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The role of sleep duration in the development of hypertension remains controversial. Little is known about the combined effects of nocturnal and daytime sleep. We assessed the association between total sleep duration and the development of hypertension in middle-aged and elderly Chinese adults. Patients and Methods: Data were obtained from 3 waves of China Health and Retirement Longitudinal Study surveys. Middle-aged and elderly Chinese initially without hypertension were followed biennially from 2011 to 2015. Sleep duration was self-reported. Hypertension was defined as a systolic and/or diastolic blood pressure ≥ 140/90 (mmHg), the current use of anti-hypertensive medications or self-reported hypertension. Results: Over 31,392 person-years of follow-up, 2682 of 10,176 participants developed hypertension. The multivariable adjusted hazard ratios (HR) (95% confidence intervals, 95% CI) for the development of hypertension between those with 0-30 minutes and ≥30 minutes daytime sleep vs those without daytime sleep were 0.67 (0.58, 0.77), and 0.73 (0.59, 0.92), respectively. The protective role of longer periods of daytime sleep (>30 minutes) varied between different subgroups. Compared with moderate nocturnal sleepers, long nocturnal sleepers (HR: 1.66, 95% CI=1.25-2.21) had an increased risk of hypertension. Compared with moderate nocturnal sleepers without daytime sleep, HRs (95% CI) for hypertension were 0.52 (0.45, 0.59) for short nocturnal sleep plus short daytime sleep and 0.55 (0.49, 0.62) for short nocturnal sleep plus long daytime sleep. People with extremely short (HR: 1.34, 95% CI=1.22-1.48) and long (HR: 1.28, 95% CI=1.13-1.44) combined sleep periods had an increased risk of hypertension. Consistent results were also found in subgroups stratified by age and gender. Conclusion: Both extremely long and short total sleep periods were associated with an increased risk of hypertension. People with short or moderate nocturnal sleep durations, especially short nocturnal sleep duration, can benefit from habitual daytime sleep to prevent hypertension.

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Background Ensuring patient safety is a top priority among health administrators and in the medical communities of all WHO member countries. This study aimed to assess fourth-year medical students’ perceptions and experiences with cultural factors during clinical rotation to identify the medical school education needed to promote patient safety. Methods A cross-sectional study was conducted on 615 fourth-year medical students at three medical universities in Heilongjiang Province, China, in 2016 using the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) questionnaire. Chi-squared for contingency tests compared the percentages of agreement to items across schools and regarding overall patient safety, patient safety behavioural intentions and five cultural dimensions. Spearman correlations assessed statistical associations. Results The five cultural dimensions positively and significantly related to perceptions of overall patient safety and patient safety behavioural intentions. Perceptions of patient safety were positive across the three medical schools. Agreement was almost universal with the following statement: ‘We followed standard operating procedures, guidelines, and protocols for the floor’ (99.5%), although 42.8% agreed that ‘A member of my team was rude and disrespectful to a patient or family member’. The respondents’ preferences for course content delivery were academic lecture, teaching in clinical rounds and case studies. The preferred course content was ‘ways to handle clinical risks’, ‘the causes of medical errors and the principles of risk prevention’ and ‘strengthening infection controls and reducing nosocomial infections. Conclusion Fourth-year students seemed willing to learn about this important issue. Policymakers should increase their focus on educational needs based on students’ clinical experiences and their emphasis on organizational problems related to error reporting to establish and implement appropriate patient safety education.

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