no statistical significant found in these factors (“year of degree”, “time spent using screen a day”).
11.2.1 The symptoms of “red tired eyes”, ”visual disturbance” and “long term deterioration of vision” associated to screen use:
There was no statistical significant when comparing the symptom of “feeling red tired eyes” after screen use to “time spent using screen”, ”gender” and “year of course” this may be explained by the small sample size <30. Those other studies have shown relation between prolong screen use and these symptoms [13],[14]. Older age group suffer more frequently from the feeling of red and tired eyes than younger age group (p=0.015).
statistical significant when comparing “visual disturbance” frequency to “time spent using screen a day”, “gender” and “year of the degree”. There was significant different when comparing it to age groups, then older age group have shown to suffer more frequently than younger age group (p=0.014). Same results are seen when discussing “long term deterioration of vision” and “age groups“ (p=0.001). And then again no statistical significant found comparing this symptom to “time spent using screen a day”, “gender” and “year of the course”. Interestingly students who were using screens continuously for longer hours were at higher risk of developing CVS syndrome compared to students who spend less hours and took frequent breaks. Even though use of computer had not yet proven to cause any permanent damage to the eyes, studies have proven that temporary discomfort reduces the efficiency of work and thereby productivity [25]. Other study show eye strain is the most common eye complaint for computer users spending >6 hours per day on their devices [31].
Based on the above “tired red eyes”, “visual disturbance” and “long term deterioration of vision” are a common complain describe in CVS and is associated with prolong screen use. Older age group are more frequently experiencing “red tired eye”, “visual disturbance” and “long term deterioration of vision”, this could be explained by the theory in which older age group have more years using screens. Long hours using screen a day is associate to eye strains [31].
11.2.2 The frequency of neck pain, low back pain and shoulder pain associated to screen use:
MS disorders are the 3rd most frequent complain over all [T-3]. The prevalence of MS pain disorders among computer users is high, with shoulders and low back pain being the most affected anatomical areas [17].
The symptoms of neck pain, low back pain and shoulder pain in association to screen use have not shown statistical significant when comparing them to “time spent using screen a day”, ”age” and “year of study” (no significant when comparing symptoms to “time spent using screen a day” and “year of degree “may be explained by small sample size <30). A significant different found when comparing those symptoms with the gender of the responders, then females complain more frequently than male on neck and shoulder pain (p=0.007/0.029). It is supported in almost all scientific studies of work-related musculoskeletal disorders, women are found to be at higher risk than men, regardless of
frequently experiencing shoulder and neck pain as compare to males, a suggestion have been made that it is due to stress related management.
11.2.3 The frequency of headache associated to screen use:
There was no association when comparing headache and time spent using screen a day, age and year of degree (no significant when comparing symptoms to “time spent using screen a day” and “year of degree“ it may be explained by small sample size <30). A significant found when comparing genders, then females was complaining more frequently than males (p=0.013). This finding have been supported in other researches; undergraduate students from University of the West Indies (UWI), Jamaica. university and among students of Gulf Medical University, Ajman show females were more likely to have mild to moderate headaches [14],[15]. Females over all may experience headache more frequently than males.
11.2.4 The frequency of sleep disturbance and screen use:
There was no association when comparing “feeling fatigue and easily falling a sleep”, or “feeling fatigue a hardly fall a sleep” and time spent using screen a day, age , year of degree and gender. No significant when comparing symptoms to “time spent using screen a day” and “year of degree“ may be explained by small sample size <30. Other studies results shows that screens use decrease quality of sleep [7],[8],[9],[10].
12. CONCLUSIONS
1. Student are considered to be excessive users using screen more than 3 hours a day, most commonly using mobile phone follow by laptop. By that students have increase risk of developing problematic internet use and internet addiction and heath disorders.
2. ”Visual disturbances” was the most common complain among screen users follow by headache and MS disorder.
3. Long screen use of more than 6 hours is associate with suffering from eye strain, using screen has been shown to decrease quality of sleep.
4. Older age groups 24-29 years old are more frequently suffering from “feeling of red and tired eyes” visual disturbance” and “long term deterioration of vision” after prolong screen use.
5. Females are more frequently complain on headache and MS disorders as neck and shoulder pain than males.
13. PRACTICAL RECOMMENDATIONS
Prevention remains the main strategy in managing of computer vision syndrome. Modification in the ergonomics of the working environment, patient education and proper eye care are important strategies in preventing computer vision syndrome [16]. It is important that prevention programs would take into account all work related risk factors (e.g. prolong daly use) – ergonomic as well as psychosocial ones, to reduce the frequency of neck complaints. Particular attention should be made to work organization– ensuring possibility of adequate work breaks every 2 h. Also work environment should be properly adapted to the employees’ individual work opportunities [20]. Preventive measures at the workplace should be directed to the improvement in ergonomic work environment and reducing job strain caused inadequate workload, high responsibilities, and weak social support [17]. Proper ergonomic positioning of the computer device is important. Screens are recommended to be 10-20° below eye level, as higher than this position requires a chin up posture with resulting muscular strain on the trapezius and neck muscles. If the viewing angle is greater there is an increase in blurred vision, because of the effect on the amplitude of accommodation. An ideal downward gaze of 15° has been recommended to reduce this effect. Students had the least eye complaints when viewing their screen just below eye level, and an increase in discomfort in more downward viewing [14]. Improve quality of sleep by avoiding screens at least 30 minutes before going a sleep, and keeping electronics outside the bedroom [30].
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