We conducted a cross-sectional mail questionnaire survey at 31 graduate schools on 12 university campuses in Kyoto, Japan to assess the sleep quality of the graduate students and to describe the factors associated with their poor sleep quality. A total of 241 responses were returned (44%) and we analyzed the data of 219 graduate students (158 men and 61 women, aged 22-39 years). The participants completed the self-reported Pittsburgh sleep quality index (PSQI) questionnaire, together with socio-demographic, psychological and lifestyle related questions. Using the conservative cut-off score of 6 for the PSQI global score, 25.6% of students (27.7% of the men and 20% of the women, without significant difference) were described as poor sleepers. A multiple logistic regression model revealed that poor sleep had a significant association with self-perceived bad health (OR = 3.72, 95% CI = 1.85-7.49, P = 0.0002) and with smoking (OR = 3.56, 95% CI = 1.62-7.84, P = 0.0016). As students often ignore their own sleep problems, sleep hygiene counseling with a holistic approach should be available at universities to raise students' awareness about the possible associations between their unhealthy lifestyles and their sleep problems.

While completing their degree courses, graduate students often complain about poor sleep and mental health, which is mainly caused by the academic environment and the uncertainty of their success in obtaining their degree. To estimate the prevalence of sleep disturbances among them and the related adverse consequences, we conducted a cross-sectional epidemiological survey at 12 university graduate schools in Kyoto, Japan. A total of 241 responses were returned (44%) and the data of 219 graduate students, representing 0.1% of the total number of Japanese graduate students in Japan (158 males and 61 females, aged 22-39 years), were analyzed. Participants completed the self-reported Pittsburgh Sleep Quality Index questionnaire, together with specific questions designed for the purpose of the study. Among graduate students, 29.8% reported fatigue, 9.6% health problems, 5% university absenteeism, and 3.2% accidents at their university as adverse consequences of their sleep problems. The prevalence rate of excessive daytime sleepiness was 4.1% in this study, lower than the reported rate in the general young adult population. The prevalence rates of other sleep disturbances were similar to the reported rates for the general young adult population; we consequently suggest that the prevalence rates of the adverse consequences of sleep problems are higher for the general young adult population than for the less sleepier graduate students. Graduate students also reported a low consultation rate for sleep problems despite high prevalence rates of adverse consequences, indicating the need to increase awareness of sleep problems and their prevention among them.

Objectives: To classify community pharmacies (CPs) in Riyadh, Saudi Arabia, in terms of the quality of medicines sold by them, using the lot quality assurance sampling (LQAS) technique with a predefined threshold. Methods: Riyadh CPs were divided into 2 categories ("lots" for the purpose of LQAS), i.e., chain and independent CPs. Upper and lower rate thresholds for CPs that sell low-quality medicines were predefined as 20% and 5%, respectively. Consumer and provider risks were predefined as 0.05 and 0.10, respectively. The calculated number of randomly selected CPs required in each lot was 36; then, sale of low-quality medicines in >3 CPs implies a prevalence of >20% of such CPs according to LQAS. A randomly selected brand of amoxicillin (selected as a quality indicator of medicines because it is both widely counterfeited and heat-sensitive) was purchased from each pharmacy by a "mystery shopper", checked for authenticity, and analyzed for drug content and content uniformity using a validated HPLC method. Results: Substandard amoxicillin was purchased in 9 pharmacies (4 chains and 5 independent). Both lots were thus rejected as unacceptable, which may indicate that consumers in Riyadh are at risk of purchasing substandard medicines at CPs. Conclusions: The quality of medicines sold in CPs in Riyadh did not meet our acceptability criterion, and appropriate intervention by decision makers is recommended. LQAS proved to be a practical, economical, and statistically valid sampling method for surveying the quality of medicines. It should enable decision makers to allocate resources for improvement more efficiently.

Exposure to excessive temperature during distribution or storage has unfavorable consequences on the quality of medicines, particularly in hot climates. This could be one of the possible reasons behind the existence of substandard amoxicillin in community pharmacies in Riyadh, Saudi Arabia. This study explored the conditions under which medicines were kept in a random sample of 181 community pharmacies in Riyadh. The pharmacist in charge in each pharmacy was interviewed and our observations about the quality of storage were recorded. The inspection revealed that in 9% of the sample the readings of the existing room thermometers were >25˚C, and that 13% of the sample lacked thermometers. Also in 33% of the sample the readings of the refrigerator thermometers were outside the accepted range, and 7% of the sample lacked refrigerator thermometers. About 15% of pharmacists were not informed about the local regulations of community pharmacy practice, neither before nor after taking up their current positions. Surprisingly, incorrect answers to simple questions about the system were frequently given by the informed pharmacists. Certain aspects of substandard storage conditions existed, in varying degrees, in significant percentages of pharmacies regardless of the pharmacists' qualifications, experience, or awareness about the local regulations of community pharmacy practice. Stricter monitoring by the authorities regarding the adherence of community pharmacies to optimal conditions of storing medicines is recommended. Continuing education of community pharmacists must also be improved.

To explore the sleep problems and sleep disturbances that different long-term sojourner groups experience, a survey was carried out on the quality of sleep of international graduate students in Kyoto, Japan, who had been on extended sojourn. The self-reported Pittsburgh Sleep Quality Index questionnaire (PSQI) was completed, together with specific questions developed for the purpose of the study, by 189 international graduate students from 31 graduate schools at 12 university campuses. Sleep habits and sleep disturbances of 182 sojourners (mean age 30.4 ± 3.8 years, 96 males and 86 females) were analyzed. Using the conservative cut-off score of 6 for the PSQI global score, 23.8% of students were described as poor sleepers. A multiple logistic regression model revealed that poor sleep had a significant association with scholarships being students' main financial source for their studies, and with self-perceived bad health. Insomnia was present in 19.8% of students, difficulty initiating sleep in 12.7%, difficulty maintaining sleep in 12.7%, and excessive daytime sleepiness in 2.2%. Among those students who indicated sleep difficulties, 83.8% did not seek professional help. These findings indicate that poor sleep and sleep disturbances are common among long-staying international graduate students in Japan, however, those with problems do not look for professional help. Disseminating sleep hygiene information among international graduate students to improve their sleep and to increase their awareness of the need to seek help is an important task. Further longitudinal studies are warranted to examine the effect of sojourn in the development of sleep disturbances.