Visual Display Terminals Health Impact During COVID 19 Pandemic on the Population in Jeddah, Saudi Arabia

INTRODUCTION

During COVID-19 pandemic, the use of video display terminals (VDT) obviously increased. It had its significant impact on general health as many researches show [1-4]. Females tended more to use smart phones, while males more frequently used laptops, desktops, as well as, handheld, (non-) active game consoles the use of smartphones dominated the rest [1, 5].

The neck/shoulder region initially reported Musculoskeletal symptoms later on also the upper and lower back, arms, wrist and hand [2].

The majority daily VDT use time of most of the partakers 6–11 hours [3, 4, 6, 7]. There is an increase in incidences of dry eye because of the extreme expansion in internet networks and its mediated communications. 36% of respondents to an internet-based self- screening questionnaire reported dry eye symptoms [8]. In the Commonwealth of Massachusetts, the effects of headaches and musculoskeletal discomfort were higher among VDT workers in public utilities, computer and data processing services than in banking, communications, and hospitals. Less frequent symptoms were double vision and coloured halos around objects, with prevalence below [9]. There is a range of 12.1% to 71.5% in the year-long prevalence of neck pain in grown-ups. The increased Frequency of neck disorder, upper and lower back extremity has been linked to the heightened us of VDT [10-12]. Lower back pain being the chief hinderance in VDT workers. The significant increase in proportion of partakers testifying about physical discomfort from backache to ocular soreness can be attributed to the higher number of VDT work hours [13-15]. An age and gender adjustment in the multivariate models showed a prevalence of wrist/hand symptoms with prolonged screen time [16]. A primarily localization of the dermatological conditions show that repetitive friction and trauma causes the majority of palm and finger problems as well as allergic contact sensitivities [17]. The worsening of depressive and anxiety states form the main mental health effects. Collectively referring to the symptoms as VDT syndrome. A sharp increase in the syndrome is attributed to longer VDT work hours i.e., exceeding five hours [18]. Prolonged use of VDT was associated, also, with insomnia, irritability, weariness, sleep disturbances and psycho-physical troubles [19, 20].

A study in Japan confirmed that an excess of 5hours in VDT attributed to a degradation in mental health in its administrative staff [21]. Additionally, poor self-rated health was linked to a 3 hour plus use of VDT according to a national study of Saudi adults [22]. An exploration of the magnitude and frequency of VDT use during the COVID-19 pandemic, and occurrence of self-reported health complaints among the population of Jeddah, Saudi Arabia was the main aim of the study.

MATERIALS AND METHODS

The method of non-probability convenient sampling was used to collect data for the cross sectional study, on the population through web based online-Google forms. The minimal sample size required for the present study was calculated to be 220 subjects, using G*Power software, according to alpha = 0.05, and Power= 95%, and 5 degrees of freedom [23]. The total number of subjects enrolled in the present study was 503 respondents. collection of data was done by a predesigned questionnaire which provided information on individual, sociodemographic, and clinical features of the subjects; in addition to information on the duration and frequency of use of VDT, as well as the purpose and way of using it. Approval of the design of the study was granted by the Institutional Review Board of the Ibnsina National College for medical studies (No. H-11-09062021).

Statistical analysis: SPSS version 22 was used. Chi square test of significance and principal component factor analysis were used and weights for loading on the variables were calculated. Loadings equal or greater than 0.5 were considered significantly associated with the extracted factor. All variables that significantly loaded on a factor are significantly associated with each other. Level of significance for the present study was 0.05.

RESULTS AND DISCUSSION

The total number for the present study was 503; with a mean of 31.95 years (SD: 12.51). Quite a number of subjects (97.6%) used video display terminals (VDT). The mean use per days of the week was 6.6 days (SD: 1), and the mean hour use of VDT per day was 8.2 (SD: 4.1).

Table 1 shows the distribution of the studied subjects by duration of use of VDT and personal characteristics and self-reported morbidity conditions. Majority of the subjects who used VDT were females (82.3%), and bachelor holders (69.2%); however, they were no significantly related to number per hour use per day (p>0.05). Students and those who have office jobs used the VDT more than 7 hours per day (38.4%, and 30.3% respectively) more than less than 7 hours per day (24.3%, and 25.2%), this difference was statistically significant (p < 0.000). Smoking was irrelevant to use of VDT (p <0.502). Diabetes mellitus was significantly more encountered among those who used VDT less than 7 hours per day compared to those who used VDT over 7 hours per day (11.2%, and 5.7% respectively), where p < 0.027. Joint diseases showed similar trend (p < 0.002). Hypertension, heart disease, visual disturbance and allergies were irrelevant to duration of use of VDT per day (p >0.05). Table 2 displays the distribution of studied subjects by duration of use of VDT per day and characteristics of use of VDT device. Majority of the subjects used smart phones (98.6%), laptops (69.1%), and tablet devices (50.5%).1%); lease percentage used desktop computers (32.1%). The duration of use per day was irrelevant to the VDT device used (p > 0.05). The purpose of use of the device was for study, entertainment and/or work; it was irrelevant to the duration of use per day (p <0.136). Majority of the subjects used the VDT 7 days per week (83.7%); however in was higher among those who used VDT over 7 hours per day (89.2%) compared to those who used the VDT less than 7 hours per day (75.7%), where p <0.002. Majority of the subjects spend time using VDT while sitting on couches (45.8%); those who use VDT over 7 hours per day tended to use desks and bed while using the devices (20.9%, and 38.7% respectively), more commonly compared to those who used DVT devices for less than 7 hours per day (15.6%, and 30.7% respectively), this difference were statistically significant (p <0.013). Table 3 reveals hours of use of VDT per day and self-reported complaints. Headache (76.5%) was the most prevalent complaint among VDT users, followed by neck pain and shoulder pain and lower back pain (59.2%, 55.9%, and 45.7% respectively). Dryness of the eye was next in frequency (52.9%). Double vision and numbness of the fingers were reported by over one third of the VDT users (32.8%, and 37.3% respectively). All these complaints were irrelevant of duration of use of VDTs per day (p > 0.05). Table 4 depicts the association between hours of use of VDTs per day and life style changes.  Mood swings (60.0%), and interrupted sleep (56.5%) were main complaints reported by the VDT users, however they were irrelevant to duration of exposure to VDT per day (p > 0.05).  Large proportion of the VDT users (44.5%) reported that using VDTs interfered with their daily life activities; and had difficulty falling asleep (44.1%); these complaints were irrelevant to the duration of use VDT per day (p > 0.05). A sizable proportion of the subjects (43.1%) reported that they got depressed, if the VDT hadn’t been available; this was significantly more common among those who use the VDT > 7 hours per day (48.5%) compared to those who use VDT < 7 hours per day (35.4%), where p < 0.004. Table 5 shows the principal component factor analysis for the VDT use characteristics and other personal and clinical variables. The variables use of DVT in hours per day (weight= 0.710), and use of VDT in days per week (weight=0.724) were significantly associated with factor 8; no other variable had weight greater than 0.5 on this factor.

It has long been established that poor self-rated health and severe psychological distress was linked to a 10 hour plus use of VDT for work [21, 22, 24]. Additionally, a 4–9 h usage of VDT especially during the Covid-19 pandemic, was linked to extreme psychological distress among young staff. However as for non-work activities, VDT did not have the extreme effects in both physical and mental health [25]. This study was done to explore the link between self-reported psychological and health distress and VDT usage among the general population, in Saudi Arabia during the COVID-19 pandemic. Smartphone use dominated with a higher usage in girls than boys, whilst in boys there was a much higher use of laptops, desktops, in addition to, handheld, (non) active game consoles. Laptop use increase with increasing school level [1]. Similar findings were found in the present study. Smartphone use dominated multiple activities: homework, videos, games and general use among the devices [26]. Social activity, like messaging and social media, was used the most in the smartphone, whilst tablet use was mainly watching videos, desktop and laptop [6]. In the present study, the purpose of use of the VDT was for study, entertainment and/or work; it was irrelevant to the duration of use per day (p <0.136). Headache (76.5%) was the most prevalent complaint among VDT users, followed by neck pain and shoulder pain and lower back pain (59.2%, 55.9%, and 45.7% respectively).  This is similar to previous studies [4, 18, 20] which stated that an increased prevalence of neck disorders, upper and lower back of the body was attributed to a higher use of Visual Display Terminal (VDT). There is an increase in incidences of dry eye because of the extreme expansion in internet networks and its mediated communications. 36% of respondents to a web-based self- screening questionnaire reported dry eye symptoms [8]. This is in line with the present study which found that over 50% of the VDT users suffered from dry eye disease.

Table 1. Distribution of studied subjects by duration of use of VDT and personal characteristics and morbidity history.

Table 2. Distribution of studied subjects by duration of use of VDT and characteristics of use of VDT device.

*S:study ; W:worke ; E:entertainment.

Table 3. Distribution of studied subjects by duration of use of VDT and occurrence of health problems.

Table 4. Distribution of studied subjects by duration of use of VDT and life style and psychological state.

Table 5. Principal component factor analysis with Vari Max rotation of the use of VDT and personal, social, morbidity history